End of life issues

I have to write an ethical paper related to end of life issues. I need to present both sides of an issue, etc. Problem is, I can't think of anything interesting to write about. I was hoping everyone could offer some suggestions!:)
I want to do something unique since I am sure the majority of people will be focusing on assisted suicide, DNR, advance directives, etc.

These are the guidelines:
a. Dilemma must be an ethical/legal issue relevant to nursing
b. Make sure you state BOTH sides of the ethical dilemma Remember, each side of an ethical dilemma has at least one “good” position; that is what makes it a dilemma.
c. Each side of the dilemma should be supported by factual material i.e. nursing statutes, Florida state statutes or laws (or another states legislation), ANA standards, the Nurse practice act, peer-reviewed journal articles, research articles, etc.
d. There should be evidence of using the ethical decision making processes discussed in class for example the one listed in the text, the ANA code of ethics, the ANA position statement.
e. Your position should be CLEARLY stated). The best way you can present your opinion is to be able to discuss why the other opinion is ‘less correct’, as well as why yours is better.
f. How the outcome of the dilemma might impact nursing practice

Hola!

Wow, so today I had about 8-9 patients and half of them were spanish speaking only!!! 4 out of 8, that is crazy. I need to learn spanish! I took two years in high school and two semesters in college, but I pretty much let the bucket go dry on that one and forgot everything I knew. Well, not EVERYTHING. I still know quite a lot compared to nothing, but when you need to say medical-type phrases or ask questions, it is hard.
I'm thinking of purchasing a medical spanish book to refresh and learn some new phrases that related to medical/nursing stuff.

I might be a bit sick in the head.

Today was my second day on the floor. I worked with an older black woman named Mary*. She was very nice. At first it seemed like she wasn't going to be much help to me, but as time progressed, I saw how she was and I like her. Surprisingly, the day was incredibly slow and somewhat boring. We had about 7-8 patients, but most of them could do everything for themselves. I did get to see a chest tube taken out, so that was pretty cool. That is one awesome thing about my floor is I see a wide variety of things, so I get to learn. I swear I didn't do much today, except vitals, helped a woman bathe, and kind of observed. The last like 2 hours were sooo quiet. I basically sat with this very talkative 45 year old woman because there wasn't much else to do. She had a great sense of humor and she was sarcastic, so we got along. I'm sure I'll see her Sunday, when I work next.
I finished all my ethical-legal for the week, so I have nothing to do Saturday. I suppose I could work on a paper or project, but pft. My boyfriend is away for a month and a week, so I am lonely.

Maybe it is only because I'm still a student and I'm learning, but when I compare my experience with the hospital to the outpatient clinic--I definitely love the hospital a lot more. I think when I become a NP, I would rather work in a hospital. However, I might change my mind after working in the hospital for so many years.

Something happened today that made me feel like maybe I was a bit morbid. When I arrived on the floor, the other PCT told us that a patient had just died and they brought him/her down to the morgue. I thought to myself, "Damn, I missed it!!!" I know, it is horrible, but I want to experience these things!!

Oh, one nice thing about today--when I left, a patient actually hugged me goodbye and thanked me a lot for helping her, so that felt nice.


I keep thinking of more things to add to my entry, but I just wanted to say how much starting my job has made me miss clinicals. When I'm there, I keep looking for opportunities to do things, but then I remember--I'm in a PCT role and I am not acting as a student RN. I want to go to clinicals, so I can start IVs, do assessments, give meds, feel smart, etc! I always knew I liked this stuff, but I am realizing how much more I like it now. I just want more experience to better my skills, I suppose.

*Name changed*

Hello everyone!
It has been far too long and I apologize. I've been a busy little girl. I got a job at a great hospital only 15 minutes away as a PCT in an "internship" program, which basically just means I get to make my schedule and they are very flexible. I've only had one day on the floor so far and I basically followed around the PCT. I'm finding it kind of difficult only doing PCT stuff and not actual nursing stuff, but it is a good learning experience nonetheless.
School? Incredibly boring. My community nursing lecture is...so.bad. The information isn't that horrible, but the professor is a major bore and she does not respect us much either. The other class I am taking is online Ethical-Legal Nursing, which has some okay reading, but then it is just quizzes, discussion board, and a paper, so it isn't all that exciting. I am doing a geriatric based community clinical at the very big local cancer hospital, working one-on-one with a nurse practitioner. The experience is nice, but I don't feel like I am doing all that much, except observing. Overall, I'd say this summer is boring. However, me and another student are doing a project for Commnity and we might make a brochure that could potentially be printed for the clinic, so that is exciting.

Lately, I've been getting nervous about someone finding this blog, so I want to change my name. ANY SUGGESTIONS? I would like for it to include the Student nurse or nursing student theme.

Semester 2 of 5: FINISHED

I finished the semester yesterday around 8:45.
My final grades are:
Med-Surg: 85 B
Psych nursing: 94 A
Pharm: 90 B

I managed to get a 970 on my psych HESI and a 1017 on my pharm hesi.

WOO FOR SUMMER (even though I start summer school in about 10 days).

the end is near!

Thanks everyone for the comments on my previous entry. I know that nursing is a tough career--physically and emotionally. I am not some idealistic nursing student with unrealistic expectations about the career I am throwing myself into.

With that, I am moving on.

This week coming up I have no exams, but then the following week I have an exam every single day, except Tuesday.
Last week I got an 86 on my MS exam, so even if I get a 100% on my final, I will only have a 92 (B) in the class. Now, I just need to make a 73% to get a B in the class, which will happen easily.
Pharm--I got a 98 on my cardiac exam. Highest grade in pharm yet. I am pretty sure I'll be getting an A in this class unless the HESI kicks my ass. Today I plan to work on the study guide.
Psych--90% on the final, so I need about an 88% on the HESI for my A. I have heard the psych HESI is easy, so I hope I can pull it off.
Time to get moving.

hmm, disgruntled much?

I just received an email (to a place I don't normally receive email) from obviously someone who is very disgruntled and bitter about the nursing profession. I thought I would share it with you all:

Dear Nicole,

I just found your blog and have enjoyed reading it very much. You seem like a very intelligent, idealistic person with a lot to offer the world.

However, your comments regarding the person in intake who was lamenting the way things are in the nursing profession worries me. I hope you do not get too disillusioned when you graduate and start working and you get the eye-opener that is the first nursing job. I saw you were recently taking three patients. Try caring for eight or nine, all of whom are ridiculously sick and your floor is shortstaffed. When you ask management for the staff you are "supposed" to get according to the hospital's staffing grid, they will tell you they will "see what they can do" but nothing ever gets done about it and meawhile you are left holding the bag. What are you going to do if more than one of your patients start coding at the same time? If something happens, no matter how perfectly and how well reasoned your clinical skills and decision making are, if one of those people dies it will be blamed on you, and be your fault, because "you're the nurse! Why didn't you do X, Y, Z" which of course naturally would have solved the probelem of how you are going to be in two places at the same time. And why didn't you catch the DOCTOR'S mistake in time? and don't forget about your other six patients who also have problems going on.

I am very sorry to hear about your classmate getting attacked. I hope she is OK. But please don't kid yourself regarding that psych patient that attacked your friend/classmate. People with psych issues walk among us every day, not all of them are safe in the psych ward and not all the people who attack are mentally ill. Some are just mean. My first year out of school I had a co-worker whose little old lady patient (who did NOT have psych issues btw) attacked her by trying to strangle her with the stethoscope worn around her neck during her morning assessment. And even if you are not physically attacked, you will definitely be verbally attacked by patients and their families, and often physicians. And don't forget the little old men who like to pinch butts or try to 'kiss the nursie".

Anyway, if nothing else, do yourself a favor-- go to the local courthouse and listen to the malpractice cases being heard. I guarantee it will scare the hell out of you. Just last fall there was a nurse in Wisconsin who was charged with a felony with possibility of jail time for a medication mistake. While you are young, while you are still in school, and still have time to make a change, do it. I would love to be able to recommend the nursing profession as you are right, the world does need nurses, but I cannot do it because what that nurse in intake was saying is TRUE.

If you still want to be a nurse, more power to you, but please really think about what you are doing. There are other, equally wonderful ways to make a difference in medicine. Nuclear medicine, radiology-(especially CT or MRI!) , sonography, pharmacy, are great ways to contribute to the field. But please don't buy into the imagery of what the hospital industry would want you to believe nursing is, because it is all a marketing lie. Even when you are in school- even in your last practicum- you are still so INSULATED from the realities and the level of unrealistic expectations that you will not be able to see how things really are until that graduation ceremony is a well worn memory and the celebration of passing your boards is, too. You will not see it because it is intended that way. If it was shown to people training for the profession beforehand, no one would do the job, and hey, the world needs nurses. How many nurses do you see running BACK to the bedside? Not many, I bet.

The funny thing is, I used to think the way you do about nursing.

One last thought in closing: Do the math. Literally.

Median wage of a nurse= in Florida about $24. New grads of course, start MUUUUUCH lower. MAybe $18. But start with the median.

$24 divided by the number of patients assigned to you as a full assignment (conservatively 7 on med surg) remember, you are responsible for these peoples' LIVES.
Grand total? $3.42

Yep, the hospitals are paying you $3.42 per patient per hour for all those nursing skills you are studying so diligently to acquire. A babysitter gets more than that. And the approximate base charge to the patient for a day's stay in hospital bed, not counting meds, treatment, etc= $1500/day. What's wrong with this picture???

Just a thought.

Good luck to you in however you choose. But choose wisely, as said in Indiana Jones and the Last Crusade.

Kelly

Why this person chose to pick me out of all the 4353543 different student nurse blogs, I don't know. All I do know is that I really do not care, so please do not email me again. Also, I find it quite disturbing to think this person took such the time to write out this letter. Honestly, I didn't even have time to read all of it when I posted it. What are people thinking writing something like this to me??

OH OK, I THINK I WILL CHANGE MY ENTIRE CAREER NOW BASED ON WHAT YOU SAID!! Yeah, Mom, I decided to quit nursing school because KELLY sent me an email telling me how shitty my life is going to be? You know, I should just jump off a bridge now because my life is obviously going to suck a lot. What? Who is Kelly? Yeah, no idea.
C'mon people, seriously.
Also, I am only semester 2 and we're only supposed to have 2 patients, so when I took 3, I was pretty damn proud of myself, so please do not take that away from me, whoever the hell you are. And why do people always comment on the entry about the guy attacking my friend? And yes, I realize psych patients are everywhere, they have reiterated this point to us over and over and over and over to the point if I hear it one more time, I just might vomit.

Now, it is 7am and I need to go dry my hair because I have class at 8 am and an exam at 12pm. I hope I pass so I can make $3.42 an hour!!! wow, what a dream.

recap

I know, it's been far too long since my last post. I've been keeping extremely busy with school, but everything is beginning to come to a rapid end.
Let me recap.
Last week I finished almost everything that needed to be done for both MS and psych clinicals: case studies x 2, AA meetings, SOAP notes, etc. I am now technically done with MS, but since I missed one day, I need to return this Tuesday. Psych though? FINISHED! woo. I am happy. I did not enjoy psych clinicals all that much. It was pretty boring and when it wasn't boring, it was more scary. Not fun for me.
As far as MS clinicals, I am happy and sad it will be over soon. Happy so I can sleep in and not wake up at 4am on Tuesdays, as well as two days in a row off from school, but sad because I know I am missing out on opportunities to grow and learn more skills. I actually feel like I've been learning a lot. I attempted another IV insertion. Got it in, got the flash of blood, but when I went to hook up the flush thinger, accidently dislogded the catheter--woops. At least I got blood, right??

As far as classes--
MS
-I have a high B, but since we only have one more exam and the final, the only way to bring it up to that 93% would be if I scored like 98% on both, which is highly unlikely. I can live with my B, thank you!
Pharm
-Had a low A, now I have a 91, but we still amazingly have 50% of our grade to go, including the HESI, so I think I can definitely bring it up to an A *crosses fingers*
Psych
-Grades so far: 87.5, 100, 96. This averages to about a 94.5, which is an A. We have one more exam (final) and then the HESI. I think and HOPE I can pull off the A. I heard the HESI for psych is a lot easier.

What's in store for this week? Amazingly--nothing! An entire week of no tests or presentations. I'm enthused. However, the following week is going to be PURE HELL. 3 exams in one week--ms, pharm, and psych. I doubt you'll be hearing from me until hell week is over.

My last day is May 4th, then I am off for about 10 days and summer session starts. I am taking Ethical-legal nursing online, as well the community lecture and a special geriatric based clinical. Usually, community is taken during 4th semester with peds/womens/ob stuff, but we can opt to get it over with early. I thought I might miss out of some aspects of community by taking the geriatric focused one, but I figure I will get it done now with less hassle 4th semester. Also, I live in Florida, so it can't help to learn as much as I can about geriatrics!

OH YEAH and I've applied to a few jobs for the summer.

I am so glad the week is over!
Monday I had my cardiac exam--88%. I can live with that.
Yesterday was my second psych exam, which I was worried about because the first one I got an 87.5, so I definitely wanted to do well, but I've just been way too tired to study the way I should have. Well, I got a 100%!!!! I know it is because she has two bonus questions at the end, woo.
I have one more week and then I am off for Spring Break! Not that I'll be getting much of one considering we have our 3rd MS exam the day we come back--evil.
This thursday is my fourth pharm exam. I am doing pretty well in that class. My grades so far: 97, 91, 96. I'm not too worried. I usually make notecards, but this time I am going to see how I do without them. Mostly just because I am behind on the reading and it takes way too long to make the cards.

My car is broken, so I can't go anywhere. I don't think I will have somoene look at it until NEXT weekend. I just can't deal with that crap when I have tests to worry about.

Goal for the day is to finish pharm reading, study a bit, and then hope to hang out with the boyfriend.

three patients

Today I took THREE patients. We're only supposed to have two, but it just worked out this way. In fact, today went incredibly smooth. I thought I would feel overwheled, but it was awesome. I went in, look at their charts, did their assessments,charted, gave their meds, and then spent the rest of the day helping/doing whatever that had to be done.
I feel like it is all starting to come together--it is much better now that we can pass meds; we're actually learning the role of nurse. I like it a lot.
The night before clinicals I always feel nervous/anxious, which makes no sense because it is always good, but for the past few weeks, I've secretly been excited to go because I can feel myself getting better! However, when that alarm goes off at 4:10am, I don't exactly share the same sentiments:)
I never talked about my patients all that much--maybe I should give an overview of them or something. First, I'm on a telemetry/MS floor that focuses on strokes.
Patient 1-CC=dyspnea
Patient 2-CC=pulmonary embolism/rectal bleed/lung CA
Patient 3-CC=Afib with RVR

I hate psych clinicals

Today I had psych clinicals and we left early because my friend was attacked by a patient! argh, it was horrible. I don't feel like typing out the entire story again, so I am just going to copy and paste an AIM convo I had, minus the screennames, so I'm sorry if the story isn't grammatically correct or sounds dumb.


oh man it was horrible..soo it was me, L, T, and A on the adult floor, which i have yet to be on. i felt weird as soon as i got on the floor bc the nurses and techs were just weird in general..then we were doing vitals and this tall black man kept coming over and talking to tammy and i..he seemed ok, then he would grab his penis and be like.."you want this, you want this!" we just moved until he was told to go into his room..so we were kind of freaked out from that. then the patients went to breakfast so we sat in the tv room. well, we were at the table and lindsey was to my left and then tammy was at the end of the table. then this guy in a wheelchair who apparently is retarded wheeled in. he was gross. he had food all over himself and on his hands and he would talk very weird..he'd be like, "I AM GOING HOME TODAY!!" but it was very hard to understand him...anyway, he wheeled in and he sat between L and T.
He was like HI I AM ROB and he shook their hands, then he tried to kiss them and they were liek NO, we cannot do that, no touching, etc. he was like "YA WE CANT TOUCH, I KNOWWW, I WANT TO HUG, BUT I KNOW WE CANT." he seemed harmless you know..then lindsey got up to wash her hands since he had just kissed it and he was gross. then he was just sitting there for a few minutes with a smile on his face, he reached his arm behind tammy to like put it around her shoulder or pat her, i dunno and then he fucking SNAPPED and he fucking grabbed her hair with all his might and he pulled her down, then he was trying to bite her and he was biting the air making this horrible noise like AARGG ARGGGH, like an animal
I jumped up so quick and i was screaming STOP IT STOP IT and i was trying to pulled his hand off the death grip he had on her hair, but he tried to bite me!! so i started screaming HELP HELP, you know.then like 6-7 nurses/techs came in and they were all over him, on the table, etc trying to pry him off and he is just like biting at the air and screaming like an animal! Then they finally got him off. oh and the whole time the otehr patients are like yelling PUNCH HIM OUT, HIT HIM IN THE FACE!!!!
I was so shocked. it felt unreal. when it was happening i was just like what the hell..is this for real!!
It was scary as hell. he turned into like an animal!
I am not going back on that floor, i dont care
--did anyone actually get bitten?
yeah supposedly this tech got bit through his gloves
but i didnt see it
--but none of you guys?
it took them forever to get him off
no thank god
--good
but T had a huge welt on her head bc he was pulling her hair so hard
---how old was this person?
if she hadnt been holding her hair at the root then he would have ripped it out of her scalp, no doubt
i dont know, it was hard to tell bc he was so weird..maybe 30-40
i was so scared! i was shaking so hard. i thought i was going to cry lol

then we remembered how earlier they were watching the movie blade, about vampires, so maybe he was being a vampire

and we werent even on the floor long at all..this all happened before 9am

am seriously going to have nightmares lol..especially with the noise and look that he made
he was biting the air going AR AR AR i dont know how to type it out lol..but animalistic..like nawing

IV

My day in clinical was pretty good. I took two patients, did all of the charting, assessments, and the MEDS.
Today I did my first SQ injection for insulin! woo go me. I did it and then I was like, "You were my first injection-EVER!" And everyone laughed and said, "oh yeah tell him after the fact!!" haha.
THEN this male travel nurse on my floor asked if I wanted to start an IV! I was like YES! Friday was the first time we ever even learned how, but that was on a rubber arm. This nurse rocks so much. He didn't make me nervous at all. He sat down with me and walked me through it. It helped that my patient was totally disoriented and old, so he had like no clue what was going on. I got it in really good, but he said to bring it a little LEFT, so I did, but I could never get a flash. Then he pushed it to the RIGHT and got it. He was like, "I'm sorry! I kept saying go left, but I meant right!!" So I ALMOST got it on my first try. I think it is way easier on a real human and not those dumb arms. Anyway, IT WAS AWESOME!!!!! He told me that I did great and that my approach was PERFECT!

wow.

Today was boring for the most past because I was in the ER intake and there were no psych patients, so I basically sat around and talked to the psych RN who was a male. This guy was either burnt out or did not think of nursing very highly. He kept saying things like, "I'm JUST a nurse," how nurses have no power, etc. I was like...what the freakin' hell?! THEN he was like, "you're young, don't do JUST nursing. I would seriously think about medical school or masters program--become a physician!"

WHAT THE HELL?!
First of all--I am not JUST going to be a nurse and it pisses me off when people put down their own profession. We need to advocate for our profession, we need respect. Putting it down does not help the matter. Also, if we can't feel respect for our profession and realize how important our role is then obviously this will not translate well to the public--no one will give us respect and therefore, people will not want to be nurses. THIS WILL NOT HELP THE SHORTAGE.
And to suggest that being a nurse is somehow like being a lower level doctor---what?? It's not even the same profession. GEE, maybe I am proud of the fact that I want to be a nurse, not JUST a nurse either. Be a doctor? Ugh, no thank you.
Some people just shock me.

pharm

I got a 96 on my first pharm exam!
woo.

my mind.

Lately I've been experiencing an influx of emotions. One second I am so pumped to study and do whatever it takes to be the best nurse I can be...and then the next--I just want to do NOTHING. Last night I felt pretty low, but then in class today I got another one of my surges of : okay, I must do this. I will work hard, I am motivated, dun dun dun!!

I came home and finished all of my notecards for pharm. NOW I have Tuesday and Wednesday to actually study (and not just prepare for studying). Although, making notecards really helps the info stick in my brain. I'm one of those people who has to DO IT to learn it, so writing definitely works for me.
We've had lectures on fluid and electrolytes/ABG all of last week and then today in every class. Wow, I never want to see the word fluid and electrolyte again...oh wait, I'm in nursing school, so that is impossible!!

I definitely want to work as a tech during the summer at a hospital, but I am kind of worried about the committment. For summer, I'm pretty much open (besides summer courses), but once school starts, I don't want to work at all, so I don't know what to tell a possible employee if they ask. I guess I could be PRN, but I'm not sure.

A problem I've been dealing with lately involves negativity. However, it is not even my own negativity--I feel like everyone around me is negative. I am not better than all of them because I am easily drawn into the negativity. But sometimes I just want to be positive and not complain about every little thing or get sucked into drama, but it is soooo easy to get wrapped up in it!! How do I always end up around people who are just as sarcastic as me? I need a change of scenery.

School has been good, but I've been exhausted from waking up two days in a row at 4am for clinicals. Besides that, I rock. Why do I rock? Well, I have been managing to read ahead, which is a miracle.
I passed my med calculations exam, so now all I have is the motor exam and then I am free to pass meds in the hospital. Watch out everyone.
My first real exam is next week--Pharm on Thursday. I'm getting ready right now to drive to the library, study for about 3 hours, and then hang out with the boyfriend.

I love 3 day weekends! Especially when they fall right after the first week of school.

The first week went well, to say the least. I already know it is going to be a rough semester. However, I feel incredibly motivated to study, learn, and be the best nurse I can be!
My goal for the semester is to truly LEARN and understand what the hell is going on. I plan to read all assigned readings for the week during the weekend. This way, I can focus on studying during the week and listening more intently during class time. I'm almost done with the reading for this upcoming week. I will say--7 more hours and I'll be done. By then, it will be time to sleep since I wake up at 4am for my second clinical day.

NERVOUS!! Last week my regular preceptor was not around, so I had a floating nurse. She was nice and helpful, but I feel like our personalities will not mesh well. I hope my real preceptor is there tomorrow and I hope she is willing to show and teach me all the things she knows, ha.
Even though we're supposed to have our own patients, etc. I feel like if someone handed me a chart and said, "Go," that I would have no idea where to even start. I can't even read half of the stuff in the chart because of poor handwriting. So, I guess that is what's bothering/worrying me the most for right now. I go into clinicals with a dreadful feeling, but once I am there--everything is fine.

Time to begin reading.

first day of MS clinical

I had a good first day. I like this other hospital (it is technically the same hospital, but a separate facility in a different city). I am on telemetry, which is cool because I am interested in that stuff. Finally, male patients!
My preceptor wasn't working today, so I was stuck with some floating nurse who was kind of weird. She seemed angry, but she was cool for the most part. She kind of quizzed me about why we were doing certain things, which was helpful.
Tomorrow we have psych orientation at the same hospital from first semester. I'm excited because we don't have to be there until 9! Also, it just seems like a fun rotation.

1st day of second semester

Tomorrow is the first day of semester 2 of 5! I'm excited.
I finished my drug calculations book, but I haven't began reading for any classes.

alright, I don't really have much to say, except for this, sooo yep. Pretty pointless entry.

school and soup stuff

HAPPY 2007!!!

There's only about 4-5 days until the first day of second semester. I'm excited, stressed, and nervous.
I still haven't worked on my med. calculations book. We have to do the entire thing--it is loooong! I will begin today once I clean, shower, and make sure everything is in order. I wish they would post the syllabus for MS1 and Pharm. Psych is up. I have about 10 chapters to read, but fortunately that class isn't until Friday 1:00, so I am not stressing about it too much.

Hope everyone is having a nice holiday break.
Yesterday I made some apricot lentil soup. It sounds pretty odd, but trust me, it is good. AND 16 GRAMS OF FIBER! WOO.
Here's the recipe:
http://allrecipes.com/Recipe/Apricot-Lentil-Soup/Detail.aspx