Times you don't want people to think you are young: when you are their nurse.
On Thursday, I went to a couple's house to visit the husband who is on hospice services. The wife and I had barely started talking when she said, "You just don't seem old enough to be doing this kind of work." On the next visit and hour later, the patient and I were in the middle of conversation when she said, "How old are you? You look like you are 15." Friday, one of my patients first words were, "Get away. You are not old enough to take care of me." I just told her what I was there to do and continued, but she called me "that babe" the rest of the time. She also questioned me frequently as to where I got my nurse training.
So you see, when you are a nurse, it is nice for people to think you are older so they respect what you say. I think the reason they've been saying this is because the weather has warmed up so my face looks rosy again. In the winter, even though Seattle is so warm compared to Minnesota, I'm always cold. Maybe I look older when I'm cold:)
Something that make me squeal with delight: looking out my window an seeing the Olympic mountains with the sun setting behind them. Do you really know how much that means to me after not having a westward facing window for 4 years?
I love my job. I haven't written much about my job as a hospice nurse. My day starts out in the office at 8am. I get my assignment of usually 3-4 visits for the day. As a float, I fill in for nurses when they are on vacation, sick, overloaded, or if they have a day off in the week because they are working over the weekend. Usually I have never met the patients or their families. I spend some time looking up notes about the patient, gathering supplies I may need, and asking questions of other nurses or social workers if I need to. I put the patients' addresses in google maps to see what route and order is most efficient, then, sometime after 9am, I call the patients and set up times to meet. I try to give a range. Sometimes for the first appointment I will say 9:45-10:15am. Especially if any of the visits look like they may be long and complicated, I may ask the last patient if I may arrive between 2-3pm. That leaves me room to take extra time if I need to, get caught in traffic, etc... Some days the patients are doing well and the visits are easy as we chat about how things are going, how they are feeling, family dynamics, what they did with their lives.
Some days, you walk into a high intensity situation with multiple patient, family, or care giving problems. Those visits can take a long time! It may include more thorough patient assessment, phone calls to pharmacists and doctors about medical treatment options, to pharmacies to fill medications, to the social worker for lots of things, to my manager or another nurse, to the person in charge of ordering medical equipment, etc... Visits like that have potential to make a huge different for the patient and family, but they take a lot more time up front during the visit as well as later with phone calls and documenting those extra things.
So, on a super good day, I might be able to do 4 visits in 8 hours, but usually 3 visits and the work associated with them takes me 8 hours. Yesterday was my longest day so far. I spent 2 1/2 -3 hours just driving, visited 4 patients, and spent over 12 hours finishing my work. I knew it was going to be long when I was assigned 4 patients rather far from Seattle. Then I read the notes, and knew that most of them could be long visits as well.
The first visit was easy. Show up, talk to the patient's daughter about how things were going and how the patient was doing. Talk to the patient a little bit who had dementia and was pleasant but couldn't carry on a conversation. Take vitals and find out that her blood pressure was very high. So, the visit was easy, but off and on all day I was trying to get in touch with the doctor's office or they were trying to get in touch with me. Finally, our triage nurse took over on that because I had too much to do. The next visit started by talking to the patient's sister about her experiences with death in her family and what she was seeing and thinking about her sister, whom she was trying to care for. The patient had declined a lot in the last couple of days. We talked about signs and symptoms of end of life and things that she can do to make the patient more comfortable. Part of that includes administration of pain medications, but most of the things I taught her had to do with swabbing the patient's mouth to keep it fresh and moist, putting lip balm on her lips, dressing a newly developing bed sore, and turning the patient from side to side every couple of hours to keep the sore from getting worse. It was hard to even leave the home because as I was trying to get out the door, the patient needed to go to the bathroom and the family wanted me to help them. They needed extra help with care giving, and I can't be there all day to do it. I was rushed because all of this was taking so much time that I knew I would be late for my Cambodian interpreter appointment at the next visit.
I ended up being a half hour late, but I helped the family more and called back later to go over instructions again and see how things were going. The Cambodian appointment went well, but I did need to make a few calls and emails related to that. I was hoping I could make it to the final appointment by 3pm, but traffic began to get bad and I was late for that. Then it took awhile because the patient had just come on hospice the day before and was having nausea and vomiting and pain all day. To make matter worse, I forgot to take my shoes off when I entered the home. I know to do that in any Asian home. I even did it at the last one, but I forgot. The first thing that happened when I walked into the room with the patient was to get scolded for having my shoes on. I apologized profusely and went back out to take them off. How could I forget? That visit included a phone call to our pharmacist to get recommendations about new meds to try for the vomiting and pain (though the patient's oncologist does not think anything will help it), calling the doctor, calling our nurse who sends narcotic orders to the physicians for signatures, and calling a local pharmacy to order the medications. I didn't get home until 5:45pm and had multiple notes to write and people to contact.
Over all, it was a good day because things were getting done that would help these patients, but it was long. However, I'm not complaining. I get pain hourly. Matt gets a salary. Matt worked all day yesterday and all night. It's 10:30am now, and I still haven't heard from him. So I don't really mind a long day when that's the case. Maybe this gives you a picture of what I do as a hospice nurse:) I really really love it!
