Hi! I could really use some advice and experience from nurses out there. I’ve been working various CNA positions over the past six years and I do feel majorly burnt out. The main factor (I think) is the number of patients CNA’s are assigned. I work in a position right now with pretty acute patients (ICU stepdown) and usually have 13 patients, although the other night I had 19 because we were short. It feels heartbreaking because I don’t get to spend the time with patients I know they deserve. I’ve kind of put up this emotional wall between myself and patients which doesn’t feel healthy.
I’m not sure if I want to work in bedside when I graduate, but I do know I want to get further education (either NP or MD, not sure yet - that’s a whole nother can of worms). I worked in hospice for quite some time as a CNA and I loved it. I’ve been anxious about the idea that if I’m this burned out in my position, I will start nursing when I graduate in August already burned out. I think that I would love working in hospice again but I don’t know if experience in that field would be looked upon favorably with grad schools. I’ve been telling myself that only having four patients will feel so much better than a typical CNA ratio, but I’m not sure. I didn’t feel burned out in hospice probably because I only had 6 patients at most, and the work culture was fantastic. This makes me consider staying at the bedside, especially if I like the internship I’m about to start on an oncology floor.
Has anyone else experienced job dissatisfaction as a CNA before becoming an RN? If so, did that change for you when you started working as an RN?

Hello everyone, I am a recruiter with Vighter Healthcare Staffing. We are looking to partner with the Rocky Mountain Regional VA Medical Center. We have several potential roles to fill. If interested, please select the role and link you are qualified for, apply and we'll have a recruiter reach out to you. Thanks!Certified Nursing Assistant - https://www.paycomonline.net/.../jobs/ViewJobDetails...Licensed Practical Nurse - https://www.paycomonline.net/.../jobs/ViewJobDetails...Medical Assistant - https://www.paycomonline.net/.../jobs/ViewJobDetails...Surgical Technologist - https://www.paycomonline.net/.../jobs/ViewJobDetails...Registered Nurse - ICU, ER, OR, Psych : https://www.paycomonline.net/.../jobs/ViewJobDetails...

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Hello nurses,
I am looking to hear your stories.
I have been an RN at bedside for 12 years, 4 of those being ICU and the most recent 6 being ED. I have been “white knuckling it” since 2020, and now am at the point where I have regular panic attacks (usually associated with work) and have even had a clinician recently state they believe I am struggling with “C-PTSD” (disclaimer this is not in the DSM V). I have always been with the same hospital.
I have never felt more burnt out or exhausted. Traveling isn’t for me (for various reasons). I can’t fathom staying where I am but also cannot fathom the stress/exhaustion of training in a new role. I HATE how fragile I’ve become but I am.
When you’ve been in a place like this, because I know many of you probably have, where did you go? What did you do for work to help yourself heal and allow your nervous system to calm down? I have applied for a transfer center job (not remote) with my same hospital but i am not guaranteed to get it.
Also note - sadly “taking time off/a break” isn’t feasible as I am single/the only income.

My mother (61) was diagnosed with MDS over a year ago. Not a candidate for bone marrow transplant due to poor health - has been diabetic since 16, kidney transplant 30 years ago, overall just too weak to take it. 3 weeks ago she was diagnosed with leukemia and given 1.5 years max. A day after learning this, she fell and broke her hip in multiple places, has been in ICU and now a “regular” hospital bed. Since the fall, she is no longer herself - she has very little short term memory, cannot hold a conversation and bottom line is we suspect she had a mental breakdown. She is refusing physical therapy and food.
When I spoke to the Dr today I was told we have one day to decide if in-home hospice or nursing home is the next step, with the understanding that she will be on her way to passing - no further transfusions or life-saving treatments. Specifically I was told her type of MDS is “a bad one” and so even without food her cause of death will be from the MDS, without further transfusions.
Basically I’m wondering what she will be going through in the end so I can prepare myself as best as I can. I’m sorry if I didn’t provide enough details or broke any rules. And I hope the best for anyone reading this that has been diagnosed or has a loved one that has.
Edit: I am sorry for the title of this post and wish I could change it. Please feel free to delete if it is too blunt and insensitive

Hello, I'm (26F) currently an agency nurse. I have an interview for a part time position in ICU. The manager at this hospital used to be my manager at a different hospital.
Now, as agency Ive always had flexibility to pick and choose my own schedule/shifts.
I DO NOT do night shifts - they make me depressed & really anxious.
My question is - do I mention this during the interview? I can even get the required medical documentation to support this.

Okay here are the basic facts. I'm an RN of 2.5 years in med-surg. The last 2 months of my first job I was charge nurse so you wouldn't exactly call me Mr charge. I observed some of the basics but like sort of half-heartedly did it as the fallback plan. I have some leadership qualities but like it's a big responsibility that my baby nurse status just didn't feel like I could live up to that, now. I was in a neuro ICU as a new grad and that was difficult enough. I couldn't cut it as a new grad in a level 1 stroke center which like is hard to begin with. Q1 hour NIHs on top of not practicing for a year. I switched organizations I went to a 22-month program through a school/health organization. Had kind of a change of heart with nursing it was the height of covid I graduated in May of 2020. And I just was having severe panic attacks in the ICU. I didn't gel with my preceptor right away... Wasn't sleeping etc and plus it's honestly really tough being a man in nursing. They literally talked to me like I was a baby at first and the morale was so low so they were just awful to new people especially men. So needless to say I didn't succeed in the ICU right away for many reasons not necessarily my gender but I digress. I transitioned to a med surg floor and that's where a majority of my experience came from and whenever I decided to leave then go to the PCU my boss was not supportive of this. So I left that position not on my own terms and I didn't have something lined up so (stupid, I know.). I thought I'd try traveling. Not because I just wanted to make a bunch of money but obviously it's more lucrative but I just didn't know if I wanted to keep up with being bedside. so I decided to just do nursing on hard mode instead and travel from place to place learning new policy after new policy and just getting exhausted. It's a hard enough job as it is being new but like the travel aspect on top of it I know it's my choice but oh my gosh I can't take it anymore. I've only had two contracts so far and one was at a quote on quote acute rehab facility and it was basically just a LTach that I wasn't prepared for. I know a lot of this sounds like I'm playing the victim of some cruel healthcare system that swallowed me up and s*** me out but I mean for real. I just don't want to be charge nurse I want to be a bedside nurse but I want to find travel opportunities that don't require that. I know that's not too much to ask. When I signed up for my last contract it said I didn't need charge I showed up they said they needed it and I told them like I would train for it but I would much rather not do that. At first the manager was okay with it but like she basically kick me out the f****** door because I didn't want the extra responsibility. It's enough being new to nursing being new to traveling and being new to med surg okay I've been in med-surg but still. Like sometimes I just can't catch a break I don't know what it is. I feel semi confident in my role as a nurse but like I just know that I can still get experience staff somewhere so I'm in this dilemma. I promise you I just speak to text it all this stuff so it sounds like it's Chat gbt but this is it. This is raw this is real please help me. I just accepted an assignment in St Louis that starts 5/10. And I couldn't be in more of a tizzy. Any advice or consolation would help me and please be kind because I'm kind of insecure.

• A real RN, BSN CCRN

Shout out to all the Murses, out there 💉🩸

I started noticing dementia symptoms in both my parents in 2015. After years of prodding them to downsize, hire in-home help, and/or move into assisted living, their hands were forced by my dad's rapidly declining health in 2018. A kind social worker at the ICU helped me get power of attorney (much easier than I realized, otherwise I would have done it sooner) and I moved them both to assisted living near my house.
Dad mercifully passed less than a year later, but mom is still hanging on. Her Alzheimer's is progressing painfully slow. She had a bout with the flu (not covid according to the tests) in fall 2022 which made her bedridden long enough that she never got the strength back to walk, so she's been in a wheelchair ever since. I was able to get her approved for Medicaid and move to skilled nursing in late 2022, but 18 months later she's still hanging in there. There's nothing else wrong with her other than the Alzheimer's. She only takes an antidepressant and melatonin at bedtime.
Every time I visit, for nearly six years now, all mom can do is ask me "what is this place," "when am I going home," "will you take me home," etc. She can still speak clearly and fake a conversation for a couple minutes, but it's the same questions over and over for the entire visit. It's dreadful. I dread visiting her. The mom I remember has been gone for years. The person in the body now only seems to get even sadder when I visit and then don't take her home.
Every time I see a call coming from the nursing home I hope it's *THAT* call. For her sake, of course, because this is a dreadful way to live - scared, lonely, confused, and depressed every waking moment. But also for myself. I'm hoping people here can understand what I mean, because people who are not living with dementia parents do not always understand AT ALL.

Hey there, thanks for clicking! A quick look around tells me that you had a lot of options to choose from.
So about me? First and foremost, I am actually a real person. I have references available if necessary 😜. I live in CST, but work night shift as an ICU nurse, so I keep very odd hours.
I'm in a questionable marriage, am a stepmon to (likely) the world's worse 5 year old, and I basically have a mini zoo. I love to read, my favorite genre changes pretty much every week. I'm not big on movies, and I watch the same 10 TV shows over and over.
What am I looking for? Best friends, casual aquantances, whatever works. I love having someone to message on a daily basis, or just send stupid memes back and forth with. Just general companionship. I also dislike the reddit platform in general for messaging (the notifications are awful), so other options would be great.
Hope to hear from you 😊 Also please send me your favorite book somewhere in the message, so I know you're human as well.

Hey there, thanks for clicking! A quick look around tells me that you had a lot of options to choose from.
So about me? First and foremost, I am actually a real person. I have references available if necessary 😜. I live in CST, but work night shift as an ICU nurse, so I keep very odd hours.
I'm in a questionable marriage, am a stepmon to (likely) the world's worse 5 year old, and I basically have a mini zoo. I love to read, my favorite genre changes pretty much every week. I'm not big on movies, and I watch the same 10 TV shows over and over.
What am I looking for? Best friends, casual aquantances, whatever works. I love having someone to message on a daily basis, or just send stupid memes back and forth with. Just general companionship. I also dislike the reddit platform in general for messaging (the notifications are awful), so other options would be great.
Hope to hear from you 😊 Also please send me your favorite book somewhere in the message, so I know you're human as well.

I am an ICU nurse with about 1 year of experience in Critical Care (nursing for a total of 2.5 years), ive been interested in perfusion since I started nursing school. I am thinking about applying to school next year (sept 2025 intake)- i wont have a full 2 years of CC experience by the application time (feb 2025). Will this work negatively against me? What kind of experience did other RNs have that went into Perfusion? How was the transition?
My nursing school GPA is pretty good but its also 2nd entry so only a total of 6 grades, not sure if they will account for my other degree as well.
Edit: I am based in Canada, hoping to apply to Canadian perfusion before trying to get in the states

(obviously this is not directed at people here, just at my ER)
For context I work in a 8 bed Psych ER attached to the Medical ER of 40 beds, at a ratio of 1:4. For Psych, I'll admit it's been a decent weekend, despite the fact I've been alone on the unit with just the tech. Chill patients who mostly leave me alone at night to fuck around. The point I can't get my medical coworkers to grasp is that ITS VERY RARELY LIKE THIS. So yeah, fuck me I enjoyed the rare night of peace after getting them all to bed on time.
For them, It's been nonstop all weekend since Friday morning. Waiting room 20 deep and no clean beds. We can't seem to catch up.
I'm out there helping as best I can. Giving meds, bringing people upstairs, turning over rooms. I left my tech alone with my 4 patients on suicide telemonitoring and checks, giving him phone number to call me if anything happens. Risky, but fuck it, im trying to be a team player. I've tried my best to help them since I started here.
I sit down in my unit at 3AM for a fucking brief break and an ER Nurse comes to chew my ass out and force me over my ratio to 6 because "everyone else is asleep". "This is ridiculous," he says. "You Psych people bitch about having 4 asleep patients but I've got basically 3 ICU patients out there". You couldn't even of asked nicely? I would have done it. You had to chew me out?
I hear this shit fucking constantly - "Psych is so easy". "You don't have to take care of sick people". "They're all asleep." I am so fucking sick of the medical nurses belittling me and my specialty because the 30 seconds they've spent on the unit a patient is asleep. I don't go out there and bitch at them when they've got more nurses than patients at 4am, having a fucking campfire chat at the charge desk while 3 antisocial meth heads are trying to murder me THE ENTIRE NIGHT, obviously not fucking helping me.
It's just bullshit, and I'm sick of how shitty we are to each other. God I'm fucking sick of the bedside. Rant over, thanks for coming to my ted talk

1st post. https://www.reddit.com/PVCs/comments/1cl6bq9/my_rvot_journey_rvot_pvcs_iraq_war_veteran/
Something I forgot to mention in my first post. The way that most PVC's work is you'll have the following pattern, beat beat pause beat (then back to regular rhythm for one cycle or more) - the pause is the PVC
Some folks have bigeminy beat beat pause beat, beat beat pause beat (then back to regular rhythm for one cycle or more)
Some folks have trigeminy beat beat pause beat, beat beat pause beat, beat beat pause beat (then back to regular rhythm for one cycle or more)
These three are the most common ways the PVC's act, or so I was told.
My PVC's were beat beat pause beat, beat beat pause beat, beat beat pause beat, beat beat pause beat (then back into regular rhythm for one cycle or more)
When you get into this cycle it's apparently considered Non-sustained ventricular tachycardia. When I had my episode in November several of the nurses printed off my ECG showing the cycles of NSVT because in their combined 100 years of nursing they had never seen a heart rhythm like mine. They were so concerned that they were debating on sending me to the ICU but after conversations with my cardiologist they decided against it. Anyway.
FYSA. I will hopefully be sharing some of my rhythms and the images from the EP study in about a month when I have my follow up, I will also share some images of my bruising so folks can have an idea of what the healing process looks like.
Day of surgery:
The day of surgery I arrived at 6am. It took them about two hours to prep me, they placed two IV's did an EKG, and a Chest X-ray. When they did the EKG my heart was all floppy floppy, the irregular rhythm was "beautiful" according to my cardiologist that I will call Dr. Stallone (as his roots are from Ukraine like Stallone's). Dr. Stallone said at that time we would be looking for the RVOT and an area which was causing SVT. I was wheeled back into the EP room and was put to sleep, Michael Jackson style with Propofol. I had two providers Dr. Fabio (he had stunning long hair) and Dr. Stallone. Dr. Fabio did most of the work and Dr. Stallone was there as the technical expert as he's performed these procedures for 45 + years. I was asleep for roughly an hour. While I was asleep they tried to induce the irregular rhythm but they couldn't. It was perfect sinus. They gave me two uppers, one was adrenaline, the other I can't remember the name, so I'll call it gojuice. They also gave me them together and it didn't induce the rhythm.
They then had to wake me up, I had no sedation, only the local anesthetic lidocaine. When they woke me up I had a catheter in my left groin going up to my left ventricle, two in my right groin going up to my right ventricle. They once again tried to induce the rhythm by using adrenaline, gojuice, and the two together and my heart stayed in perfect sinus. It was then Dr. Stallone looked over at me and said something to the effect of, "Tell me about your ex-wife.", and dollars to donuts in less than 20 seconds my heart was flopping around like a fish out of water. A nurse was then tasked to ask me about my ex-wife whenever my heart went back into sinus, in addition to pushing the uppers.
They looked around the right ventricle, particularly the right outflow tract for the source of the irregular rhythm. They couldn't find it, and thus ruled out RVOT. Then they started looking around the right ventricle generally and couldn't find it. Then they started looking in the left ventricle and were unsuccessful. They decided at that time to add a third catheter at that time in my right ventricle. It is a very, very strange sensation feeling a catheter sliding up your blood vessels inside of your body and feeling it slide into your heart.
They then decided to look towards the middle of the heart for the irregular rhythm and they found it. For me, there was some irregular cells in the left ventricle about 1.5 cm away from the center of my heart. They poked at it with the catheter, and used electricity to cause the irregular rhythm and it worked every time. Finally, they had the spot that they needed to address. Then Dr. Fabio inserted the ablator to send those cells to the burn pit. My providers at the time chose to use radio frequency to address the irregular cells instead of ice, or other methods. I was told that it was going to hurt, a lot but I could not move, and I cannot cough.
The provider did round one, and oh boy did it hurt. My chest was on fire, and my jaw was screaming in pain. All I could do is repeatedly say, ow ow ow ow. remember, I had no pain relief or sedation or anything during this procedure. Once he stopped ablating my heart immediately went into regular rhythm. They did two more rounds of ablation to ensure the cells were destroyed and that was it. When three rounds were done I looked at Dr. Stallone and said, why can't I hear my heartbeat? He was like, you're not supposed to. I responded, I have heard my heartbeat every single day, every single hour, minute, and every few seconds for the last 10 years. Not hearing it after all that time was surreal.
The ablation hurt, a lot but it was worth it if I were to describe the of being ablated it was like having a match in your chest pressing against the inside of your heart that just got hotter and hotter and hotter, all while you're repeatedly getting punched in the jaw over and over again, until it stops.
After the ablation they tried to stimulate the rhythm again and were unsuccessful, no matter how much they brought up my ex-wife or gave me uppers. I was on the journey to be cured.
I was sent from the operating room to the discharge area, which confused a lot of the nurses because they thought I was supposed to go to recovery. They were then told that I was awake the whole procedure and their jaws nearly hit the floor. At the hospital I got treated at being awake during the procedure simply does not happen. I had to say there for three hours while the plugs in my legs solidified and was released.
I have the normal limitations post ablation, no lifting more then 10 lbs for a week, don't go up multiple flights of stairs, don't do anything crazy ect.
I am supposed to start exercising keeping my heart rate below 125 bpm starting Tuesday. I have a follow up stress test in about a month along with potentially a monitor for a week or two.
Post procedure my heart is still in perfect sinus. I feel amazing, I have way more energy, and it was so worth it at least so far.
Feel free to ask any questions if you have any.

Just wanted to put this out there for all you lovely future nurses that you do not need to do a year of acute care, accept the first job you are offered, or need to get straight A’s.
Some nursing school tips - in my opinion, above all else in nursing school your mental health comes first. Nursing school is stressful, but try to keep anything else you can control low stress or eliminate it from your life. Unsupportive friends? Don’t need them. Clique-y, rude classmates? Don’t need them. Your unsupportive parents? Don’t need them. You don’t need to be in a study group or fit in. I literally went to class and left immediately when done. Shared my notes if someone that didn’t rub me the wrong way asked, but I didn’t study with anyone, even my friends because we’d end up distracted.

• personally I did not mind knowing or telling my exam scores. Don’t use it to compare, use it as a marker. If everyone does poorly, it’s more of a reflection of the teaching, and not the students themselves. I wanted to know if we needed to come together and talk to the professor or the director of the program if everyone was failing.
  
• have time to yourself, whatever you like doing as long as it’s not dangerous, you need you time.
  
• no all nighters, wake up early if needed, go to bed early or on time and wake up, get or make some brain food and study if you want before an exam.
  

Other tips (financial/job related) - if you don’t get grants or aid, consider an ADN and have your employer pay for any other pursuit of higher education. Have very little debt or pay out of pocket.

• apply everywhere (within your own personal guidelines, for example I did not apply to any private for profits or any that used the HESI vs the TEAS). Don’t bank on one nursing school.
  
• Do well (A’s as much as possible) in prerequisites, especially if you’re going into a merit and competitive application process (most of California for example). You don’t need A’s in nursing school you just need to pass.
  
• work a job in the specialty area you want to be in, if you can find it. If you want to be in the ED be an ED tech, if you want to be in ICU try being a tech in the ICU or PCU, try being an anesthesia tech, SPD, supply chain, or PCA in the OR. Also look into externships after your first semester and know that many hospitals look internal before external for residencies and new grad jobs
  
• for your resume, name, phone number, email only. Do not put your references names, your address, etc. protect yourself and your people! Put any experience you have if no medical field experience and try to relate the traits needed to succeed to nursing.
  
• apply to any job, new grad, residency, etc especially if you want a specialty. Try to build as many connections as possible in nursing school. You can’t even get in the door if you don’t apply, it’s always worth trying. Also don’t compare yourself to your classmates. I had no job lined up when I graduated because I declined all non-OR jobs, and I got offered one after Christmas.
  
• for specialty areas, especially like ICU and OR, do your research and maybe study in your free time. Knowing stuff when you get interviewed especially if it’s not a residency made for new grads makes you look more impressive as a candidate. See if you can have observation clinicals in a specialty you want. If you have a passion, it’s not a burden or homework. Like I found myself looking up different procedures and the different robots
  
• Above all else, be yourself. I knew what I wanted in nursing school, and I know who I am as a person, outside of handbook guidelines, I did not try to mold myself into someone I wasn’t to appease my professors or peers.
  

I will also say, I learned nursing school can bring the ugliest out of people and job stress does it too to a lesser extent (coworkers may get short, but go back to laughing after the case or in the break room). I’m okay with that but some of the ways I was treated in school by peers was not acceptable to me especially for 2 years. I’m not letting you KMA when finished and going to be your buddy now that you can justify being nice to me. Stand up for yourself and protect your mental health and know your worth as a person!
Hope this helps. Never settle and always look to grow and achieve what you want.

Here is your Friday update of the best job listings for today.- Registered Nurse (State of Alaska)- Assistant Receiving Manager- Nurse Practitioner - Hospice and Palliative Care- Behavioral Health Clinician (LCSW, LPC, LMFT, LADC) - Behavioral Health Home- Reg Respiratory Therapist-GIG- Sales Agent - Only for Columbia, SC Residents- Direct Care Worker - In Home Care- Travel Registered Nurse RN Cardiovascular Intensive Care Unit CVICU- Intensive Care Unit - ICU RN - Travel Nurse- Retail Team Member (Overnight) - Maverik See more details and apply here:=> https://workfromhomejobsads.jobsjab.com/search

Here is your Thursday update of the best job listings for today.

• Registered Nurse (State of Alaska)
• Assistant Receiving Manager
• Nurse Practitioner - Hospice and Palliative Care
• Behavioral Health Clinician (LCSW, LPC, LMFT, LADC) - Behavioral Health Home
• Reg Respiratory Therapist-GIG
• Sales Agent - Only for Columbia, SC Residents
• Direct Care Worker - In Home Care
• Travel Registered Nurse RN Cardiovascular Intensive Care Unit CVICU
• Intensive Care Unit - ICU RN - Travel Nurse
• Retail Team Member (Overnight) - Maverik

See more details and apply here: https://search.hiredgood.com/search

This might be too niche, but there has been these anonymous people sending emails to the Adams Morgan listserv and I just found out that they are all made by one person, Chris Otten. The newest one is a fake black advocacy group called "blackneighborsdc.org". It seemed fishy to me (blank website, it was only 87 days old, and was speaking about the 1617 U st. development in almost the exact same terms as these other "advocacy groups").
I used this website to see what websites were being hosted on the same IP address as the black neighbors website. It showed all the other groups that had been spamming us and some others: dc4reality.org, dcgrassrootsplanning.org, dcfeedback.com, howardeastneighbors.org, chrisotten.com, savedcpublicland.org, ustreetair.com
You'll notice ChrisOtten.com which he used for his Ward 1 council member run.
Weirdly if you go to the IP address that hosts both of those sites you get this http://143.95.244.31/ which looks like some sort of demon themed arts class?
In the Adams Morgan listserv after this was pointed out, Chris confessed to the being his websites.
I've also found some other reddit posts about him and he seems like quite the figure.
https://www.reddit.com/washingtondc/comments/13drmkg/if_we_want_affordable_housing_why_dont_we_build/
https://www.reddit.com/washingtondc/comments/8zv3kg/years_ago_an_activist_group_procured_millions/
UPDATE:
Chris tried to call me out but shows that a sockpuppet of his posted in this thread u/Substantial_Steak769 :
https://twitter.com/dc4reality/status/1788997447932604839
Such sad floundering on his part.

https://bandana.co/jobs/0fec0ff2-55dd-4978-92e9-93fd9d031ec6?utm_source=reddit
Job Duties & Responsibilities:
• Work collaboratively with multidisciplinary health care teams to maintain professional nursing practices in a clinical setting.
• Collect comprehensive data on patients' health, analyze it, and develop individualized care plans.
• Carry out prescriber orders appropriately and timely, collaborating with ancillary staff.
• Integrate patient care standards in all clinical activities, participating in performance improvement activities.
• Promote a supportive and team-oriented environment.
Qualifications and Requirements:
• BSN from an accredited school of nursing.
• 1+ years of PACU, ICU, Step Down, or ED Experience as a registered nurse.
• NYS RN license and registration.
• BLS, ACLS, and PALS certification.
• Pay Range - Minimum: USD $62.39/Hr.
• Pay Range - Maximum: USD $72.11/Hr.
Hospital for Special Surgery is consistently ranked among the top hospitals for orthopedics and rheumatology. As a recipient of the Magnet Award for Nursing Excellence, HSS is known for its innovative, supportive, and inclusive environment. With a focus on providing exemplary customer service and maintaining high standards of care, HSS offers unique career opportunities and competitive compensation packages.
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My uncle passed a few days ago after almost 3 months in the hospital. He had been in the ICU for 75 days and was transferred to the infirmary a few days before he passed. He was seemingly doing much better, but just died all of a sudden.
My grandma (his mother) wasn’t there when any of this happened. She’s almost 99 years old and is being cared for at home, and the family chose not to tell her about his condition until he got better (which sadly did not happen).
But - despite not being there and not even being aware of my uncle’s condition - it seems she’s been having conversations with his spirit every night this week. The nurse who’s been taking care of her told me that this started on Saturday night, and then again on Monday morning (which was at time my uncle passed). Since then, it’s been happening every night.
I’m looking for spiritual teachings or anything that could help me understand this phenomenon better. I know that people tend to get better before they go, so I understand why he might’ve gotten well for 1 week and then passed away; it was just enough time to say goodbye to everyone… but I’m very conflicted about telling my grandma about his death - she’s very old and her health is already extremely fragile, so the family is worried this might trigger a heart attack or something else. It seems she already knows though, at least on an unconscious/ spiritual level.
So yeah, any insights/ helpful readings/ spiritual pointers would be very helpful as I’m trying to make sense of all of this, and to hopefully guide me in making the best decision about whether to tell my grandma about her son’s passing. Thanks!

Saying goodbye before dying - which spiritual teachings talk about this? How to learn more?
My uncle passed a few days ago after almost 3 months in the hospital. He had been in the ICU for 75 days and was transferred to the infirmary a few days before he passed. He was seemingly doing much better, but just died all of a sudden.
My grandma (his mother) wasn’t there when any of this happened. She’s almost 99 years old and is being cared for at home, and the family chose not to tell her about his condition until he got better (which sadly did not happen).
But - despite not being there and not even being aware of my uncle’s condition - it seems she’s been having conversations with his spirit every night this week. The nurse who’s been taking care of her told me that this started on Saturday night, and then on Monday morning (at the same time my uncle passed) it happened again. Since then, it’s been happening every night.
I’m looking for spiritual teachings or anything that could help me understand this phenomenon better. I know that people tend to get better before they go, so I understand why he might’ve gotten well for 1 week and then passed away; it was just enough time to say goodbye to everyone… but I’m very conflicted about telling my grandma about his death - she’s very old and her health is already extremely fragile, so the family is worried this might trigger a heart attack or something else. It seems she already knows though, at least on an unconscious/ spiritual level.
So yeah, any insights/ helpful readings/ spiritual pointers would be very helpful as I’m trying to make sense of all of this, and to hopefully guide me in making the best decision about whether to tell my grandma about her son’s passing. Thanks!

Clinical Nurse Specialist References: This looks like the acute care pharmacist role in ICU and ER.
You Tube Nursing Uncharted. The Role of a Clinical Nurse Specialist (CNS) Ep. 06 Highlight Nursing Uncharted
https://www.youtube.com/watch?v=L1_QwTuS3Hc
You Tube Nurse.org. How to Become a Clinical Nurse Specialist (CNS)How to Become a Clinical Nurse Specialist (CNS)
Nurse.org
https://www.youtube.com/watch?v=n8RXYQC0uIo
Nurse.org
How to Become a Clinical Nurse Specialist
https://nurse.org/resources/clinical-nurse-specialist/

What Does a Clinical Nurse Specialist Do?

A clinical nurse specialist's job varies depending on the type of facility they work at and their chosen specialty. However, their primary goal is always to improve outcomes. Therefore, they constantly ask questions like:

• How can I help the nurses at the bedside?
• How can I help these patients on the unit?
• What changes would improve processes throughout the hospital system?

Clinical Nurse Specialist Duties and Responsibilities

According to CNS Andrea Paddock, CNS responsibilities may change daily:
“My day-to-day can transition from being in my office planning for a project. So I'm doing a lot of reading, researching, writing, things like that. Other days, I'm out on the unit helping the nurses, running to codes, running simulations, teaching classes, running meetings, etc. No one day is ever the same.”
In fact, according to the 2020 NACNS survey, CNSs said they spent 26.6 percent of their day providing direct patient care, 22.1 percent consulting with nurses and other staff, 26.5 percent teaching nurses and staff, and 19.7 percent leading evidence-based practice projects. The majority of their time is spent precepting students (32.5%).
Clinical nurse specialists will also perform the following activities according to the survey:

• Assist with evidence-based practice projects
• Assist other nurses/staff with direct patient care (aka act as a resource)
• Assist with research
• Teach patients and families
• Conduct research as the primary investigator
• Teach in the community
• Provide transitional care

In other words, CNSs wear several hats and are valued members of healthcare teams.
What Does a Clinical Nurse Specialist Do? A clinical nurse specialist's job varies depending on the type of facility they work at and their chosen specialty. However, their primary goal is always to improve outcomes. Therefore, they constantly ask questions like: How can I help the nurses at the bedside? How can I help these patients on the unit? What changes would improve processes throughout the hospital system?
Clinical Nurse Specialist Duties and Responsibilities According to CNS Andrea Paddock, CNS responsibilities may change daily: “My day-to-day can transition from being in my office planning for a project. So I'm doing a lot of reading, researching, writing, things like that. Other days, I'm out on the unit helping the nurses, running to codes, running simulations, teaching classes, running meetings, etc. No one day is ever the same.”
In fact, according to the 2020 NACNS survey, CNSs said they spent 26.6 percent of their day providing direct patient care, 22.1 percent consulting with nurses and other staff, 26.5 percent teaching nurses and staff, and 19.7 percent leading evidence-based practice projects. The majority of their time is spent precepting students (32.5%).
Clinical nurse specialists will also perform the following activities according to the survey: Assist with evidence-based practice projects Assist other nurses/staff with direct patient care (aka act as a resource) Assist with research Teach patients and families Conduct research as the primary investigator Teach in the community Provide transitional care In other words, CNSs wear several hats and are valued members of healthcare teams.

CNS Certifications & Specialties

CNS certifications don't cover all specialty areas of nursing like other degrees. Currently, clinical nurse specialists can earn certifications in the following specialties:

• Adult
• Pediatric
• Neonatal
• Geriatric
• Oncology
• Critical Care (Adult, Pediatric & Neonatal)
• Orthopedic
• Perioperative
• Psychiatric-Mental Health (Adult, Adolescent/Child) CNS Certifications & Specialties CNS certifications don't cover all specialty areas of nursing like other degrees. Currently, clinical nurse specialists can earn certifications in the following specialties: Adult Pediatric Neonatal Geriatric Oncology Critical Care (Adult, Pediatric & Neonatal) Orthopedic Perioperative Psychiatric-Mental Health (Adult, Adolescent/Child)

CNS can bill for services and have provider status in many states. Pharmacist do not seem to have this.
NP, CNS, and CNM Services:7 Medicare makes payment for NP, CNS, and CNM services based on the MPFS.
The MPFS is a fee schedule with an individual payment amount for as many as 8,000 different procedure
codes. Section 1833(a)(1)(O) of the Act requires NPs and CNSs to be paid 85% of what Medicare would pay a
physician for the same service or 85% of the MPFS payment amount. Until January 1, 2011, CNMs were paid
65% of the MPFS payment amount. Beginning January 1, 2011, Medicare allows CNMs to be paid 100% of
the MPFS amount. The final section of this paper will posit arguments for changing the statute so that all
APRNs are paid at 100% of the MPFS.
Reference ANA: Medicare Payment for Registered Nurse Services and Care Coordination
https://www.nursingworld.org/~498582/globalassets/practiceandpolicy/health-policy/final_carecoordination.pdf

CNS Independent Practice MapCNS Independent Practice Map

https://www.ncsbn.org/nursing-regulation/practice/aprn/aprn-consensus-implementation-status/cns-independent-practice-map.page
All Nursing Schools:

What You’ll Do as a Clinical Nurse Specialist (CNS Job Description)

https://www.allnursingschools.com/clinical-nurse-specialist/job-description/
https://preview.redd.it/jlk3in7crczc1.png?width=798&format=png&auto=webp&s=f6d55786d31c2eb16c766654faf8c9e0f0a83466
International Council of Nurses. Guidelines for Advance Practice Nursing 2020:
https://www.icn.ch/resources/publications-and-reports/guidelines-advanced-practice-nursing-2020
https://www.icn.ch/sites/default/files/2023-04/ICN_APN%20Report_EN.pdf
https://preview.redd.it/wh0da0a2sczc1.png?width=749&format=png&auto=webp&s=3244c41cae29378b5b16cea0c81450ed7b4014d7
https://preview.redd.it/hljay7v6sczc1.png?width=781&format=png&auto=webp&s=a31841593469f6cbb913a6ab27b064f020a555c1
https://preview.redd.it/4abhhsn9sczc1.png?width=768&format=png&auto=webp&s=cf2d63e1b9b50de0142b2997e1bb42dbf829b598
The role of the nurse is also expanding in Ambulatory care. This looks like the AMCare RPH References:

RN Role Reimagined: How Empowering Registered Nurses Can Improve Primary Care

https://www.chcf.org/publication/rn-role-reimagined-how-empowering-registered-nurses-can-improve-primary-care/
https://improvingprimarycare.org/sites/default/files/topics/RN-Intro1-RN%20Role%20Reimagined-CHCF-Aug2015.pdf
With growing demands on primary care and a shortage of primary care clinicians, safety-net clinics are asking, What is the role of the registered nurse (RN) in primary care?
This report describes how 11 community health centers and county health systems in California, as well as two health centers outside California, are using the following strategies to expand the RN role in primary care:

• Provide RNs with additional training in primary care skills, so they can make more clinical decisions
• Empower RNs to make more clinical decisions, using standardized procedures
• Reduce the triage burden on RNs to free up time for other responsibilities
• Include RNs on care teams, allowing them to focus on their team’s patients
• Implement RN-led new-patient visits to increase patient access to care
• Offer patients co-visits in which RNs conduct most of the visit, with providers joining in at the end
• Deploy RNs as “tactical nurses”
• Provide patients with RN-led chronic care management visits
• Employ RNs’ skills to care-manage patients with complex health care needs
• Train some RNs to take responsibility for specialized functions
• Schedule RNs to perform different roles on different days
• Preserve the traditional RN role and focus on training medical assistants (MAs) and licensed vocational nurses (LVNs) to take on new responsibilities

https://preview.redd.it/1u7knbc8qczc1.png?width=376&format=png&auto=webp&s=50f6048598c3ba69093cfcf77dee5727a7fa0bdf
American Nurse:

Preparing RNs for emerging roles in primary care

https://www.myamericannurse.com/preparing-rns-for-emerging-roles-in-primary-care/

Registered Nurses: Partners in Transforming Primary Care

https://macyfoundation.org/publications/registered-nurses-partners-in-transforming-primary-care
https://macyfoundation.org/assets/reports/publications/macy_monograph_nurses_2016_webpdf.pdf
Registered nurses, the largest health profession in the nation with over 3.5 million
members, are ideally suited to provide the bulk of care for people with chronic
illnesses. In primary care, RNs may assume at least four responsibilities: 1) Engaging
patients with chronic conditions in behavior change and adjusting medications
according to practitioner-written protocols; 2) Leading teams to improve the care
and reduce the costs of high-need, high-cost patients; 3) Coordinating the care
of chronically ill patients between the primary care home and the surrounding
healthcare neighborhood; and 4) Promoting population health, including working
with communities to create healthier spaces for people to live, work, learn, and play.

The Vital Role of Nurses in Delivering Transformative Primary Care

https://www.chenmed.com/blog/vital-role-nurses-delivering-transformative-primary-care
Depending on their level of education and experience, the BMC Health Service Research Article observes, nurses can independently "provide a broad range of patient services, including preventative screening, health education and promotion, chronic disease management, acute episodic care, and a wide variety of therapeutic interventions."
The activation of nurses—under the guidance of MDs, physician assistants, and nurse practitioners—was a hallmark of 30 "high-performing, innovative primary care practices" highlighted in a 2017 study published by the Journal of Ambulatory Care Management. These organizations had "practice-wide standing orders" that directed nurses to "independently conduct preventative visits, manage minor acute illnesses, and provide significant chronic illness care and management" to the patient panels.

Value-Based Care Elevates the Role of the Registered Nurse in Primary Care

https://www.hfma.org/payment-reimbursement-and-managed-care/value-based-payment/54348/
For example, a patient may need to see only the nurse and nurse assistant for one scheduled visit but on another visit needs to be examined by the physician and provided training by the nurse.
Additionally, the patient pathway from appointment preparation to next appointment rescheduling was streamlined to shorten wait time by starting intake procedures from the moment the patient enters the office. Further, the critical handoff between the physician and the nurse is expedited by the needs-based stratification of patients, each associated with evidenced-based care protocol. This expands the role of nurse, allowing them to assume greater responsibility for patient care.
To be successful in such value-based initiatives, healthcare organizations must ensure nurses are working at the top of their license. Progressive providers have increased patient access by conducting new nurse-only patient visits during which registered nurses document patient histories, order lab and other diagnostic tests, and determine patient acuity.
By implementing newly defined standardized procedures, clinics are increasing the registered nurse’s scope of clinical decision making including medication refills and anticoagulant and chronic care management. Nurses also are conducting physical examinations, providing triage, and subsequently presenting patient cases to practitioners—activities that significantly improve overall workflow and efficiency. Moreover, evidence shows nurse-led chronic, complex, and transitional care management results in decreased hospital days and emergency department (ED) admissions.
The Ohio State School of Nursing

Redesigning nursing education to support patients in primary care

https://nursing.osu.edu/news/2020/12/16/redesigning-nursing-education-support-patients-primary-care
https://preview.redd.it/uidu1bhktczc1.png?width=514&format=png&auto=webp&s=0c4b7aaf011e99de7c902915d66da15f7c2e7112
Implementing Nurse-Run Hypertension Clinics
https://www.careinnovations.org/resources/nurse-run-hypertension-care/
https://preview.redd.it/xpcdyccttczc1.png?width=798&format=png&auto=webp&s=67261d97068fd650e07c6e09f27a8ef876243782
https://preview.redd.it/zqwqlyywtczc1.png?width=855&format=png&auto=webp&s=5ea5fd3225bf154d658c8b3424fbc337d1d6e3d4
These tread seems to be international as all countries seem to move toward Value Based Care.

Tension as practice pharmacists ‘encroach’ on nurse duties

https://www.nursingtimes.net/news/primary-care/tension-as-practice-pharmacists-encroach-on-nurse-duties-12-03-2019/

Hospital hires newly qualified pharmacists for wards amid nurse shortage

https://pharmaceutical-journal.com/article/news/hospital-hires-newly-qualified-pharmacists-for-wards-amid-nurse-shortage