[Hellllllo Nurse]

Just fantastic posts from Gianine, Talaxandira and Hospicenurse.

Very wise, compassionate, and obviously very knowledgable about hospice.

Any nurse interested in hospice nursing would do well to read these nurses' expert words and give them serious thought and comptemplation.


When in doubt, I believe its better to err on the side of compassion- better to give narcs to a drug seeker than to withold narcs from a pt in pain.
This applies to pts in any setting.

[Nemeth]

Originally Posted by txspadequeen921

Remember you are not working in a hospital setting when you are in hospice. Your job as the nurse is to make them comfortable and help them make this transition easier, not to second judge them. Everybody reacts to pain differently and you must grasp that. I have had many patients that I have given PRN Roxanol on a routine basis just to get the pain under control. I have given ungodly amounts of morphine 3 and 4 cc every 15 min (20mg/ml) , but this is normally just in cancer patients. And that is ontop of all the Intensol ,rectal meds and such.. Now of course these are the patients that are close to death..I think hospice is a wonderful are to work,it is one of the places I felt like I have made a difference.

I am also a hospice RN and agree that comfort at end of life is parmount. Addiction becomes a none issue. My experience has not been the patients abusing drugs, they need them, but I have had the experience of family and/or friends diverting drugs. I also have had coworkers who have diverited drugs for there own use. They were fired. Hospice is the most rewarding work I have ever done. I feel I do gods work and get paid for it. How cool is that??!!?? What I do matters in the world and makes it a better place. I am studing for the CHPN and am taking it in about a week. I am also starting classes on-line at University of Phoenix at the end of September after the test. Any feed back is appreciated. I also am married to a man who fits the your husbands description. Except mine is a Newport smoking, rock musician, who owns a Harley, and has Black Hair to the middle of his back. Amazing how many of us Angels of Mercy marry these bad bad boys. Great comment e-mail me any time you need support hospice wise or with the Hubby Nice to know you. KIM

[talaxandra]

Originally Posted by hospicenurse

I think it's even scarier that you are attacking her for expressing her thoughts. She needs our support and education, not decapitation.

Agreed.

[JacelRN]

Thank you again, everyone,

You have given me a lot to think about and also have educated me on what to expect.

I will be going into classroom orientation in 2 weeks. Also I will be taking a math test, I suppose it is to be sure I can calculate proper med dosages (anyone ever heard of this specifically for hospice?). Then I will will begin 2 weeks of on floor orientation for 6 days total.

I intend to keep my eyes and ears wide open during orientation. I also plan to read some hospice books and ask plenty of questions to the nurse I shadow. She'll be sick of me by the end!

I believe my biggest difficulty lies in the transition. I will still be working one day a week on my med-surg floor. It will be so different. Caring for those dying most of the week and then caring for those with abdominal pain/pancreatitis the next. I am praying my compassion will carry over.

A nurse at work told me that I hadn't given Med-Surg enough time yet and that I should just bear with it. In one aspect I can agree with her, I feel green enough to the job but I also feel I have reached a plateau in my experiences-I tend to care for a revolving door of diagnoses. I am searching for bigger and brighter areas of nursing. I hope Hospice will allow me to feel compassionate and caring instead of frustrated and fed-up.

I hope you all will not tire of my questions, I will be back. I would rather ask the questions than presume I can know everything. The latter is furthest from the truth.

God Bless,
JacelRN

[talaxandra]

Originally Posted by JacelRN

I hope you all will not tire of my questions, I will be back. I would rather ask the questions than presume I can know everything. The latter is furthest from the truth.

Questions good!
Regarding the advice one of your colleagues gave you about not having given Med/Surg enough of a chance - if you're feeling burned out and frustrated that will be affecting your care. you owe it to yourself and your patients to recognise and act on this, as you have The belief that only those of us who've been nursing for ages can be burned out is mistaken.
I hope you find pallaitive care working better for you - keeping your acute skills up won't hurt, either Good luck

[hospicenurse]

[quote=JacelRN]Thank you again, everyone,


I believe my biggest difficulty lies in the transition. I will still be working one day a week on my med-surg floor. It will be so different. Caring for those dying most of the week and then caring for those with abdominal pain/pancreatitis the next. I am praying my compassion will carry over.

A nurse at work told me that I hadn't given Med-Surg enough time yet and that I should just bear with it. In one aspect I can agree with her, I feel green enough to the job but I also feel I have reached a plateau in my experiences-I tend to care for a revolving door of diagnoses. I am searching for bigger and brighter areas of nursing. I hope Hospice will allow me to feel compassionate and caring instead of frustrated and fed-up. [UNQUOTE]

Good luck, JacelRN! I think you will find that in hospice you will gain a new understanding and empathy that will stay with you no matter what area of nursing you pursue in the future. Looking forward to hearing from you again.

[Mister Chris]

Originally Posted by JacelRN

Hello all,

I have finally worked it out to transfer to hospice. .......My question is regarding "pain med seeking" behavior in hospice. Do you get it often? I have the least amount of compassion for these types of patients. ...............Please understand my term "pain med seeker" to be someone who is obviously timing their meds. I know we are to treat each patient as their pain is real to them, but in reality, much abuse is present in the current hospital setting..............................That is my true hope in transfering is that I can care for patients as I wish to-and their pain.
JacelRN

Hello and a big thank you to you all involved in this passionate thread - I
had to say I agree, yes, yes, working in Hospice/palliative care is very different from the normal hospital where you have to carefully sort out the genuine with the hypochodriacs. Qualifications at the hospice (beside RN, EN or AIN etc.) should include compassion, patience, a passion for care and a belief or reverence in your own spiritual self. Believe you do have something to offer. and be prepared for some unexpected tears from yourself. As I was told many years ago "if you loose the compassion then leave the hospice!". Good luck.
Mister Chris

"There was a flower beside her as she opened her eyes.
Each time it happened it was a wonderful surprise.
Midst the pain and anticipation of treatments to come,
That small breath of freshness with warmth from the sun.
So thoughtful and precious yet simple its bloom,
Poured out its beauty, all round the room.
During the long night when sleep avoided its call,
Someone had delivered it, this choice gift so small.
Yes someone so thoughtful popped in through the night,
Left the gift from nature a single flower so bright.
As light came slowly through blinds all drawn close.
There it was again, but how? Nobody knows.
Each morning it happened she never knew who
Had felt for her loneliness, knew her heart break too.
The flower gave pleasure and a meaning to live,
But her health now fast dimming, she'd nothing to give.
As days passed by she could no longer speak.
The flower was there, each day, each week.
Her fight for life fading, the sickness came fast;
The flowers kept coming, how long could it last?
Did she notice these tokens of love and good will?
When she lay on her bed so quiet and still.
The nurses and doctors knew her time had now run.
Blinds remained closed yet a fresh flower had come.
Very early that morning as her life drifted away.
The kind soul left a token, a red rose for Her day.

[Dr. Scully]

[quote=chris_at_lucas_RN]I kinda thought if patients say they have pain, they have pain, and we are supposed to treat them, not second guess them. If it's ordered and they ask for it because they have pain, who are we do judge whether they are sufficiently sincere in their need? Aren't we supposed to treat the pain before it gets very bad, so that it doesn't get very bad?

I don't know about abuse in a hospital setting. If someone is in hospital, they are likely uncomfortable. Do you truly want to be responsible for making a judgment call on a patient's comfort? What about the "truly needy" patient who is aware enough of time and spacing and understands aggressive pain management, and thus asks for pain medication when they feel they need it, not waiting until the pain hurts? Aren't they doing what a responsible patient should do, taking an active role in their own care?

I would worry about a nurse taking care of me in my terminal illness who might have some issues with whether or not she felt my pain was severe enough to justify medication--or if I was "seeking pain meds."

We learned a lot about the separation of our own issues from those of our patients, when we were in school. It came under the topic of "ethics." We are not here to control the patient's behavior, we are here to help the patient meet their needs, and when they cannot, to meet those needs for them.

I thought "nursing" wasn't about deciding the patient's needs, I thought it was about assessing their needs. How do you assess pain? We were taught to ask.[/QUOTEI kinda thought if patients say they have pain, they have pain, and we are supposed to treat them, not second guess them. If it's ordered and they ask for it because they have pain, who are we do judge whether they are sufficiently sincere in their need? Aren't we supposed to treat the pain before it gets very bad, so that it doesn't get very bad?
] Hello everyone!
I truly applaude the responses from the nurses who "get" the idea that we should not "judge" someone who calls for pain medicine right on the minute. Do they not teach us in nursing school to give meds thirty minutes before it is due?? I remember being in the role as a surgical patient; and believe me; that clock sure ticks slow when you are in pain.
I worked as a Hospice RN manager for several years and truly loved it! It made me feel like I was doing a "calling" instead of just a "job". I think you will switch into a whole different "mode" if you love it. No more will you think of "time"...you will only want to relieve a person's suffering. I had to educate many doctors to the fact of hospice care and pain management when I worked. So many could not grasp the fact that the patient's pain required levels of medicines they would never have prescribed.
Good luck with your new job, and always talk with other Hospice nurses for support and questions.
Pamela

[mjamesRN]

If I may echo a previous post: Give them WHATEVER they WANT. If you have a problem with drug-seeking patients, hospice isn't where you should be. If you were dying of a terminal painful illness, I think you would want to be as stoned as possible. Get it?

[TDub]

Doesn't matter if they're seeking meds or not. They're dying. Dope them to the gills if they want.

Edit: Didn't mean to sound so harsh. One thing to remember---hospice and hospital nursing are quite different. Hospice patients can comfortably take amounts of Roxinol that would kill anyone else. Know the effects and limits of drugs. Develop confidence. Use your mentors. Keep an open mind. Know yourself...