Not doing what I was hired for - page 8

Another vent again. I was hired as a hospice nurse into my company 5 months ago. I was told there would be " a little bit of palliative care". Well, its only me the supervisor and the director in... Read More

  1. Visit  dudette10 profile page
    1
    This is why the difference between hospice and palliative is so confusing to working nurses, regardless of what was or was not taught in nursing school.

    DNR Order, Question & Answer, Hospice Foundation of America, Ask the Expert, Community | AGIS

    Hospices should make it clear to patients that hospice election means giving up aggressive treatments and accepting that death is approaching. But, there is no legal requirement to force this choice by signing a DNR before admission. In practice, many hospices choose not to be so blunt, and give patients and families time to adjust to the terminal illness and prognosis, even paying in some cases for life-extending treatment such as chemotherapy and radiation.
    NRSKarenRN likes this.
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  3. Visit  BrandonLPN profile page
    2
    Well, I think being full code and hospice simultaneously is nonsensical. There's nothing 'hospicie-ish' about breaking someone's ribs or shoving a tube down their throat. Doesn't that violate the very principal of hospice theory??
    PMFB-RN and JMBnurse like this.
  4. Visit  caroladybelle profile page
    0
    Quote from BrandonLPN
    Well, I think being full code and hospice simultaneously is nonsensical. There's nothing 'hospicie-ish' about breaking someone's ribs or shoving a tube down their throat. Doesn't that violate the very principal of hospice theory??
    It has less to do with common sense and more to do with legalities. In some states, a hospice (as well as some other healthcare entities) cannot choose or decline patients based on their DNR/nonDNR status with violating certain pt rights. To do so, would bar reimbursement from some state/federal sources ...... Or so is my understanding.

    Thus, it is a bureaucratic issue.
  5. Visit  angel337 profile page
    0
    I think many people here have said that they didn't know the distinction between hospice and palliative nurses and its good to know that there is a difference because it puts a different light (slightly) on the situation. I don't think any nurse proclaim to be perfect and sometimes people need a break from patient care so that they don't lose their mind and so that the patienst get what they deserve. My mother was a hospice patient so I do view this from a patient/family point of view.

    Quote from MomRN0913
    that's fine, you are all entitled to your opinion.

    Then only perfect nurses should be taking care of patients I guess. The nurse who says quietly to herself "OMG, he pooped again?" you wouldnt want that nurse either. or the one who says in their head "stop rining the call bell, I'm going crazy, wasn;t I just in here turning your TV channel?" Bet their family wouldn't want their nurses having those thoughts. guess they shouldn't be taking care of anyone either.

    If you never had a negative thought about a patient, you are a liar, end of discussion!

    Even my company sees palliative care as different from hospice patients. My director does too. When our homecare nurses help us out, they only help with palliatve, not our hospice patients, BECAUSE THEY ARE DIFFERENT.

    Wasting my time here.
  6. Visit  jadelpn profile page
    0
    Hospice Vs. Palliative Care

    This is a really good article on the differences between hospice and palliative care.
    I can absolutely see the OP's point. Wtih reading this article, palliative care can be symptom control for a chronic illness....rather like a visiting nurse in a general sense, as opposed to a nurse who is caring for an actively dying patient on comfort measures. So between those two types of nursing can be a HUGE amount of a difference.

    I apologize for getting caught up in the details of the original post, but I do tend to get a bit put off by venting comments in the heat of the moment. And when I said that I could sense your frustration, I meant that sincerely. But it was, in my opinion, a pretty harsh vent, and hate palliative care or not, it did come off as if you were disgusted by a number of your patients. Sometimes, it is in the art of the vent.

    With that being said, after researching a bit on the differences, I can see that when one's expectations are that of a hospice care nurse and they become a general visiting nurse (which shout out to all of the extra-ordinary homecare nurses out there--you all ROCK) I can see that it would be frustrating. Palliative care is really quite different than hospice care.
    In any event, I think that if, OP, you are able to actively pursue answers regarding a timeline and thoughts about hiring (and hiring specific to palliative care) then perhaps you could stick it out for the year. If they can not give you a specific timeline, and what they are doing to hire, then I would definetely look for a specific hospice postion (and perhaps NOT in a homecare agency setting)-- or a general home health position where you could have a variety of patients, and be clinically challenged similar to an ICU setting, but home care nursing is not for everyone either. A way that you may be able to do that is to specifically look for hospice care centers or floors within a hospital setting. Another choice is to find a hospice organization where perhaps you could work with families and patients within group sessions, talking about comfort care--as your years of experience in ICU could prove invaluable. If you are a single Mom with a child in daycare, then maybe a surgical day, doctor's office, or school nurse to completely switch it up a bit, and think about hospice care nursing when your child is older. Or, with your experience, an oncology chemo clinic to get certified in chemo, or even an oncologist's office.
  7. Visit  PMFB-RN profile page
    0
    All hospice patients are, or should be DNR. Even when they are not officialy DNR they are DNR. Hospiced patients are expected
    to die in the next 6 months or so. Like BrandonLPN said, there's nothing hospice like about the brutal process of coding a person. I would, and have refused to code a hospitrce patient. Unlike palliative patients who are usually full code and expected to leave the hospital to home or other living situation.
  8. Visit  netglow profile page
    0
    Geez peeps it's not so hard. And no PM you don't get to decide. Resus hurts. It hurts if if you were a hospice patient or if you weren't. Either way you were about to die, so?

    If that is what the patient wants that's what you do (running away is your choice, not the patient's choice). You have to live with the betrayal.

    A patient said something to me long ago that should help some of you understand things:

    "I want to live till I die of what's supposed to kill me (cancer) - I have an agreement with my body about that."
  9. Visit  JMBnurse profile page
    2
    Quote from BrandonLPN
    Well, I think being full code and hospice simultaneously is nonsensical. There's nothing 'hospicie-ish' about breaking someone's ribs or shoving a tube down their throat. Doesn't that violate the very principal of hospice theory??
    I agree. It goes against the philosophy of Hospice care. From the section posted above from the HFA, it says to me that that there is not a law that says a person must have a signed Physicians DNR order to be admitted to hospice. I will not argue with that, especially because in my state, nobody has to have a DNR signed by a Physician. In my state, people can sign their own DNR order, however that may not be the case in all states. It also suggests that there are some hospices that will admit a patient without a DNR with the plan to quickly ease them into that decision. It read to me like this was more the exception, than the rule.

    In all of the hospices I have encountered, not having a DNR upon admission to Hospice is non-negotiable. However, it may be the policy of the facilities as opposed to the law. I have seen the Hospice reps. come to the hospital to see patients, go in and talk to them and the family and come out and shrug and leave. When asked if the patient would be transferred to their hospice care, the answer was, "No. He did not agree to the DNR". I've seen many other patients already in hospice being brought back to the ER repeatedly by the family after calling 911 and resulted in their immediate discharge from the Hospice. They were basing these decisions on their policies, not on laws. They never seemed to me to be one bit worried that they would be sued for discrimination against full codes.

    As I mentioned before, if a patient is not ready for DNR, then they are not ready for Hospice. It seems as though there may be some facilities where they are willing to, on occasion, admit a patient that may be a little scared and have a few doubts and give them a brief bit of time to agree to the DNR. And that is the ultimate goal. Hospice does not work as designed with the patients being full codes. It's okay to be a full code, the patient just may not be ready for Hospice.
    kaliRN and MomRN0913 like this.
  10. Visit  jadelpn profile page
    0
    If a person has a terminal illness and wants to be a full code, they could be a palliative care patient for however long they need to be, for management of the illness and best functional level. I am sure there are patients who are not prepared to face an inevitable, and are palliative care patients to the point of not being able to make their own decisions, and then I would think it up to the HCP to decide for a DNR (or not--have had those HCP decisions to code before in my career) when the patient would be an active hospice patient.
    When a person chooses to become a DNR, then I would think they could still be palliative care, and perhaps when they get to the point in their terminal disease process where there's a change in functional level, then they become a hospice patient (when they are in a more active dying process) and at that point, I would think that patient's "control" comes into play and they can make their own decisions on DNR status.
    My understanding is that there is little difference between a general home care patient and a palliative care patient, except for the paperwork part that for diagnosis, and the expected outcome.
    Regarding the OP, I think that when one expects to be a hospice nurse, and to go into a case when the patient is in the active phase of dying, which is a specific type of nursing using a specific skill set, but instead have patients that require just general nursing management at home and are still quite functional, all of the venting comments aside, that is a whole different type of nursing which is seemingly not what the OP was interested in pursuing when she took the job. There are nurses who are specific to palliative care and who transfer care when the patient goes into an active dying phase. But I think that the company that she works for, although communication is better, perhaps hired her downplaying the part that perhaps she was not really into pursuing. So it has been a learning experience for many (myself included) that if one wants to be a specific hospice nurse, then it is perhaps better to seek a job that is hospice specific, and not pallative care as well.
  11. Visit  PMFB-RN profile page
    0
    Quote from netglow
    Geez peeps it's not so hard. And no PM you don't get to decide.
    *** Actually I DO get to decide who I will code and who I will not code. I will not knowingly cause harm to my patients, nor will I preform codes on them when I know they don't want it, nor will I subject them to imorral treatments. In my state I am protected under the concious clause.
    I have refused to code several full code patients in my roll as ICU RN and rapid response RN. In each case I had reason to know without a doubt that the patient did not want to be coded but remained a full code anyway. Usually as a result of family member interfering with the patient's wishes after the patient can no longer make their needs know.
  12. Visit  edmia profile page
    5
    Quote from PMFB-RN

    *** Actually I DO get to decide who I will code and who I will not code. I will not knowingly cause harm to my patients, nor will I preform codes on them when I know they don't want it, nor will I subject them to imorral treatments. In my state I am protected under the concious clause.
    I have refused to code several full code patients in my roll as ICU RN and rapid response RN. In each case I had reason to know without a doubt that the patient did not want to be coded but remained a full code anyway. Usually as a result of family member interfering with the patient's wishes after the patient can no longer make their needs know.
    Wow, that is playing with fire. In my state, you go by the papers at hand and if the patient cannot express their wish, there is a clear decision making hierarchy to follow. No RN or MD gets to decide. That's just nuts.

    Part of being a nurse is to understand that my own opinions about issues are that-- my own. The patients will often have different opinions and may make choices that I would never make, but it is unethical to override their decision. In my opinion anyway.

    Sent from my iPhone using allnurses.com
    Elladora, kaliRN, JMBnurse, and 2 others like this.
  13. Visit  dudette10 profile page
    3
    Quote from PMFB-RN
    *** Actually I DO get to decide who I will code and who I will not code. I will not knowingly cause harm to my patients, nor will I preform codes on them when I know they don't want it, nor will I subject them to imorral treatments. In my state I am protected under the concious clause.
    I have refused to code several full code patients in my roll as ICU RN and rapid response RN. In each case I had reason to know without a doubt that the patient did not want to be coded but remained a full code anyway. Usually as a result of family member interfering with the patient's wishes after the patient can no longer make their needs know.
    Several? Did the family members find out that you refused to code their family member after the code status was changed?

    I would like to know the consequences because I find it hard to believe there weren't any consequences to deal with.
    Elladora, JMBnurse, and edmia like this.
  14. Visit  enchantmentdis profile page
    0
    Quote from Kooky Korky
    How do you know that?
    Because i'll walk into a particularly dirty house and the daughter or son will apologize right off the bat that, "Mom's house has been this way for years, sorry, let me make some room for you to sit". Also there are different levels of dirt and some of these folks have been on hospice only weeks or days, yet their walls are caked with dirt, the carpets are laden with funk, and the cobwebs are hanging in your face. However, the folks are just as nice, or even nicer and more relaxed than the people who have spotless, upscale homes. I just have to wash my hands even longer afterward. No problem. We also have shoe covers if we are so inclined to wear them.


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