Hospice akin to "giving up"???

  1. For the past year I have worked in a LTC that recently began to work with Hospice. It was so wonderful to see these patients getting one on one, and the kind of time and attention that we just didnt have to give. At the DON's request, I handled the majority of referrals for the house for while, until management decided they wanted a committee to select them - (which never did materalize). Last week I called the local hospital with a suggestion that one of our patients who had been transferred there who was heartbroken with his prognosis, and was alone and failing MIGHT make a good Hospice referral for them. I told my supervisor about it and she said "Good for you!!".
    The next day my adminsistrator called me in and told me that "out in the community" there was a rumor that we are "giving up" on our patients, putting them on Hospice and killing them off with Morphine. They then fired me, because I had called the hospital with my suggestion. My supervisor sat there and denied saying that to me.

    I dont even know how to feel. But it isnt good. I was looking out for the patient! It seems to me that I was sacrificed to answer the "rumor" ? Any other takes?
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  2. 10 Comments

  3. by   KaroSnowQueen
    That is just not right. That is one reason I gave up on LTC, they all seem to have this convoluted thinking process. I am sorry this happened to you.
    The only suggestion I have is this: Why not go apply for a job with Hospice? Either home care or an inpatient unit? You sound like you would be a perfect candidate, and I hope things go better for you.
  4. by   VivaLasViejas
    I agree with KaroSnowQueen.

    Personally, I think this unfortunate series of events happened for a reason........look at it as God's way of telling you that you're meant to go into hospice nursing.

    Frankly, it's a wonder people will even work in LTC anymore, with the kind of garbage that goes on there. It's not worth the heartache, the bad back, or the risk to a nurse's license. They couldn't pay me enough to work in a nursing home again.........the facilities I've worked in have been fair to absolutely horrid, and the bureaucracy is ridiculous. I rarely say "Never", but as far as LTC goes, I can say with reasonable assurance that I will NEVER work in one again.
  5. by   CHATSDALE
    i don't really understand exactly what occured here...was this outside your job responsibility??? anyone who believes that hospice is 'giving up' is not too smart...of course many of hospice patients are going to be depressed .. dying esp if you are alone in the world is going to be hard to face until you reach the acceptance stage...maybe the patient said something to someone what was misconstrued...
    whatever you must now move on...maybe the others were right about the direction your career should take now...many nurses are very uncomfortable about dealing with terminal patients and how to handle family..maybe you have a talent that you should persue
    as for your supervisor, forget it...she probably could see the way things were coming down and thought about the car payments etc and covered her butt...a time honered pratice among all medical workers
  6. by   CHPN1680
    I agree with the above posters. This all happened for a reason. I think that you will find yourself in a more rewarding position whether it be hospice or some other compassionate environment.

    Your administrator is typical. Has he/she been out in the community representing your facility? Has he/she bothered to get educated about hospice and how hospice can improve the lives of the facility residents while decreasing the burden on the facility staff? Probably not. If he/she had been knowledgeable, the result may have been different.

    I applaud your action and think that it is great that you were on the patient's side. It sounds like this patient has nobody else. Often in acute care environments, the focus is so much on fixing things that they lose sight of what would most benefit the patient. There is nothing wrong with a suggestion for the discharge planner or social worker that hospice might be an option.

    Good luck to you.
  7. by   zacsmimi
    Quote from BobL
    I agree with the above posters. This all happened for a reason. I think that you will find yourself in a more rewarding position whether it be hospice or some other compassionate environment.

    Your administrator is typical. Has he/she been out in the community representing your facility? Has he/she bothered to get educated about hospice and how hospice can improve the lives of the facility residents while decreasing the burden on the facility staff? Probably not. If he/she had been knowledgeable, the result may have been different.

    I applaud your action and think that it is great that you were on the patient's side. It sounds like this patient has nobody else. Often in acute care environments, the focus is so much on fixing things that they lose sight of what would most benefit the patient. There is nothing wrong with a suggestion for the discharge planner or social worker that hospice might be an option.

    Good luck to you.
    BOBL - you made my day. Thanks.
  8. by   Blackcat99
    When I worked nights at the LTC I mentioned to the day nurse that I thought It might be helpful to call hospice for one of our dying patients. She said "No. I'm not going to call the doctor. He will die eventually. We don't need hospice coming in here and killing our patients with morphine."
  9. by   CHPN1680
    Quote from Blackcat99
    When I worked nights at the LTC I mentioned to the day nurse that I thought It might be helpful to call hospice for one of our dying patients. She said "No. I'm not going to call the doctor. He will die eventually. We don't need hospice coming in here and killing our patients with morphine."
    Please don't let that nurse care for anyone that I know! It is truely unfortunate that a nurse (especially in a LTCF ) does not understand the benefits of hospice. Obviously this nurse knows nothing about the benefits of morphine in end of life care. She is doing a great diservice to patients and families if she spreads ignorance like that!
  10. by   steelcityrn
    After I read your post twice, I sort of figured what happened here. A resident from the LTC had to go into the hospital. While he was there, you called and suggested that their case manager that handles his discharge consider hospice for him? Is that about right? In that case I do feel that you handled this wrong. First off, the patient (if still oriented) and family would need consulted. Then the physician would need consulted (you can go on hospice without their blessing, but it sure does make it a smoother transition).
    I think your heart was in the right place, but why didn't you wait until he returned to your facility? And the fact that others formed the opinion that you were "giving up " and "killing them on morphine" probably was made in ignorant jest. I think we can all learn something about your situation. Good Luck in your next job









    Quote from zacsmimi
    For the past year I have worked in a LTC that recently began to work with Hospice. It was so wonderful to see these patients getting one on one, and the kind of time and attention that we just didnt have to give. At the DON's request, I handled the majority of referrals for the house for while, until management decided they wanted a committee to select them - (which never did materalize). Last week I called the local hospital with a suggestion that one of our patients who had been transferred there who was heartbroken with his prognosis, and was alone and failing MIGHT make a good Hospice referral for them. I told my supervisor about it and she said "Good for you!!".
    The next day my adminsistrator called me in and told me that "out in the community" there was a rumor that we are "giving up" on our patients, putting them on Hospice and killing them off with Morphine. They then fired me, because I had called the hospital with my suggestion. My supervisor sat there and denied saying that to me.

    I dont even know how to feel. But it isnt good. I was looking out for the patient! It seems to me that I was sacrificed to answer the "rumor" ? Any other takes?
    Last edit by steelcityrn on Mar 12, '05
  11. by   NRSKarenRN
    Quote from zacsmimi
    Last week I called the local hospital with a suggestion that one of our patients who had been transferred there who was heartbroken with his prognosis, and was alone and failing MIGHT make a good Hospice referral for them. I told my supervisor about it and she said "Good for you!!".
    The next day my adminsistrator called me in and told me that "out in the community" there was a rumor that we are "giving up" on our patients, putting them on Hospice and killing them off with Morphine.
    My take on this situation:

    BUSINESS was perceived as being affected by "community perception" that this skilled nursing facility was a place to go "when they're (docs/nurses) giving up on you" as several residents dying in the facility on hospice. Families told of loved ones dying there and getting morphine. Ill advised family/friends started gossip mill that YOU don't want to go there, as they give you morphine and die.
    So patients who would benefit from short term rehab or long term care no longer considering facility.

    Wonder too if # clients on hospice draining financial $$$ facility would receive from Medicare too.

    Unfortunately, you were the scapegoat in this case. Agree with other colleagues: consider it a blessing and investigate hospice programs in your area. Would'nt it be ironic, you coming back to the facility as Hospice nurse???

    Additionally, hope you filed for unemployment. Would also consider filing "wrongful termination" case.

    Hope you spread the word in conversation that Hospice isn't about giving up, but MAXIMIZING time and providing tons of "Comfort Care and Symptom Management".

    Sending a {{{{{hug}}}}} your way.
    Last edit by NRSKarenRN on Mar 12, '05
  12. by   OneThunder
    Quote from zacsmimi
    For the past year I have worked in a LTC that recently began to work with Hospice. It was so wonderful to see these patients getting one on one, and the kind of time and attention that we just didnt have to give. At the DON's request, I handled the majority of referrals for the house for while, until management decided they wanted a committee to select them - (which never did materalize). Last week I called the local hospital with a suggestion that one of our patients who had been transferred there who was heartbroken with his prognosis, and was alone and failing MIGHT make a good Hospice referral for them. I told my supervisor about it and she said "Good for you!!".
    The next day my adminsistrator called me in and told me that "out in the community" there was a rumor that we are "giving up" on our patients, putting them on Hospice and killing them off with Morphine. They then fired me, because I had called the hospital with my suggestion. My supervisor sat there and denied saying that to me.

    I dont even know how to feel. But it isnt good. I was looking out for the patient! It seems to me that I was sacrificed to answer the "rumor" ? Any other takes?
    1.the discharge planner/social worker at the hospital was not doing their job, they should have considered hospice at one of the choices for this patient
    2. Sound like a good opportunity for hospice to do some much needed education in this community regarding not only hospice but the LTC facility nurses (AND administrator) need to know the correct information about morphine and symptom control.
    3. YOU sound like you care for your patients,YOU should pershaps look into a career in hospice

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