New hospice nurse with questions

Kerber · Sep 20, 2014

We were both told when we hired 7 days on 7 days off by HR but the administer lady said no that is meant 7 days of on call and 7 days off call. So we both work durning week with total 7 patients we split them and take turns being on call for 7 days. This is my week off and my weekend off. I have made plans to go to church and help with our festival also my son comes home on leave from army this weekend and then goes Korea. So I get a call today Saturday I am off from the other hospice nurse asking me to do some hours on a patient today or sun for continuous care. I told her I couldn't because of church and my son. Was I wrong? I feel a bit guilty now.

lifelearningrn, BSN, RN · Sep 21, 2014

No, you were not wrong. You need to set boundaries now, or they will take full advantage of you. This was your weekend off and you had plans. Don't feel guilty.

toomuchbaloney · Sep 23, 2014

They hired another hospice nurse we take turns each week to be on call this week I am off call next week mon-sun iam on call does that seem right? We only have 7 hospice patients and 2 RN

I am fairly dismayed that your nursing director/manager does not participate in the oncall schedule for the small agency. Is that nurse too special or important to work as an RN?

toomuchbaloney · Sep 23, 2014

We were both told when we hired 7 days on 7 days off by HR but the administer lady said no that is meant 7 days of on call and 7 days off call. So we both work durning week with total 7 patients we split them and take turns being on call for 7 days. This is my week off and my weekend off. I have made plans to go to church and help with our festival also my son comes home on leave from army this weekend and then goes Korea. So I get a call today Saturday I am off from the other hospice nurse asking me to do some hours on a patient today or sun for continuous care. I told her I couldn't because of church and my son. Was I wrong? I feel a bit guilty now.

You are not wrong and you should not feel guilty.

You do not own and are not responsible for the day to day operation of this agency.

An agency that size has no business actually trying to provide continuous care without the assistance of more professional staff. Again, where is the nursing leadership?

Kerber · Sep 23, 2014

Like I said there are just two of us field RN we are both new! Just got clinical supervisor but no hospice director yet. I heard people quit so the administer is running hospice. there wasn't much of orientation I was pretty much threw in and learned that way

westieluv · Sep 24, 2014

Khaley, I give you credit for sticking it out. To have to go out in the field into patients' homes with little orientation and no hospice background must feel overwhelming at times. If you find that hospice nursing is your thing, then I sincerely hope that either your company hires more staff and starts treating you better or that you are able to move on to a more professional, better run hospice company.

Do not ever feel guilty about not picking up someone else's shifts, even if it's on call only. You work hard and you need your time off. That's OFF, as in not doing visits and not taking call. You will burn out quickly in hospice if you never have days where you have no obligation to your employer and can do whatever you want or need to do. Take care of yourself and you will be able to give better care to your patients. Everyone needs a break now and then. If your company is short staffed, it is NOT your problem, and it is not your duty to fill every hole in the schedule. That's what they pay management for.

Best of everything to you. You sound like a caring and conscientious nurse!

Kerber · Sep 24, 2014

Thanks! I really enjoy it I am still learning my way. I am not quite understanding the meds though. When I sign someone up hospice pays for certain meds that are related to Terminal Dx. Now will Medicare pay for other meds such as if they are on cholesterol or b/p meds or even vitamins ?

toomuchbaloney · Sep 24, 2014

Thanks! I really enjoy it I am still learning my way. I am not quite understanding the meds though. When I sign someone up hospice pays for certain meds that are related to Terminal Dx. Now will Medicare pay for other meds such as if they are on cholesterol or b/p meds or even vitamins ?

maybe

if they are on hospice is there a need to be on a "cholesterol med"?

same with oral vitamins...what is the short term benefit of those huge pills? (remember that hospice length of stay is less than 6 months so goals are generally very short term).

In many cases, patients benefit from a dramatic simplification of their medication POC with the focus directly on quality of life and comfort.

chopwood carrywater · Sep 25, 2014

We always try to d/c statins and vitamins.

Think more along the lines of insulins, existing psych meds if they are still effective, also certain respiratory meds to name a few.

Kerber · Sep 25, 2014

So I should focus more on disease meds and comfort meds. What about blood pressure and cholesterol meds and there not related to disease?

toomuchbaloney · Sep 25, 2014

So I should focus more on disease meds and comfort meds. What about blood pressure and cholesterol meds and there not related to disease?

In the short term BP meds can help to keep the patient comfortable, same with insulins or meds for COPD, etc.

Medications designed to prevent something over a longer period of time are not so important to the end of life medication plans.

If the goal of the medication is not promoting comfort or quality of life it is fair to question if the patient desires to continue it's use.

Kerber · Sep 25, 2014

Thanks I still have a lot to learn but I will get it!