aimeee 10,152 Views
Joined: May 12, '99;
Posts: 3,488 (2% Liked)
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There's a long list.... strong assessment skills, ability to "connect" with a wide variety of people and yet maintain boundaries, good listening and communication skills, teaching skills, time management and organizational skills, team player, critical thinking skills, ability to prioritize what HAS to happen today and what can wait, ability to leap tall buildings in a single bound... oh, wait, sorry. Got carried away.
Patients should be discharged as soon as it is determined that they are no longer appropriate for hospice and a plan for supporting their needs can be put together. If you wait until the end of a cert period you might not be reimbursed for that care if you are audited. Be careful how you chart during the transitional period. Once you state in your charting that the patient is no longer appropriate, you will be vulnerable for reimbursement should the chart be audited. Better to state that their status is being closely evaluated while weaning them off services to see if their status declines.
There is no specific requirement to gather MAC in the new cops. What the new COPS require is a form for the gathering of data elements to be utilized in your QAPI program. It is up to the individual organization to determine what form will be used, and what data will be gathered on it.
We have some male nurses and age is only a factor as far as it correlates to limited life and professional experience. Each person must be judged on their own merits. Some people have more experience and maturity at 20 than some ever achieve in a lifetime. But the tendency is that the younger nurses haven't had the experiences that bring them to a place where they can deal with the breadth of situations that they encounter and to know that this work is something they really want to stick with. Energy, passion, and a willingness to learn go a long way though.
Yes, there is a core curriculum and a study guide. Your most economical alternative is to purchase a membership in HPNA and then the cost of the test is discounted and so are the study materials. If you go to the HPNA.org website you will find links to all the information you need.
I agree with the above... they should cut out the requirement to be at IDT's. 1 person per 70 is definitely justifiable at full time, especially on the weekend. We have a census of about 200 and have three people covering call. On the weekends we also have a phone triage nurse because the call volume is so high. And although you can't be paid extra for holidays since you are salaried, they should give you some sort of compensation, like an extra day off somewhere else.
Looks great! Very clean, fresh, and easy to read (which is a big plus for those of us who need longer and longer arms every year)
That sounds like a policy that is not patient service driven. In fact, your post shows the unintended effect... the difficulty of obtaining the medication is driving use instead of what would be the best medication for relieving the symptoms. The trouble with CIII's is that you quickly reach the ceiling dose so if your patient is in a pain crisis they are out of luck.
We have standing orders that allow us to titrate the dosage up another 50% if necessary to achieve relief but after that we would have to call the physician to get an increase. If you are doing hospital nursing you will probably not have such liberal titration orders. The principle you are referring to is that of "double effect".
Freedom? That's an interesting word I never would have thought of applying to hospice nursing. Autonomy maybe. It certainly can be stressful, or it can be delightful. It all depends on what comes about. Certainly every day is different as no two admissions are alike. Every patient, every family is unique. I'll tell you what a day is like under our model, but recognize that many hospices use different models for admissions.
The day generally starts with coming to the office and updating the laptop and pulling in information about the days assigned admissions. Usually we do two, but sometimes the plan changes at the last minute as to which ones we will be doing. Lots of times referrals are made at the last minute so there is often shifting of assignments to meet the needs. You learn never to get too mentally attached to any plan for the day.
You head out for the appointment. Spend maybe 20 minutes talking about hospice, showing the patient/family how it will meet their needs, getting papers signed. Then about another hour assessing the patient, making a med list, careplanning and educating the family, ordering equipment, collaborating with other team members etc. Then there is about another hour of charting and phone calls to do getting that all typed out in the computer. If there are medication changes needed to get the person's symptoms under control (and there often are) that can add to the time involved.
If things go smoothly, it will take close to 4 hours all inclusive. If there are a lot of hurdles, it can easily expand to 6. We do A LOT of stuff up front though. Some hospices do less on the admission visit, and may even have a rep who goes in before the nurse and explains about hospice and gets all the consent forms signed. In those situations, the admissions nurses generally do 3 admissions or even 4 in a day.
We cannot exclude patients due to full code status. It doesn't make much sense to be a full code when terminally ill.... but still... some can't bring themselves to sign a DNR. Sometimes it means no one has really educated the family on what running a code really looks like at time of death. It looks so easy on tv... one little jolt with the paddles and the next minute they are sitting up in bed joking with their loved ones again. Usually the family doesn't actually want the code done when it comes down to the last minute, but some do.
It runs the gamut from people who just need a little reassurance or have a question about a medication to a patient that has just decided constipation is an emergency to a family freaking out because they are suddenly confronted with the reality of death. One night there may be no calls, another it may be constant. There is no typical. You will get a sense after a while of who needs a visit right off the bat and who will be fine with a little advice and teaching.
The small numbers may reflect that while few people actually MAKE the choice, they want to be able free to make it. It may reflect that we have deep taboos in our society and makeup about taking our own lives that keep us from doing that even when we have the means and the freedom.
I think it is just another euphamism for dying that is coming more and more into vogue. And like the word dying, it all depends on how you define it. Dying can happen in a day or it can be a lengthy process that takes weeks. We had a discussion about the terms active dying and pre-active dying a while back. If you include the pre-active stage of dying and are utilizing term transitioning instead, it could be a two week window. Its more what's happening than a precise amount of time.
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