Latest Likes For Kittypower123

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Kittypower123, ADN, BSN, RN 3,388 Views

Joined Feb 13, '09. Posts: 142 (65% Liked) Likes: 279

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  • Sep 29

    Time management can be difficult. You can plan your week, but it won't turn out that way! One thing I do is front-load my week. I plan to get almost all of my visits done in the first three days of the week. I know it won't happen, but if I plan for 4 visits on Friday, I know I might end up with 8. As I plan my week, I try to cluster visits geographically. I also think about which visits should be pretty straightforward (patient is stable, not much in the way of education needs, etc) and which will likely take more time. I think about which visits can be moved to later in week if something comes up and which can't. Having this information in my mind helps me change plans as I go and still be sure patient needs are being met. I'm constantly reviewing my schedule to check my progress and any changes I've had to make. If I have a CC or GIP patient, I see them first. I know they can take more time and I want get them taken care of. Most of time, if something else comes up with them after the visit, I can handle it by phone. It's tough to get time managed well in hospice, it takes time and practice. Use the frustrations with time management to learn. It will get easier.

    As for documentation, that takes practice too. Remember to document decline. For example, on admission patient ambulated with rolling walker, now confined to wheelchair. Also, you don't need to write a narrative for every system. Focus on what is an issue for that particular patient. For example, if you have a CHF patient, what is their b/p, hr, heart rhythm, do they have edema, is it better/worse/the same, are they on oxygen, are they compliant with meds, what education did they need, etc. For us, the assessment is mostly checking boxes and imputing certain stats like vital signs, last BM, Diet and % eaten, pain rating, that sort of thing. The narrative itself doesn't need to be long, just focus on the reason for the visit or the particular issues for that patient.

  • Sep 26

    Time management can be difficult. You can plan your week, but it won't turn out that way! One thing I do is front-load my week. I plan to get almost all of my visits done in the first three days of the week. I know it won't happen, but if I plan for 4 visits on Friday, I know I might end up with 8. As I plan my week, I try to cluster visits geographically. I also think about which visits should be pretty straightforward (patient is stable, not much in the way of education needs, etc) and which will likely take more time. I think about which visits can be moved to later in week if something comes up and which can't. Having this information in my mind helps me change plans as I go and still be sure patient needs are being met. I'm constantly reviewing my schedule to check my progress and any changes I've had to make. If I have a CC or GIP patient, I see them first. I know they can take more time and I want get them taken care of. Most of time, if something else comes up with them after the visit, I can handle it by phone. It's tough to get time managed well in hospice, it takes time and practice. Use the frustrations with time management to learn. It will get easier.

    As for documentation, that takes practice too. Remember to document decline. For example, on admission patient ambulated with rolling walker, now confined to wheelchair. Also, you don't need to write a narrative for every system. Focus on what is an issue for that particular patient. For example, if you have a CHF patient, what is their b/p, hr, heart rhythm, do they have edema, is it better/worse/the same, are they on oxygen, are they compliant with meds, what education did they need, etc. For us, the assessment is mostly checking boxes and imputing certain stats like vital signs, last BM, Diet and % eaten, pain rating, that sort of thing. The narrative itself doesn't need to be long, just focus on the reason for the visit or the particular issues for that patient.

  • Aug 22

    What is this for? How long is the lesson supposed to be? Who will you be teaching? Can you give more information please?

  • Aug 21

    What is this for? How long is the lesson supposed to be? Who will you be teaching? Can you give more information please?

  • Jun 11

    Quote from Nurselm14
    I'm have found that working by myself such as a hospice case Manager or home care help a with the sensory overload part of it. I am responsible for my work with very little drama from other nurses. The families we work with are over the top sometimes but with some time by myself at the end of the day i did it for almost 6 years.
    Me too. I scored 22 on that little list. As a hospice case manager, I visit patients where they live. I love being able to see one patient at a time, then spend time by myself between visits. Facilities can be a bit on the noisy side, but I don't have to stay there for an entire shift, just long enough to complete the visit(s) I have there. I also make sure to take a lunch break. I eat and read (or something) and don't think about work. When I worked in LTC I quickly learned to leave the building during my break, even though I just sat in my car. It can be challenging for us sensitive folk, but it's doable.

  • Jun 7

    I just want to put this out there - "Normal" is a setting on your washing machine. Everyone is unique. As others have said, there is no stigma with taking medication for diabetes, allergies, hypertension, sleeping disorders or whatever. There shouldn't be with ADD either. Figure out what works, learn to work the way you need to. Just because someone else organizes themselves a certain way doesn't mean you have to. I get teased a bit at work because of how I do things, but I also get compliments for the results. I laugh with my coworkers (it really is all in fun, we get along great) and keep on doing what works for me.

  • Jun 7

    Quote from nutella
    I and my coworkers wonder a lot lately...
    Granted, I work in end-of-life care and there is a lot of symptom management related to terminal illness. There has always been the group of providers who are very hesitant to prescribe narcotics for symptom management pain and would not prescribe liquid morphine to deal with SOB unless the patient decided to be CMO.
    Pain management is not that easy to begin with if a person has more than the standard pain issues or prior substance use. When we see patients who have a prior narcotic history or are already on high doses they may do better with methadone but many prescribers do not have the experience and do not like to deal with it for example. I had a patient basically screaming out in severe pain because of cancer and the patient had a prior tolerance history with taking up to 200 mg of morphine a day. What can I say? methadone fixed the problem but it was an act to get there....
    I do think that providers need to be more educated about prescribing narcotics and also utilize other medications and methods.
    So well said! So much more education on pain control and narcotics is needed, specially in regards to end of life. I run into the Morphine kills, once you start taking Morphine you'll be dead in 2 weeks, type comments. Thankfully, I work with a doctor who is comfortable with Methadone - works wonders for bone and cancer pain too.

    As a side note, I do my own conversion calculations before I talk to the doctor. That way I can say "if we switch to x drug, the equivalent dose would be y." It helps that I work with great doctors.

  • Jun 4

    I just want to put this out there - "Normal" is a setting on your washing machine. Everyone is unique. As others have said, there is no stigma with taking medication for diabetes, allergies, hypertension, sleeping disorders or whatever. There shouldn't be with ADD either. Figure out what works, learn to work the way you need to. Just because someone else organizes themselves a certain way doesn't mean you have to. I get teased a bit at work because of how I do things, but I also get compliments for the results. I laugh with my coworkers (it really is all in fun, we get along great) and keep on doing what works for me.

  • Jun 4

    I just want to put this out there - "Normal" is a setting on your washing machine. Everyone is unique. As others have said, there is no stigma with taking medication for diabetes, allergies, hypertension, sleeping disorders or whatever. There shouldn't be with ADD either. Figure out what works, learn to work the way you need to. Just because someone else organizes themselves a certain way doesn't mean you have to. I get teased a bit at work because of how I do things, but I also get compliments for the results. I laugh with my coworkers (it really is all in fun, we get along great) and keep on doing what works for me.

  • Jun 4

    Quote from nutella
    I and my coworkers wonder a lot lately...
    Granted, I work in end-of-life care and there is a lot of symptom management related to terminal illness. There has always been the group of providers who are very hesitant to prescribe narcotics for symptom management pain and would not prescribe liquid morphine to deal with SOB unless the patient decided to be CMO.
    Pain management is not that easy to begin with if a person has more than the standard pain issues or prior substance use. When we see patients who have a prior narcotic history or are already on high doses they may do better with methadone but many prescribers do not have the experience and do not like to deal with it for example. I had a patient basically screaming out in severe pain because of cancer and the patient had a prior tolerance history with taking up to 200 mg of morphine a day. What can I say? methadone fixed the problem but it was an act to get there....
    I do think that providers need to be more educated about prescribing narcotics and also utilize other medications and methods.
    So well said! So much more education on pain control and narcotics is needed, specially in regards to end of life. I run into the Morphine kills, once you start taking Morphine you'll be dead in 2 weeks, type comments. Thankfully, I work with a doctor who is comfortable with Methadone - works wonders for bone and cancer pain too.

    As a side note, I do my own conversion calculations before I talk to the doctor. That way I can say "if we switch to x drug, the equivalent dose would be y." It helps that I work with great doctors.

  • Jun 4

    Quote from nutella
    I and my coworkers wonder a lot lately...
    Granted, I work in end-of-life care and there is a lot of symptom management related to terminal illness. There has always been the group of providers who are very hesitant to prescribe narcotics for symptom management pain and would not prescribe liquid morphine to deal with SOB unless the patient decided to be CMO.
    Pain management is not that easy to begin with if a person has more than the standard pain issues or prior substance use. When we see patients who have a prior narcotic history or are already on high doses they may do better with methadone but many prescribers do not have the experience and do not like to deal with it for example. I had a patient basically screaming out in severe pain because of cancer and the patient had a prior tolerance history with taking up to 200 mg of morphine a day. What can I say? methadone fixed the problem but it was an act to get there....
    I do think that providers need to be more educated about prescribing narcotics and also utilize other medications and methods.
    So well said! So much more education on pain control and narcotics is needed, specially in regards to end of life. I run into the Morphine kills, once you start taking Morphine you'll be dead in 2 weeks, type comments. Thankfully, I work with a doctor who is comfortable with Methadone - works wonders for bone and cancer pain too.

    As a side note, I do my own conversion calculations before I talk to the doctor. That way I can say "if we switch to x drug, the equivalent dose would be y." It helps that I work with great doctors.

  • Jun 3

    I just want to put this out there - "Normal" is a setting on your washing machine. Everyone is unique. As others have said, there is no stigma with taking medication for diabetes, allergies, hypertension, sleeping disorders or whatever. There shouldn't be with ADD either. Figure out what works, learn to work the way you need to. Just because someone else organizes themselves a certain way doesn't mean you have to. I get teased a bit at work because of how I do things, but I also get compliments for the results. I laugh with my coworkers (it really is all in fun, we get along great) and keep on doing what works for me.

  • Jun 3

    I just want to put this out there - "Normal" is a setting on your washing machine. Everyone is unique. As others have said, there is no stigma with taking medication for diabetes, allergies, hypertension, sleeping disorders or whatever. There shouldn't be with ADD either. Figure out what works, learn to work the way you need to. Just because someone else organizes themselves a certain way doesn't mean you have to. I get teased a bit at work because of how I do things, but I also get compliments for the results. I laugh with my coworkers (it really is all in fun, we get along great) and keep on doing what works for me.

  • May 25

    I work in hospice too and am going to pursue wound certification. If you go the WOCNCB website and look at the eligibility for the exam, it explains that there are two different pathways. Taking a course and successfully completing it make you eligible to sit for the exam (you must apply to take the exam within 5 years of completing the program). The other option is to qualify through experience. This pathway requires 50 CEs for each specialty (wound care, ostomy, and continence) you wish to test for and 1500 direct patient clinical hours within the last five years (at least 375 within the last year). I am opting to take the course. I am only pursing certification in wound care at this time, not ostomy or continence. You can look at the requirements at Eligibility | Wound, Ostomy and Continence Nursing Certification Board. Hope this helps.

  • May 7

    They're all alive and I'm off at 5!


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