Kittypower123, ADN, BSN, RN 3,837 Views
Joined Feb 13, '09.
Posts: 142 (65% Liked)
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.
I was watching The Walking Dead and the town they were in was attacked. Not by zombies, by other people. Anyway, a woman is carried into the clinic with a large slash wound to her abdomen. The lady who was the "doctor" (she was actually a psychiatrist, but at least she'd been to med school, right?) says "She's severed her femoral artery."
What is this for? How long is the lesson supposed to be? Who will you be teaching? Can you give more information please?
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.
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.
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.
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