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tewdles 28,463 Views

Joined: Jul 10, '09; Posts: 4,871 (60% Liked) ; Likes: 8,286

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  • Mar 16

    Don't you have care conferences with this spouse and the care team?

  • Mar 15

    Actually, hospices can reach out to patients if their family requests the information visit.
    If the patient and family are in agreement with hospice, and the criteria for admission is met the hospice professional will then contact the PCP and request a medical referral and orders to admit.

    You also could ask the provider about hospice. You would have a much better idea of how that provider might react to that request. Some docs are not very nice about that sort of thing while others appreciate your input.

    Good luck and thanks for advocating for your patient!

  • Mar 15

    I was told when I moved to Fairbanks that Fairbanksans don't want their community to get too big. So I am supposed to tell everyone that it is too dark, too cold, and there is too much snow so they should stay in the lower 48.

    Other than that, I would highly recommend it. AK is a beautiful state and has lots of opportunity. AK has not been as troubled by the recession as the lower 48 have been. There are no dumb people in AK, they freeze along the road in the winter.

    Okay, that last comment was a bad joke, I will admit...and there is the matter of their recent Governor that would beg argument on the point anyway.

  • Mar 14

    As we practice our profession, we expand and enrich our professional knowledge. For instance, if you are expert in symptoms and their management, you have more information in your brain to inform your already well practiced critical thinking.

    Critical thinking skills should be developed over the lifetime of every human. We see evidence, everyday in our work of people who have poorly developed skills. These skills DO translate many many times into the nursing model. New grads who have more general life experience that demonstrate good critical thought development are more attractive to me as a manager than a new grad with little life experience.

  • Feb 9

    I am dismayed that the nurse who had a legal medical marijuana card was not hired because of it...
    Would that also have been true if the nurse had tested postive for ativan or some other med for which he/she had an RX?
    Like the other medications included on the drug screens, marijuana actually has proven medical benefit for some people in some circumstances, often with fewer side effects than other more "traditional" medications.

    so sad...

  • Feb 1

    Every specialty area has it's own unique set of stressors for nurses.

    The fact that you are only 6 months into this unit is, all by itself, stressful. When we change specialties it takes a minimum of 6 months typically to feel like we are not a danger to our patients. It takes about a year to feel proficient as a nurse in the department.

    Hang in there, stay connected with your peers and preceptors. You will come out good on the other side.

  • Jan 31

    Quote from ws582
    Very curious about something. I'm new to inpatient hospice and have only had 4 deaths so far. Two of the patients had a single tear. One of those patients, the niece saw her previously unresponsive aunt open her eyes wide focusing on something in front of her (not looking at her niece) then took her last few breaths. That's when I arrived I saw her tear. The other nonresponsive patient that passed did not have anyone in the room at the time, so I don't know if he opened his eyes or not, but did have the same single tear. Is this common, and do you think they are seeing something so beautiful it causes a tear, or do you think it's caused by fear/pain? Thank you in advance for your responses.
    I don't have any idea why they might have a tear...

    If I have done my job well, then I suspect that they are not in pain (spiritual, emotional, or physical) otherwise I would be expecting other evidence of the discomfort. We cannot know with certainty what our patients are experiencing at the end. We only know what our science, our faith, and our experience tells us.

    In my opinion, we should hold tight to the perceptions and beliefs that give us hope and strength. My mom opened her eyes as she took her last breaths, and she too had a tear in her eye.

  • Jan 29

    Jess, you cannot let your own grief and struggle with the horrors of cancer to cloud your perception of what cancer victims are experiencing.

    As a cancer survivor I can tell you that much of the experience is like a battle. We fight to remain positive even when we feel like crap. We fight to have the energy to go to our 8 year olds birthday party, to go to the high school play for our daughters, and to give our parents, siblings, spouses hope when we feel that our only hope may be for the healing power of heaven. We fight the nausea and the pain and the sleeplessness. We fight the depression and the fear.

    And many of us survive...not enough, but many.

    As for would be unfair to narrow the success to only survival...there is the concept of fighting for a normalized, fulfilled life while dealing with cancer. Thus, there will be winners of that fight even though they do not survive the disease.

    Good luck.

  • Jan 22

    Quote from MichelleRN34
    I lost my license for over a year for smoking one joint....3 weeks later i had a drug test.....ruined my life for a while....i will never agian partake in any illegal drugs..
    And this is just plain wrong...wrong on so many levels it is crazy.

  • Nov 25 '17

    I am dismayed that the nurse who had a legal medical marijuana card was not hired because of it...
    Would that also have been true if the nurse had tested postive for ativan or some other med for which he/she had an RX?
    Like the other medications included on the drug screens, marijuana actually has proven medical benefit for some people in some circumstances, often with fewer side effects than other more "traditional" medications.

    so sad...

  • Aug 19 '17

    You comfort atheists they way they want and need to be comforted. It is individual for each dying person while we are using the basic elements of listening and hearing the person.

    We don't treat atheists any differently than we treat any other type of person. It ALL hinges on them, their needs, their lives, etc.

    So...if they need me to leave them alone, I leave them alone. If they need me to hold their hand, I hold their hand. ETC, ETC, ETC. It really can be just that simple.

  • Jul 28 '17

    Quote from Vishwamitr
    Hi Suzie,
    Regardless of the fact if I am a Christian or not, I think that this is not the most appropriate forum to extend your personal belief. I just wish that people would not be so fanatic about their faith that they lose all sense of appropriateness and push their agenda for proselytizing in a nursing forum.
    Perhaps this is a good thread for you to avoid then...

  • Jul 8 '17

    When families are requesting unreasonable nursing visits because they are not able to complete the daily and ongoing care we are VERY direct about the need for either other in-home caregivers or placement in a facility. We will arrange an urgent respite, if necessary, to give them a few days to make appropriate arrangements. Most hospices CANNOT afford to set dangerous precedents of daily nursing visits simply to reassure the family...there are other, less expensive, and possibly more effective ways to provide that support. I certainly am aware that we have the occasional VIP patient for whom the agency execs may want that sort of attention. However, those are the very people who can generally afford addtional supportive care and we do not hesitate to be very clear about our role and availability.

    I don't intend to sound "hard nosed" but if you allow a few demanding people to misuse the professional staff in terms of frequency of visits it has the potential to create dangerous staffing patterns for the other patients on service...and THAT is not acceptable.

  • Jul 3 '17

    It is ALWAYS difficult when a team member drops a ball...lots of splainin and butt kissing to do after that while working to get the pt back into a state of well-being.

    Perhaps a meeting between field and admission teams to discover how your processes might be tweaked or what additional safe-guards could be put in place to better support one another and insure that patients have what they need?

  • Jun 17 '17

    Quote from CJsGirlRN
    After working in Med surg for 4 years on two very difficult units, I have been offered a job as a home hospice nurse. No more working every other weekend, no more working holidays. On call requires only 2 days a month. And i'm hoping for once i will be in a position where my nursing skills will be much more appreciated. I am so excited to be working with families to help them through their difficult times and to make the patient comfortable in their last days of their life. I am a little nervous, but excited at the same time, for a big change. Any advice to a new hospice nurse out there? Any good tips that you wish someone had told you when you started? Thanks!
    Welcome to Hospice! This is what I wish someone had told me...

    Be aware that all hospices are not nice places to work, so pay close attention to the management style and agenda in your new work place. If this employer does not acknowledge or honor good and reasonable personal/professional boundaries set by their professional staff - begin to look for another job immediately. If the tone of the work place is not upbeat and positive, begin to look. Lots of hospices are hiring so you do not have to work in an unhappy or abusive environment. Hospice is a very emotionally demanding job and your employer should not add to the burden recklessly.

    As many posters have stated previously...on call expectations can vary wildly and can be vastly different from the pitch one may get during the interview/hiring phase. On call can be a huge issue for full time case managers. If "excessive" it is exhausting at best and dangerous at worst. You will hear of case nurses who work 50 hours/wk managing large case loads and also provide as many as 150 hr/mo of on call coverage (mandated). If your management team seems disinterested or insensitive to how on call adversely affects the staff (you), I would suggest you be very cautious. Self care is very important in hospice and self care is difficult when you are overworked and exhausted.

    I imagine that you possess some reasonably fierce bedside the technical skill part of field case management should present no significant challenge. We do see some pretty complicated wounds, drains and tubes of all sorts...the obvious things like foley's and ports. Your technical skills will be appreciated by your team. Many hospice nurses I have known over the years are not comfortable with intravenous skills...not starting, not drawing, not infusing...IV therapy has a very small role in hospice care overall. So your comfort/skill with that will be helpful. The challenge for you will be learning bag technique and developing your own style of working effectively and efficiently in the living space of other people. Mostly it requires a learned and stubborn foundation in fundamental skills of asepsis, etc with a huge dose of creative flexibility.

    Focus on the nursing process...what can you do for these people, as a nurse, that can help them along this pathway. Remember that you have a team. While you can offer guidance and prayer you do not have to be the chaplain or the social fact, you shouldn't be.

    Embrace the notion of "point of service" documentation is NOT going to go away.

    I hope you love Hospice, I is rewarding work in so many ways. Good luck.

    If you