Race Mom, ADN 13,945 Views
Joined: Jul 2, '05;
Posts: 812 (10% Liked)
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8 year(s) of experience
NICU/L&D, Hospice, and back to Mom/baby!
I just submitted everything yesterday and hope to start July 1st. I still am debating RN-BSN vs. RN-MSN. I have a few friends that have done the BSN-MSN through WGU and now they are both going through an FNP program, online, through another school.
Also, the MD has to sign an order to obtain a kit. The first incident I would have revoked and sought out another hospice plain and simple. And yes, the kit is in your home, it is actually your possession per new laws. We cannot even dispose of them anymore legally at time of death because it technically belongs to the patient and family. Everything that happened to you is everything that is wrong with certain types of hospice agencies trying to profit from this hard and terrible time for patients and families.
Thank you everyone for your loving words. It was hard enough to be losing my sweet, young sister, but couple that with advocating. You will never question yourself more in your life. Her death will pain me forever.
I would have revoked if I had a choice. (I was her MPOA) Unfortunately, they were the only hospice in the county. The ONLY one. So, the night she had a seizure, besides no answer at the hospice number, and no way to leave a message, by the time we got ahold of someone (continued to try to call them), the nurse was in a town that is over an hour away and was with another pt. This is a non-profit hospice. I do plan on filing a complaint. I just need to get through some grief first so that my letter is professional instead of fueled by emotions. I am guessing the spouse will get the survey, so this may not help. He is aware of the issues, but as a non-medical person, he wasn't aware of what was going on because he didn't know any better. If I lived in Florida, I would really be thinking about opening a hospice in this community.
No, no puppies This was for my sister who went on hospice. She had some incontinence at one point, when they had her overmedicated. I asked for some chux and was denied. They told me they didn't provide them, but were very happy to tell me where I could buy them. Funny twist from what you said about the puppy. They had some of those pads at home and we decided we would just use those if we needed to. Pretty sad.
Two days before she passed, she had a seizure (only time she ever did). At that point, she transitioned to active dying. When we got her into bed, after calling hospice (which took multiple tries...getting voicemail but it didn't allow you to leave a message) I made the quick decision to open the kit. Her seizure was at 3am and it was about 6 am before the OC nurse arrived. He said "who opened this kit?" I told him I did (although I didn't use anything, just got it ready and looked to see was in there). He said "well, I don't know if there could be any legal ramifications for you since there isn't an order for those meds." I told him I didn't care. I couldn't get ahold of them and she was non-responsive. He was a really nice RN, but that just hit me weird. Then next night, when she was in a large pain crisis, I called the oncall (this is after her CM wouldn't come and open her kit). I asked her, when she called before making the visit), if I had permission to open the kit. I was told no. It took over 3 hours for them to arrive. So, while waiting the 3 hours, I opened the kit. If they weren't going to take care of their hospice patient, I certainly was. I pulled out enough morphine for 3 doses, giving her one, and fridging the other syringes. Taped the box back up, and put it in the fridge. I made this decision after I was told the OC nurse was in a town 1.5 hours away and wasn't done with that visit yet. So unacceptable.
I really did see my sister's death as being something more peaceful and spiritual, but it was the opposite. I will struggle with this for a long time, I'm sure. This went against everything hospice was supposed to be.
Sorry for the confusing way I typed this. As you can tell I was a little angry. I have been a hospice RNCM and have worked for two really good hospices. Unfortunately, my young sister went on hospice (in another state) and this is the story of her death. No one would open the dang kit! I was so mad! It would take 3-5 hours to get the oncall RN there for a crisis at nighttime. Her CM refused to come over and open the crisis kit when I called and asked her to please come and do this. Her response was to crush what can be crushed and give her MsContin rectally (they don't supply gloves or lube, even though they supplied suppositories PRN).
So, in a nutshell, my intent was to ask if any of these situations were ok and I was just being out of line by requesting them. The whole hospice experience for my sister's death was a horror story. (They wrote on FMLA paperwork that her hospice dx was brain cancer, and CM verified it with me when I questioned it, only to tell me a week later she didn't have it but offered not one glimpse of an apology for what that did to our family. She discussed her "next pt visit" with the SW while sitting at our table during the visit, mentioning how difficult the pt was.) There is SO much more that is even worse than these examples, but I'm not going to mention all of it, cause it would just be a rant. Thanks for your reply. It is greatly appreciated
When I was an L&D nurse, I would always advocate for my pt. Docs would come in and want to AROM the pt and up the Pitocin. The pt would just nod in agreement. When the doc would leave, I would tell my pt "you don't have to have your water broken. You can let this go more natural. All you have to do is tell the doc that you want to wait for interventions." The pts always expressed gratitude but allowed the doc to AROM them. Nurses need to really be strong and not worry about what the doc thinks. I always advocated for my pts. After that, it was their decision. Of course, this means that I have gone head to head with a few docs. I don't care if they don't like me. I have seen too many poor outcomes from wanting to deliver in the 9-5 world.
So, if you have a pt that is within 1-2 days of end of life, has thrush causing difficulty swallowing, when do you change meds to liquid vs crushed? What would keep you from opening the comfort kit at EOL? Is it ok to give pt the [COLOR=#444444]Hyoscyamine[/COLOR] from the comfort kit, even though it "causes urinary retention"? If a family member calls you on a Friday at 1630 with c/o pt having pain crisis and family requests visit to utilize EOL kit, is it ever ok to say no and direct family to continue to crush all meds or give them rectally vs visit to open comfort kit for liquid meds and not visit? Yes, your guess is correct, this happened. It makes you want to open your own hospice in that town.
I used to be a hospice CM. I asked our hospice RN CM (for our family member on hospice) for a pack of chux pads and she told me they don't supply them but I could go to the store and buy some, same with briefs. I was always under the impression that hospice covered these supplies so I became pretty confused by her answer.
Pt has private insurance. Is hospice required to provide incontinence supplies for a pt on hospice with need for incontinence supplies (chux, etc). No other dx other than what pt is on hospice for. Young pt with no previous need for incontinence supplies.
I am having trouble finding any hospice care (home visits) in Englewood, FL. Tidewell seems to be the only one. Anyone in this sunny state know of anyone else?
My mother-in-law died from a brainstem glioblasoma multiforme. She was on hospice for almost 3 days. She taught me how to be a hospice nurse. I was an L&D nurse at the time, but quickly educated myself on hospice (it was a weekend admission and not very much support for us, unfortunately). She never lost her wit, or her mental ability. She just faded quickly that last week. Her last day was spent with her eyes closed (she said the day before that the earth was spinning and it made her nauseous so she kept her eyes closed). I had a true heart-to-heart with her, about 2 hours of me talking and crying and laughing and forgiving and telling her we would all be ok. At that moment, she transitioned. She began Cheyne-stokes breathing. She was also having the "death rattle". It was so unforgiving and difficult to listen to. She blessed me with teaching me "textbook dying". I was grateful to have researched what to expect. It really taught me how to educate my families. Perhaps this family was witnessing "death rattle" and Cheyne-stokes breathing. It is a normal process that is believed to cause no distress to the patient. God bless
I work at St. Luke's and it is a really nice hospital to work for. They are very supportive of new grads!
Visiting the newborn in L&D, as the nursery nurse, I was happy to comply with the family's request of waiting 2 hours from birth for bonding. I arrived a few minutes prior to 2 hours (parents were accepting of vitK but not erythromycin) to give the VitK in our standard 2 hour time frame, as well as newborn assessment/Ballard/etc. I had prepped the VitK, ready to give, and the doula walked in between me and the infant (on the warmer) and coo'd over the infant for at least 2 mintues while I stood there with an exposed needle. The warmer is in a confined area in the room, so I could only feel that it was intentional. The rest of the family did the same thing repeatedly during my assessment. I was hoping to get it all done quickly so they could continue with the bonding, but my assessment ended up taking about 45 minutes with all the "stand in front of the RN while she is working". It was frustrating. In the end, the family thanked me for not taking the baby off the breast and allowing for bonding. No harm, no foul, but my interest is that the baby is transitioning well and I need to assess that. That is what we do in a hospital environment. The baby is just as important as the mother.
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