confusion re: hospice care

lisa_22 · Oct 8, 2005

These are not good nurses.....why would you even question it? You sound like you are.......:)

Katillac, RN · Oct 9, 2005

Nurse for 23 years I always regarded hospice nurses as angels but lately my views are getting disappointed...Lately our facility has been using this form of care alot...is just old age a terminal disease? One nurse came on my shift for 8 hrs. when asked what she would be doing she said just to monitor resident's breathing!!!!(she was dying!!) doesn't comfort measures include at least change of positioning? sips of ice chips? talking reading etc? No this Rn. talked on her cell phone most of time, applied makeup in resident's bathroom and watched her favorite sitcoms on tv !!! This was crazy!! Another nurse different resident charted foot massages on a resident with necrotic and big sores on both feet bandaged which changing dsds caused such pain we medicated him with morphine prior to dsd changes!!! Whats going on I'm not viewing these nurses as angels anymore!!!

No, old age isn't a terminal disease, nor is TMBD (Too Many Birth Days) a hospice diagnosis. But debility is. Latest figures suggest that up to 10% of a LTC's residents may be hospice appropriate, which is why you may see more hospice patients.

And hospice nurses aren't necessarily angels any more than med/surg, L&D or any other nursing specialty. You'll find good and bad practitioners in every arena.

Should you run into this kind of situation again, you might ask her, as the case manager and end of life specialist, what comfort measures she thought would be appropriate for her patient. Take what she says, add the ones she doesn't list, and ask sweetly, "So that we have good continuity of care I need to be clear about which of these tasks will you be performing and which ones I'll need to plan to do." After all, it's supposed to be a collaboration.

If that doesn't do it, you could ask your DON to contact the hospice's Director of Patient Services and ask for clarification of what the hospice nurse's role is in the situation. Sure beats questioning your views on what all hospice nurses are based on the behavior of two.

As to the charting on the foot massage, well, there's lots of ways to approach that. But posting here probably won't be effective.

aimeee, BSN, RN · Oct 9, 2005

One nurse came on my shift for 8 hrs. when asked what she would be doing she said just to monitor resident's breathing!!!!(she was dying!!) doesn't comfort measures include at least change of positioning? sips of ice chips? talking reading etc? No this Rn. talked on her cell phone most of time, applied makeup in resident's bathroom and watched her favorite sitcoms on tv !!!

You need to report this behavior back to the hospice. Supervisors have no way of knowing that nurses act this way out in the field if they don't receive feedback.

Another nurse different resident charted foot massages on a resident with necrotic and big sores on both feet bandaged which changing dsds caused such pain we medicated him with morphine prior to dsd changes!!!

Again, you have to speak with the supervisor at the hospice. I'm not sure if you are implying falsified charting or inappropriate intervention here, but either way, the hospice needs to know about it so they can address the issue.

Sudden increase in the number of hospice patients at your facility? Is this the same hospice you have always been served by...or is it a new group? It sounds like the pattern you might see when an aggressive for-profit moves in.

You need to let your supervisors at your own facility know about the poor quality care being provided to your residents by this hospice as well. Your administrators determine who the hospice contracts go to and if this group is wining and dining them and making lots of promises but not delivering on with quality care, they need to know it!

RnRatchet · Oct 9, 2005

Sudden increase in the number of hospice patients at your facility? Is this the same hospice you have always been served by...or is it a new group? It sounds like the pattern you might see when an aggressive for-profit moves in.

:nono:

That's what I was thinking!

I work for a non for profit hospice and we are constantly trying to fight the "bad rep" some of the for profits are causing in the area. We've even walked in for an appointment with a family at a LTCF and they were trying to take a patient out from underneath us. Unless they were skimming through the charts how did they even know there was a referral??

LOL.. when questioned if they had spoken with the family the nurse said, no.. our nurse said, "Oh well I have an appointment with her." And then up walked the family.. when questioned if she had a preference for hospice care the daughter said, "I chose your hospice, of course!" to our nurse.

I know I've had nurses at the LTCF's in the area complain that some of the for profits are trolling the halls for patients.. just not ethical if you ask me! :stone:

webblarsk · Oct 11, 2005

That's what I was thinking!
I work for a non for profit hospice and we are constantly trying to fight the "bad rep" some of the for profits are causing in the area. We've even walked in for an appointment with a family at a LTCF and they were trying to take a patient out from underneath us. Unless they were skimming through the charts how did they even know there was a referral??
LOL.. when questioned if they had spoken with the family the nurse said, no.. our nurse said, "Oh well I have an appointment with her." And then up walked the family.. when questioned if she had a preference for hospice care the daughter said, "I chose your hospice, of course!" to our nurse.
I know I've had nurses at the LTCF's in the area complain that some of the for profits are trolling the halls for patients.. just not ethical if you ask me! :stone:

I do believe that goes both ways. I have seen non-profit operate the same way. I don't understand why For profit gets such a bad rap? Boy I must live in a glass bubble and be extremely lucky. I work for a for-profit hospice and haven't run into anything like what is being described. In fact I just hired a nurse that worked at the non-profit hospice in our area and described them and giving horrible patient care and cutting costs at every corner. So please don't be so quick to lump all for-profits into one category.

CHPN1680 · Oct 19, 2005

I agree. I work for a for profit and have not experienced the "trolling". I have always been proud that we continue to do the right thing for the patient and family regardless of the cost.

I have heard of less than ethical practices in both non profit and for profit hospices. Sweeping generalizations don't solve the problems, they just create animosity.

aimeee, BSN, RN · Oct 19, 2005

I did not mean to imply that all organizations are alike. What counts is the quality of the care. Each must be judged on its own merits. I am happy that you, Bob and Weblarsk, work for great companies that have their priorities in the right place.

janf_rn · Oct 20, 2005

I work for a major non- profit hospice organization that has a free standing in-patient facitility....have we ever seen the changes!.... Today we admitted a patient that was dependent on BI-PAP for life support! It is becoming a numbers game...who can get there first and who can provide the most life saving treatments; seems to be driven by allot of ECF's and Hospitals that are dumping patients so they won't have the deaths on their stats. All of the nurses are becoming frustrated as we feel we are running an ICU for the terminally ill..... Seems like we are giving more transfusions, more lab work, more sandosatatin to dying patients...where is the comfort in all this?