Having a hard time with hospice

[Anonymous666]

Hi, I've been having a hard time with the hospice care my father-in-law has been receiving the last couple of days.

He's 79 was misdiagnosed with Parkinson's a couple years ago. A few months ago another neuro doc dx'd Him with Lewy Body dementia. He went to hospice, and his daughter stopped his sinemet.

Friday he went to hospice crisis care. We've had some good nurses and some bad nurses. The day shift guy the last couple of days has been a nightmare. He gets 15 mg morphine q 4 scheduled buccal and 15 mg q 1 hr prn. Ativan 0.5 sc q 4 hrs prn.

We have stressed since the beginning please give him everything.... morphine every hour and Ativan every 4. This nurse has been such a dick about it. He got defensive, like he's inconvienced by our presence and our simple request.

Today he decided to turn him and change him just before his shift ended. He was dry. The nurse even stated whoops. He was dry. So my father-in-law goes into a labored breathing pattern. My wife is crying and has to leave the room. This nurse just sits there waiting for 7pm... shift change. I ask him when he last gave the morphine. Ugh, after having to fight him on this the last couple of days... he didn't even answer me properly. Just blabs ********. I asked again and again (this has been a common pattern). He finally answers 6:15. So I'm like he can get some more at 7:15, right?

The night shift nurse finalky shows up. My wife is back at bedside. Mr. crap nurse starts to give report. Night shift nurse immediately asks when did this pt last get morphine? He needs morphine. She was able to tell this just from hearing his respirations. Also, she checks and notices there is not enough morphine left to cover her shift. She makes him order more and has me help her reposition the pt, which sorts him out. This bs nurse tells her he last gave morphine at 6pm. ***** He lied to to me? I can't kick up a fuss and cause drama in front of my wife and her dying dad.

Then! This idiot ... while the patient is gasping .... goes over and tells him good bye I'm leaving.... and wait for it "you need to repent for your sins." I almost punched him. The patient is a research scientist who taught neuro anatomy to med students and a staunch atheist. *****?

Thank god the night shift nurse came in and took care of business. She even asked... morphine every hour? Yes please! And Ativan every 4, please! Her response was, "of course. Whatever is your, the family's, wishes." How ******* sad is it that it's taken that long to get that response, rather than having to fight people to give him his prn morphine a hour. What are you scared of? Dropping his bp? Slowing down his breathing too much? **** you

sorry. I'm kind of worked up and had to step outside. Plus, the day shift nurse as part of his report pointed out the 2 empty beer cans I had drank during the afternoon. Mate, I'm a grown man and can do what I please. I can sit here with a bottle of whiskey if I want (I don't like whiskey. I like beer and I'm gonna drink a couple hanging out with my dying father-in-law. Don't judge me).

Im sorry, but to me it's pretty clear that these hospice companies are nothing but bs milking Medicare for cash while human beings suffer.

I had a 45 year old pt years ago when I worked transplants. He had pulmonary fibrosis 2ndary to taking amioderone as a kid because of a heart defect. He was unable to get a lung transplant and decide to go to "terminal life care." He requested me to be his nurse that night. He was a pharmacist. The order was for a dilaudid drip 2mg q hr. I explained this to him. He understood, hesitated, and then said go for it. I did. He died that morning. What on earth is going on where actual hospice nurses are withholding prn pain meds and why on earth wasn't a damn IV morphine drip started on this guy? We have to drag his death out to make more money? Ugh

Yes, pissed off

[Hsbyard04]

Ugh. I am so sorry you have to deal with that. That nurse sounds like someone who should not be a nurse at all, let alone a hospice nurse...

[pmabraham, BSN, RN]

Hugs. I'm sorry for your experiences.

Please speak with the unit's social worker, unit manager/RN supervisor as well as the charge nurse. You have the right to lodge a complaint. When you lodge a complaint, stick to facts.

Some key facts to point out: Morphine and Ativan timings, letting the morphine available for the patient get so low the next nurse might not have enough for the patient, the nurse goodbye statements to the patient. I would also add in the lack of giving the patient morphine prior to attempting to change the dry patient who didn't need changing.

I'm glad you had good nurses, and not just a bad one as all hospices are different.

Hugs.

[Possum_RN]

Oh, my goodness....I'm SO sorry you had this experience. Thank you for sharing though: I'm a new hospice RN, and hearing about experiences like this is helpful to me. I would DEFFINATELY speak to the manager, and go up the chain as far as I needed to - pmabraham's suggestions on what to focus on are spot on.

It's terrible to me that you've been so soured on Hospice care. I've been so impressed with my employer and the competent, compassionate care I've seen provided...it does not strike me as a cash-grab at all, and I'm very proud of what we do.

Recently, I had a patient whose scheduled Morphine and Ativan were no longer adequately controlling his symptoms. We exhausted his PRN doses too. The nurse who was training me explained that I needed to call the in-house doctor to adjust doses, and I was told "he might seem short if you call him at 3am, but do it anyways....you won't see him actually ANGRY unless he hears you let a patient suffer without advocating for them. Don't ever let that happen".

[Neats, BSN]

So sorry for your father in laws and your family situation.

Not all Hospice nurses are like this and you have the right to let the Hospice company you do not want this nurse in your home taking care of your father in law.

Most Hospice Nurses are a dream of compassion and have a heart that is able to be filled with sorrow and happiness in a way that balances out for comfort.