Hospice RNs, what is your typical routine at a facility?

[pizzaanddisney]

RNCMs - I am curious what your routine looks like when you go into a facility, whether ALF or SNF. I'm a six month old hospice nurse and struggling with many different ethical and procedural issues with some facilities and it's making me question many things. My company has been around for awhile but is a bit of a mess administratively, so I'm wondering if what I was trained to do is even correct. I'd love input on what you're doing at these places. Thanks for any help

[nutella, MSN, RN]

I am working in a hospital right now but this is how I did my work in facilities as hospice CM:

Arrive, sign in, find pat unit, talk to nurse, review of chart to look for new orders or other documentation, review bowel book, review narcotic book. See pat with pat assessment, talk to HCP if needed, talk to nurse again about my visit, write recommendations, sign out when done.

I had to print out IDT and note and place the printout into the chart regularly.

In ALF I also called the family / HCP and usually had some kind of communication book.

The most important thing is to remember that you are a guest. Treat all the nurses and CNAs with respect, often the nurses who medicate are LPN - collaborate in all regards, be pleasant, don't be "know-it-all" or think your way is the only right one....

Also, SNF doctors sometimes take some while to get back when you write a recommendation.

I always carefully listened and also ask how things are going with the hospice aid.

[HazelnutCream]

We have specific protocol sheets developed for each facility, telling us who to talk to/report to, how to document (some require their own specific forms), and anything else important (any codes needed to get in the building, for example).

Definitely check in with the appropriate person (usually floor nurse in a SNF, RCD in an ALF) at beginning and end of your visit, see your patient, coordinate care with whoever needed (MD for orders, update family or IDG team), and make sure the facility has whatever documentation, supplies, and scripts they need.