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SuesquatchRN 56,033 Views

Joined: Jan 26, '06; Posts: 13,193 (46% Liked) ; Likes: 17,904
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  • Jun 10 '15

    Quote from RubyS
    I would be considered a case manager, no I do not job share; on the days I am off, the "on call" nurse covers my patients. Team meetings are included but are infrequent I'm told. I'm only going to see those 8 during my 20 hours but also am required to take call 6pm-2am every other week in addition to my 20 hours a week.
    Interdisciplinary team meetings must occur at least every 14 days and the RN Case Manager must be present to discuss the ongoing POC for the patient. That is a requirement for all hospices, a Condition of Participation.

    At minimum you should anticipate spending at least 8 hours per week simply engaged with your patients in their environment of care...providing the nursing assessment, teaching, intervention, and documentation (avg 1 hour visit/pt/week unless they are experiencing symptoms requiring intervention). That 20 hours will include any travel time to and from patient homes.

    You have to follow up on every patient who has c/o pain after hours that was addressed by the on call team. Ideally, the RN CM follows up next day with ANY patient on his/her team who accessed the oncall staff in the previous 24 hours to make certain that there is an adequate POC in place to meet their needs during the coming nights and days.

    Additionally, as the RN Case Manager you will be responsible for updating the POC and generating all documentation needed for the IDT meeting and all follow up that is required AFTER the meeting (there are generally new medical orders, etc for at least some patients). Dependent upon how you are documenting, this pre IDT prep often takes at least 15-30 min/patient dependent upon their physical and emotional status.

    So if you work your 8 hours and then start call at 6 pm, what happens if you are out and about the entire 6 lhours of your call shift and then have to work the next day? Are you compensated for your oncall time? Are you paid OT if working more than 8hrs/day or only if more than 40hrs/week?

    Hospice is a very rewarding field of nursing.

    Take the time to learn about professional boundaries and how they are critical to successful hospice nursing, please. Good luck!

  • Sep 28 '14

    Quote from Pangea Reunited
    Babies soil themselves and need help eating, too. I definitely think there's room for improvement in end of life care, but confused, incontinent people who need help eating can still have pleasurable lives if they're well taken care of.

    Yeah, I can just think of how "pleasurable" it could be to be confused, incontinent, incapable of performing even the most basic ADLs independently.

    ​Languishing in a nursing home is not my idea of a good life.

  • Sep 28 '14

    I'm totally in favor of voluntary active euthanasia. I mean, we consider in inhumane to let pets/farm animals suffer at the end of life when it can be painlessly and peacefully put out of its misery. Don't humans deserve at least as much compassion as our animals. I firmly believe any healthcare provider who is against euthanasia either has never cared for a terminally ill pt or has no heart. All of us know how agonizing it can be just to watch much less experience.

    That being said, I think their needs to be safeguards on euthanasia to prevent abuse. I fully support the Dutch model which requires than only a pt can request VAE, pt must request on more than on occasion, must be terminally ill, 2 physicians verifying dx., totally informed consent of alternatives (palliative care, tx options for condition).

    It's about much more than pain. End of life symptoms often include dsypnea (for pathology, meds, or both), dehydration and nutritional problems, incontinence, immobility, depression and anxiety, delirium and/or hallucinations. Sure these symptoms can be managed by good palliative care but why force someone to endure IVs, tube feedings, inconvenience, bed bound, endless meds, and mental anguish when it's totally unnecessary. I'm all for high quality palliative care but I'm also for options in end of life care.

  • Dec 5 '13

    Thank you for your advice! I am on the job hunt and trying to stay focused on the positives of hospice while I do it! I really do feel like I'm out there all by myself with no backup. And I agree, it's definitely a job that needs support and teamwork. It boggles my mind. There's so much more to this story than I can convey...two years worth of it. I wouldn't be the first person to leave this company because of the inept administration and rules that only apply to certain people at certain times. It's sad that I may have to leave a job I love d/t politics.

  • Nov 29 '13

    Quote from Asystole RN
    This has to be the only profession where being more educated is looked down upon.

    Hard to keep well educated people as submissive little servants. I can see the hospital not wanting to provide tuition reimbursement for diploma mills. They should set standards on the schools they'll pay for, then.

  • Nov 29 '13

    Quote from BrandonLPN
    I think it's a little naive to say that four year degrees in the likes of journalism, fashion design, philosophy, etc. are never a waste. Of course they can be a waste. They can be a huge waste of time and money. For the vast majority of grads, these degrees do not result in gainful employment. How can that not be a waste?

    Who are these people investing in four-year degrees simply to "broaden their horizons" or "find themselves"? Trust-fund babies? Not everyone is independently wealthy. For the average Joe a bachelors in most liberal arts studies will make him the most well-rounded fry-cook in a paper hat.

    A BSN from an online diploma mill will result in better job opportunities than a four-year journalism degree from a respected university. I'm not saying that's right or nice or pretty, but it's true.

    This touched a raw spot for me. I have a degree in art. It was NOT a waste of time. I love art. Just because I don't have a career in it anymore does not make it worthless OR anyone else's business. I do not have any type of gainful employment in any art field. SO WHAT?

    I am also looking into getting a business degree. Why? Because I want to understand business and don't. I learn better with a structured curriculum than I do on my own.

    I am not a trust fund baby. I am actually trailer trash and the first in my family to graduate college. I work for each degree I get and I am still paying for the first one.

    I have a diploma now, but I want a BSN. I may go as far as MSN, because I like to expand my practice and learn new things. I just like to learn. I don't understand why that is a big deal.

    If other people want to remain ignorant, good for them. Just don't be the crab in the bucket that pulls down people like me that realized ignorance isn't bliss, it sucks.

    PS - If I want to be a fry cook, why does that make me less because I will be an educated fry cook? What if I just like to read philosophy over french fries?

  • Nov 29 '13

    Education for education's sake is a virtue I would hope to see in any clinician.

    Quote from Esme12
    I liked it when I had a boss who got promoted because she was excellent at the bedside
    Nursing has a reputation for extremely poor managers. I think it is because people are selected for management because of their bedside ability, not their management abilities.

    I've seen too many managers who don't know the first thing about how to be a manager but were promoted because they were good at their subordinate's job. These people make good instructors and clinical resources. The ability to manage people is a very different set of abilities. It is nice when a good manager also knows their subordinates jobs to the point of being fully competent to wade back into it. It is not a requirement.

  • Nov 29 '13

    I think the assessment that quality education is a "waste" if it doesn't lead to some income producing work-a-day job is the saddest thing i have ever read. A "job" is not the purpose of education. Pursuit of knowledge and understanding is the primary purpose of education. Career potential is merely a secondary consideration. Education is about coming to understand ones-self and the human condition, so as to improve circumstances for all. That is it. It has nothing whatever to do with a paycheck. What a sad way to think about it, and with that mindset, it is no wonder so many people never get very far.

    "I must study politics and war, that our sons may have liberty to study
    mathematics and philosophy. Our sons ought to study mathematics and
    philosophy, geography, natural history and naval architecture,
    navigation, commerce and agriculture in order to give their children
    a right to study painting, poetry, music, architecture, statuary,
    tapestry and porcelain." -
    John Adams

    The study of the classics humanities and the arts is the single most important undertaking of any student. No learning is more critical than gaining an understanding of human history, the human heart and the human mind. This is best done through literature and the arts. The most interesting and successful people will always be those that have the best liberal arts education guiding their philosophy. Getting a vo-tech certificate just to get a job is one thing, it will help make a living. It will not help one make an impact on their culture or community. Aim higher people. Life is not about just getting by. What a sad view of one's potential and frankly, a waste of a whole lifetime, if you ask me.

  • Nov 29 '13

    Quote from Asystole RN
    This has to be the only profession where being more educated is looked down upon.
    Don't want those women to start thinking for them selves, or too well of themselves, you know. Just shut up and empty those bedpans, and don't worry your pretty little head about running the place.

  • Nov 29 '13

    I have a Masters because I wanted to get a masters. Didn't and don't want to leave the bedside, but I fail to see how being better educated hurts my practice!

    I'm with llg , diploma mill degrees aren't worth the paper they're printed on, but that doesn't mean the majority of us who studied are ignorant as well.

    And, I learned a heck of a lot about the politics of nursing, and those who think to control our profession. If we don't pay attention to the legislation and the criteria used in accreditation, etc., we are no more than factory line worker bees. Our scope of practice is under attack, by use of "trained" but not "educated" techs and assistants. Yes, anyone can learn to put in a Foley or access a central line, with good technique; but have they learned the anatomy, the potential problems, the assessments that go along with it? Nursing is not tasking, it is thinking, while providing care.

  • Nov 28 '13

    I went back to school for my BSN because I wanted it, for myself. I am going back to school for my MSN/MBA because I want it, for myself.

    The end.

  • Nov 28 '13

    Hi sorry! This was my first time posting and I didn't realize there were responses.

    I work in palliative home care and I sent two patients with cancer (2 different occasions) to the palliative tertiary unit in the hospital. They both had abdomen pain that we couldn't manage at home. When they arrived in the hospital, the doctor suspected there was a perforation somewhere (but in the end both chose comfort measures). The doctor felt because it happened twice, I should have better assessment skills to recognize these were emergency situations rather than something less emergent like uncontrolled pain... if that makes sense.

    I did end up asking for help today at palliative rounds to differentiate. Another doctor explained it to me that for an acute abdomen pain, it's a term they use for emergency situations that require surgical intervention (eg- perforated viscus). She said the patients normally describe the pain as something different from their "normal" cancer pain, client does not want to be moved/touched due to pain, the abdomen would be firm, distended and bounces back when you palpate, decreased/no bowel sounds, and it's a rapid change from their baseline (eg within hours).

    In the end, the palliative team said I did the right thing sending them to the hospital and the two cases were complex (isn't that always the case hah) that masked the acute abdomen pain (eg ascites, pain management issues with their "normal" cancer pain, etc).

    Thank you for your help!

  • Nov 28 '13

    What type of electronic charting is your facility using? I may have an idea how that had happened, as some systems can be confusing. I'm sure when you ordered the medications it asked for an order from the physician. Make sure to know that's a red flag if it happens again, as documenting meds by history shouldn't ask for an order. I wouldn't worry about any disciplinary action as it was corrected.

  • Nov 28 '13

    You didn't write an order or a prescription, did you? If not then you're not practicing outside of your scope. It is well within the scope of a nurse to take and document a medication history.

  • Nov 28 '13

    Hi, I have been a nurse since 2008. I wanted to be an L&D nurse, but hospitals stopped hiring right before I graduated. Since then, I have worked in LTC, SNF, Wound Care and now Home Health. I have had anxiety since nursing school, and have been going through a lot of personal issues. I am now so depressed and anxious that I have taken a LOA. I am depressed that I didn't get the job I wanted, although I love nursing and helping people, I don't really like my job. I feel almost paralyzed by the way I feel, heart palpitations, and I cry every day. I feel so let down in so many ways, not just job. I feel like I have had a nervous breakdown. will this affect my chances of ever getting the job I really want? I started taking an antidepressant and anti anxiety (which only last a couple hours). Any advice from anyone? I live in Cali which I know is not the best place to get a nursing job. My husband and I have thought about moving out of state, but I am so mentally out of it right now, there is no way I can muster up the ability to move. I really need help, advice. Has anyone else gone through this and how did you get past it...if you Have?