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Ginapixi, BSN 5,264 Views

Joined: Dec 28, '07; Posts: 122 (40% Liked) ; Likes: 74
started in L&D ended in Hospice now "retired"
Specialty: 30 year(s) of experience

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  • Dec 22 '14

    There is no way to predict the timing of the decline and death.
    I watched an ESRD patient resume making urine after years of dialysis and spent months on hospice at home. It was very unusual, to say the least, but the patient and family were obviously thrilled.
    Typically the decline and death are quick and symptoms are easily palliated when dialysis is DC'd.

  • Dec 21 '14

    You did everything you could, an unpredictable resident like that could kill a staff member or peer.He belongs in an LTC dementia unit or a dementia care facility.He is not going to be appropriate for AL much longer and I doubt he is appropriate for it now but I bet he has the money,the admin will try to keep him until he is broke.
    Your request is also appropriate,we have moved residents to other floors due to this type of conflict between the charge RN and an elderly male Alzheimer's resident.He grabbed her by the throat and almost picked her up off of the floor-staff were able to intervene before she lost consciousness. It was felt her fear could trigger him further so he was moved,his family was fine with it.

  • Jul 10 '14
  • Jun 24 '14

    Quote from leniz
    I agree, I don't think she'll find anyone to take on the task. I will not considered it anymore. My sister in law stopped me midway through the job description. She said this person is insane, this job is not for you. Moving on! Thank you, for your replied.
    Thank goodness! It sounds like a person with no hospice experience trying to make a profit and not wanting to pay the salary an administrator deserves. The description you gave was for you to run her hospice agency, not a staff RN. Ridiculous. Good luck on your job search!

  • Jun 24 '14

    I agree, I don't think she'll find anyone to take on the task. I will not considered it anymore. My sister in law stopped me midway through the job description. She said this person is insane, this job is not for you. Moving on! Thank you, for your replied.

  • Jun 20 '14

    Sometimes more is less:
    Taking VS q hourly is more about details and less about giving comfort.
    I think that doing all of that vs assessment - especially every hour - interferes with the nurse's and the family's ability to be "present in the moment". Many of us are unfamiliar with how to be be present around someone who is dying, and this gives us a task and having a task gives us some 'distance' from the event, from the person who is dying, from the people who are gathered there. It may also create a barrier to the people who are gathered there to vigil and be with the pt.
    I can be pretty unobtrusive getting a radial pulse, getting resps, and touching BUE and BLE to assess for warm and dry or cold and damp, but putting a bp cuff in and pulling a stethoscope out q hour over a period of 4+ hrs seems a bit much.
    I would attend to symptom mgt and then gently ask if anyone has any questions about what is, or will happen as the person gets closer to death. If needed, I model ways to be be around the dying person.
    I usually start off by explaining the need to try and keep the level of stimulation down (with allowances for cultural differences and traditions), I give them the analogy of the pt being like a young child who's been sick and miserable for several days and has finally gone to sleep; you want to be there and reassure the child that you're in the rm, but then it's times to keep the lights down, the tv off, conversations in the rm should be soft. I recommend that if they are going to talk to the dying person, they should talk with a gentle tone; talk low and slow - take pauses to allow time for the person to process to whatever level of understanding they can. This is generally not a time for asking questions as the ability of the dying person to understand what is being said may create undue stress. I talk and show ways of touching the dying person, I tell them not to stroke or rub too much - that is typically more about our own anxieties - it's an understandable human reaction, but it may not be what's best at this time. And I always make sure to say that these are guidelines, not rules.
    I tell them I only have 2 rules:
    If they are doing something and it's working to make the pt feel better, keep doing it - if it doesn't, stop.
    And, try not to make the nurse cry.

  • Jun 11 '14

    I totally agree that monitoring V/S to get numbers is not important with those who are actively dying (and I do hate that term, like they are riding a bike in laps around the room, but until we come up with a better one-since I don't think CMS will take our southern usage of "fixin' to die".)

    Chart any vitals you can get withOUT causing the pt. or family discomfort or grief, and then just chart what your eyes see, your ears hear, your nose smells, and your hands feel. For example, the BP cuff can cause agitation or pain, and if the last reading you got was 50 over palp....what difference does it make to check it again???

    In all of nursing, but most especially in hospice, the question behind any test or assessment should always be "WHAT are we going to DO with this information?!?" In the OR, a dropping BP means fluids and pressors and maybe blood; in hospice it is just another sign that your patient is getting closer to leaving this world for another.

  • Jun 11 '14

    A good rule of thumb is don't obtain vital signs that you would not act on. You don't need to get a blood pressure on someone who is dying. Maybe a respiratory rate to chart on (document cheyne-stokes or agonal breathing). But you're only treating symptoms, not curing. Document your observations, interactions with the family, interventions, evaluation. Hope that helps.

  • Jun 5 '14

    Just found this site this morning, so this is my first entry. Have been in the Denver Metro area x 25 yrs, and doing hospice for 20. There are a couple of large hospices that handle a lot of patients, such as Denver Hospice and Hospice of St. John, (both non-profit) and VistaCare and Centura Hospice (for profit). I usually have had more support from the smaller hospices, but better training and education opps from the larger hospices. The biggest risk in a small hospice (less than 50 patients or so) is variation in census causing either cut hours or too little coverage when the census grows or someone is out for vacation or illness. I'd suggest you ask to accompany a nurse on routine visits and ask about his/her day and feelings about the organization. There are some hospices that seem to be in it for the money only, and they are all about the numbers. IMHO, they tend to be the ones that did not begin as hospice, but started as either a home care agency or long term care facility, and branched into hospice. I think hospice has to begin in one's heart, not in the boardroom. Anyway, best of luck to you. We can always use a good nurse here, and it is a fairly small community.

  • May 26 '14

    And just to clarify, I'm not trying to be the national company that works its nurses to the bone and burns them out, and I want a happy staff, but I don't want to be paying a bunch of people to sit around doing nothing while the agency is breaking even in a good month, and requiring cash infusions in bad months, especially with 30 patients after a year and a half.

  • May 26 '14

    Why do you require a DON and an ADON with that census? Is that a state or regional requirement?

  • May 18 '14

    I work for Heartland Hospice. It is owned by HCManorCare, who has LTC, Subacute rehab, AL, Home Care and Hospice and even out patient Pt/OT offices. How good the office is depends on how good your administrator and DPS (director of professional services, the DON) is. I work under one of the best DPS's I have ever had. The company is very compliant with Medicare guidelines and corporate audits are done at least 2 times a year to insure we are compliant with eligibility. That said, we've also had a bad director or 2 in the many years I've with them. Those were bad times. The best I can say is try to get a feel for the office when you interview. And please don't discount Heartland just because it is "for profit". There is a large "non profit" in our area who has huge turnover, doesn't supply the extras to the pts that we do (nice tab diapers, pull ups, nice absorbant chux, etc). And over the past year, we have gotten a lot of transfers from this "non profit" due to their service failures. From not providing a home health aide when the family wanted/needed them to, as one family member told me, employing the most cold hearted people the family member had ever met. Good luck on your move and job search!

  • Apr 13 '14

    Thank you everyone for the kind & encouraging words.. I love my job and I'm just going to have to learn not to be so hard on myself.. learning takes time and I'm just going to take it one day at a time

  • Mar 23 '14

    Other physicians were attending to her care?
    Were they ordering medications that were outside of the hospice POC?
    Did the hospice medical director ever have conversation with the other physicians?

    Seems like there is an information gap here.

  • Feb 24 '14

    And sometimes we are asked to not say 'hospice' or wear a company badge. Of course many times the gig falls apart as the family forgets or speaks out loud about the disease, utters the word hospice, or tires of the charade.