Overly agressive hospice

[CoffeeRTC, BSN, RN]

Vent:

I consider myself well seasoned, but I was made to feel 2 inches tall by a hospice nurse and really didn't stick up for myself or resident.

I don't work this wing a lot, so I thought i might have missed something. A resident was newly admitted to hospice services and the nurse was in to do a follow up visit. When she walked in I gave her a "everything is fine report" There were no issues (pain/ sob/ changes in adls etc) I last saw the resident about an 1/2 hr prior.

Hospice nurse comes in and wants me to give her the roxinal stat, then follow up with ativan if not effective. She was sitting in her WC "lethargic" and with resp of 38 and HR 120. Sats were low and dinner was un touched.

I got the third degree...How long has she been like this, why isn't she eating, doesn't anyone feed her? is there a nurse that can make sure she is getting her medications??

Okay...situation looks bad, so I gave her a quick does of Roxinal. This was her first time ever getting the med. I'm totally on the hospice bus (would love to get out of LTC for hospice one day) and have had a great experience with many hospice companies personally and professionally.

After getting the third degree I also re assessed my resident.

She was just recently incontinant and asked the CNAs to get her back to bed and changed, she didn't eat dinner because she fed herself a huge dinner that family brough in prior to our dinner and her resp/ hr was up because she took her O2 off herself. (the CNAs were just in there before the hospice nurse came in and told her they would be back in 5 minutes to get her into bed etc)

Now....in the mean time, the hospice nurse got orders changed and make roxinal ATC and increase the PRN dose and also made mention this resident is a full assist with feetding and is starting to decline. She also gave me an education on meds.

I did let her know that this resident does have these periods with dyspnea and gets tacchy esp when she gets confused or wakes up from a sleep. She normally is ind after set up with feeding. I didn't push more, because i had not seen her in week and since she started hospice services. I can kick myself. I did call the very involved family to fill them in on med changes and got the support I needed.

So...end of rant. I wish I stood up more for myself and resident. I just hated to be looked at as "one of those nursing home nurses" because I'm not. Now I need to make sure we don't over medicate her because of an agressive call on the hopice nurse.

[JustBeachyNurse, LPN]

It sounds like the hospice nurse knew the patient less than you did after a week off. I know when my dad was on hospice the nurse would have been asked to step aside and family called if such an aggressive encounter occurred...I know because I was first call on the list if my mom needed a break.

An on call nurse flipped out on the wrong issues and was totally inaccurate in her assumptions (notice I said assumptions not assessment) fortunately it was one of the good nurses on at the facility that I knew was clinically competent (and not the lazy one that I had to threaten to get a court order via APS to keep her away from my dad.) I was more than happy to back up the facility and make a call to the on call supervisor.

It sounds like the family supported you. I'm sorry for how she made you to feel with her overly aggressive approach.

[CoffeeRTC, BSN, RN]

Turns out is was too much being RTC. Resp dropped to 8-12, over sedated.....aka...not necessary.

[CapeCodMermaid, RN]

Hospice nurses are guests in your facility. They are an adjunct to the services and care you provide. It sounds like there needs to be a meeting about team. Although, with a respiratory rate of 38, I most likely would have given the Roxanol.

[CoffeeRTC, BSN, RN]

I did give the roxanol after all, she had the need for it (copd) but I also looked at the resident...O2 was re applied, comfort care given etc and big aggrivating factors removed (anxiety due to incontinace and fatigue from being out of bed). When these issues are addressed and anticiapted, of course there is more overall comfort.

[ktwlpn, LPN]

Hospice nurses coming to our facility do not call the resident's physicians directly for orders.They make recommendations,we call the resident's physician and discuss the orders.We are responsible for the care of the resident 24x7,the hospice staff should be collaborating with you......

[quiltynurse56, LPN, LVN]

If the resident is getting too much Roxanne, get the order changed. The hospice care that comes to the facility in which I work usually allow us 0.5 ml or 1.0 ml q hr prn. We are then able to assess the resident and their pain and decide which amount to administer. The order leaves it open to our assessments and when hospice calls or comes in, they ask about how much the resident is getting.

Here, when we need something for a resident on hospice, we call the hospice nurse who then gets the order for us. We sure appreciate the hospice nurses and the help we get from them.