ray2512

This is so typical. Hospice administration wanting to inflict as much emotional damage as possible to employees seeking greener pastures. It is so odd that hospice administrators depend so much on compassionate employees yet so often they are so heartless.

If you don't know how to maintain your boundaries in hospice, you will burn out very quickly. Don't go against your natural inclination just because your a hospice nurse. Maintain your boundaries in every area of your life! Be strong and don't let people take advantage of you. Overcome this tendency to try and please everyone and it will be growth for you. Hospice is a good place to grow! Good Luck

Have you tried gabapentin. 300mg first day, second day bid, third day tid.

You didn't say where the pain was. But if it is in his shoulder its probably brachial plexus. Nuerontin would be the med for that nerve pain. 300 mg tid to start can go up from there.

I have a big problem. I must prove that our clients are not getting adequate care due to understaffing. I need to have my evidence by tomorrow afternoon about 3 pm. Here is the problem. I am having to explain not getting documentation done, quantitively or quality, I'm not sure. And there was a concern report that I was "not responding in a timely manner". We have a inpatient unit that is full most the time with 16 clients and having daily deaths and admissions. We only have 2 nurses staffed in the day time. Please let me know what your staffing is. It is way to busy to meet everyones needs and do perfect documentation too. Everyday there is some sort of crisis going on. Our home care staff have 20-21 clients per RN with four RNs on a team with one (sometimes) LPN helping. Understaffing seems to be an agency wide problem. But the management does not seem to make a connection between the needs of dying clients/families and staffing levels. I don't get my half hour lunch half the time and my breaks are usually cut short or non existent. I have been working there for 6 weeks and have only used the bathroom twice. I work three 12 hour shifts a week. My feet ache for hours when I get home. Please help!!!!!!!!!!!!!!!

Even low doses of decadrone 2-4 mg daily are helpful in increasing appitite. Considering the possible side effects, thats plenty.

Maybe its time to start a National Hospice Nurses Union!

Amen bro

I think the reason most of it is negative is because it's an oppurtunity to vent. In many settings, such as my own even positive feedback is taken as a bad attitude. One in which you can be fired for even if your a great nurse. Oh, by the way, WWIII has already started!

I have had 18-19 client mostly at home for the last several months. I drive an average of 700 miles every two weeks. We have lpns that assist but most of the time they are filled up so I don't get to use them much. I usually do one night of call either for primary or admissions about every two weeks as well. I have been doing hospice for almost 14 years now and still love it, but I think management takes advantage of me because they know how much it means to me. I've wanted to quit a half a dozen times, but manage to keep chugging along. I have seen many many nurses come and go. It really takes about two years for a hospice nurse to put it all together and be proactive. If you make it past the two year point you will probably make it. Learning how to prioritize and keeping a tight schedule are key. Support each other, and tell at least one person a day that their doing a great job and it will come back to you as well. Try not to get down on yourself when things don't go as well as you would like. Your only human, people are dying, thats life and its not always pretty. Keep your shin up, but sometimes you just need a place to go and cry.

I will soon be a team leader soon as they hire a nurse to take my case manager position, which takes a long time since our HR is so slow. I have the feeling that the new team leaders will help design the job some what, but I already know about somethings we will be doing. Timesheet approval, but we have a new software for that. Nursing competencies. Productivity reports and making sure everyone is making enough visits. Teaching new nurses and probably doing some inservices. Attending leadership meetings and what we call Home Care Solutions, which is sort of a think tank to make improvements in customer service. Probably will have to take customer complaints, and complaints from nursing homes and do the resulting teaching and perhaps disciplinary stuff just to name a few. And oh yeh, carry 5 to 7 clients!

I went to hospice as a GN and had no nursing experience at all. Infact sometimes its better if you havent had a lot of curitive experience. Hospice is much different from any other kind of nursing. I have been in hospice now nearly 14 years and still find it interesting and challenging. The only way to get experience for hospice is to do hospice. They dont expect you to know everything about hospice, they will train you anyway, there is a lot to unlearn and relearn.

First of all do you have a inpatient hospice? Secondly do you have an inpatient contract with the hospital? Maybe they just wanted the client to go to an inpatient unit instead of back to assisted living or a nursing home. If your agency has a inpatient contract with the hospital you can just keep the patient on hospice and all you have to do is make daily visits to the hospital. The contract involves receiving inpatient reimbursement from the medicare hospice benifit, then paying the hospital that rate. Another thing is I dont recommend reglan for hospice clients, when there is something preventing GI movement or an obstruction thats what reglan does, reverse peristalsis.

All you really have to do is be quite and smile a lot. That goes a long way. Is that really such a strugle. Give some words of wisdom occasionally, think about what you say before you say it. Don't feel you have to change everything right now. When things fail around you, people will remember what you said and how you said it. Eventually you will win thier ear and respect.

I dont think there are any laid back nursing jobs, but you might consider hospice.

I was 41 when I started nursing school, I am now 57 and have been practicing on most 14 years. Being older if anything is an advantage!

We have a full time on call nurse who is now sick. He works 123 hours every 2 weeks, covers 155 home care and about 17 pace clients. He is sometimes called to pick up meds for the hospice house (oh brother) and misc duties there. He also has to give up 24 hours eto for weekend days off. I did the same job about a year ago and they figured my eto at about 2/3 of the hours, because I worked about 43 hours more than everyone else in two weeks. But now it seems they have gone to hour for hour. That I think is very unfair and he is now sick and burnt out. I also had a director that thought call was "not that bad" and made me work 96 straight hours over Thanksgiving. I almost fell asleep at the wheel twice. I immediately put a application in for case manager. I hope I will never have to go back to full time call as it is now. And I feel that when we do have to take it occasionally we should get paid the same as the on/call nurse, a full days pay!

This sucks. I will get paid about $25 bucks for answering calls, and $25 per visit or $50 for death visits. I have all ready gotten 4 calls and its only 615pm Sunday night, I started at 5pm. I will be on call till 8am tomorrow, then work my regular 8 to 5. The census is about 165. Still have about 14 hours to go. Hope its a quite night but I know several people are actively dying.

Im sorry. We get $25 weeknights for carring the pager, $45 on the weekend. Then an additional $25 per visit in town and so on. We also get 48.5 cents a mile reimbursement. No additional for documentation time, but that only takes 10 minutes or so. So if I make 4 visit in town on weekend I would get $145 plus mileage. Total. Thats for 24 hours. Like Friday at 5pm to Saturday at 5pm. The fulltime on call people get salary and mileage. I feel like we should just get a day salary just like they do, since we work all day then sometimes have to take call. Some nurses although make a visit everytime they get a call if possible. Even if it only takes 15 minutes its still $25.

Have not been in here in a very long time. Hope I do this right. Its amazing how many different variations there are on all these topics among Hospice Nurses. To bad there is not a standard nation wide for these things. I have been a Hospice Nurse for almost 14 years now. The only reason I stay in it is because I love the work so much. I make about $27 an hour at this point and will soon be a team leader that will pay about $29, but I have taken a lot of crap to get to this point. I am salary but last weak I made about 28 visits and worked about 50 hours. We have lpns that are supposed to help, if you can find one that is not already booked up. A lot of times they are doing HHA duties. We have an full time on/call nurse, but sometimes we also have to do that. It pays about $25 on weeknights and I think around $50 on weakends. We also get vist pay of $25 in town, $50 out of county and also the same for death visits in town. $75 for out of county death visits and admission visits out of county. $50 for in town admission visits. Now a days on/call is pretty much non stop for the intire time and just plan hell. No one of course in adm has a clue what call is like. I presently have a case load of 19 clients which is way too much. A case load of max of 15 would be ideal in my opinion, 17 would be ok if you could depend on having a lpn help. Hope this helps and plan on being in here more often. Also will let you know how the team leader position goes and what it entells. Have a good one.

I work 8 to 5 pm with an hour lunch which I take most of the time. I have sat and sun off. We have full time on call nurses so I rarely do call. A lot of hospices especially small ones require case managers to take some call.

5cc over

We put the morphine sulfate solution between the cheek and gum. I absorbs well there and does not drip out of the mouth if you use 1 cc or less. SC morphine is not pain free, labour intensive and expensive. If your really woried about contamination of the dropper, use a 1cc oral syringe can be thrown away with each use.

You don't need to put Roxinal in anything it asorbs in the oral mucosa but you can if the client is able to swallow soft foods.

Why don't you just stay in social work? Each client in hospice is assigned a social worker, your experience there would be great. If you decide to complete your nursing education, get a BSN. That, I think is a better education to know how the systems work together, quite important in hospice. The other thing to remember that each patient have a social worker already, they don't need a social worky nurse, that can get you in trouble with the rest of the team if you don't keep your boundaries. Good Luck!