river1951

Hi, We are evaluating how adding LVNs to our staffing could help stretch our RNs. Since we have no experience, if I could hear from anyone who uses LVNs this way it would be very helpful. Thank you in advance! river

Thanks to you all for your helpful replies. river

As far as utilazation goes, the patient who revokes loses the rest of that benefit period, which is fairly meaningless since there is no limit on numbers of benefit periods. You have to find a good fit with your team, it is your mothers' death, she g...

People who have pain can have high pain and still talk- some folks will always rate their pain as a 10. But we still must treat- I would use immediate release morphine elixir and have them give him enough to knock the pain back- get a range from the...

Methadone can work very well for cancer pain. Best of luck to you and your brother. River

It is the certification in hospice and palliative care.:welcome:

Way to go all of you!

It sounds ridiculous and stupid, if I understand you correctly. So they are transferring the patient to the inpatient hospice unit to preserve their stats? I get their rationale, but their hearts must be stone. It is different if folks are begging to...

Yes, it is different things to different people, sorta like the parable about the blind men and the elephant. For me, it is about letting folks know they do not walk alone, and then being there for them in the way they need. River

do you feel powerless, strongest no 5-4-3-2-1 i can't solve the problem so i feel powerless 5-4-3-2-1,strongest no i feel overloaded 5-4-3-2-1 3 my job interferes with my personal life 5-4-3-2-1 4 too much to do and too little time 5-4-3-2-1 4 emo...

This is totally unrelated to her hospice diagnosis, so I'm pretty sure hospice would not be billed for it. Medicare sshould still cover it, just as it would any other unrelated diagnosis. River

Michael et al, Fatigued with it, I know was being a wise butt being fatigued with human nature- it is very limiting. That of course is why we just need to help each other along thru this difficult life. Aberrancy? Michael- that's harsh. River

"Your hospice should not be revoking the patient during this procedure. It is related to the patient's comfort and should be paid for by your hospice. The procedure is not that expensive and should not require an overnight in the hospital." Right on!...

Point well made. I am so simplistic, that at times I have thought the lack of caring equals lack of being able to put yourself in another's place, not the denial you will ever be in that place yourself. Sounds very convoluted but I know what I mean. ...

Over medicated? If she had no symptoms. I don't understand why any hospice nurse would medicate. So you will have to tell me more so I can understand what you mean. Hospice doesn't mean medicating patients to oblivion; palliative sedation is only con...

We do palliative pleural taps all the time and it sounds as if that could be of help. Also positioning and tiny does of oral morphine- very helpful. If this hospice is not interested in helping you have a right to one who will. God bless you for advo...

There are those black and white thinkers who cannot flex. For ethical principles, I have always been taught it is the desired end of the treatment that makes a difference- If we sedate to relieve suffering and physical death occurs- there was nothin...

Don't give up. We encourage ride alongs if a nurse has never done any home care especially. Good to know if it's the right thing before jumping in. Where are you in the country? River

My thought is that birth and death are not that far apart. Your teaching skills are very important as well as your ability to listen or just be present. I would think oncology would be a great bridge.

At some point the doctors have to give it up! They don't know everything and for some MDs (perhaps many) that is a difficult realization- one never addressed in some cases. I do find, as a hospice nurse that the docs many times turn my requests back...

At our hospice we do realize docs look to us to know what to do without pesting them to death. Our solution is to call, let them know our plan and request a return call if the doctor wants something different. This wastes less of their time and our t...

not stupid, yes it does. We had a patient on the Actiq which also caused lots of buccal irritation.

In California, it's in the 30's per hour, but you can't buy a house here on that! So think before you move anywhere for better money. :nuke:

Leslie- that is soo hard. I will hold you in my heart and thoughts. I agree self awareness is the way to peace, but I see that for nearly everyone, self awareness is depressing, being human we are all horribly imperfect. Self awareness forces us to l...

Well, I can't explain it. Fool that I am, I actually thought lots of people would be talking about their patients and how they were able to help them resolve issues so they could have relax and be ready and not worry. I never thought we'd be just th...