KatrinkaRN

Help!! I'm a new ER nurse..used to be a hospice nurse...the last thing I want to do is to have to revert back to hospice nursing practice while in the ER. The ER I work in routinely uses Ketamine for sedation on pediatric patients for procedures. They also use diprovan when doing cardioversions. I asked the ER educator about scope of practice and nurses giving anesthesia meds such as diprovan and she said its not a problem with scope of practice. Hospital policy for moderate sedation allows for use of these medications and to be administered by RNs. Yet at another hospital I worked at RNs were forbidden to administer any anesthesia meds. Would my state board of nursing be a resource for resolving this issue? If not who should I talk to...

I've been working in hospice for 3 years now...I've learned to not use pulse ox's...instead I go by how my patient presents...if oxygen makes him comfortable by all means use it...but if the patient is actively dying and appears dyspneic I more than likely would medicate with morphine than increase the oxygen. Morphine is excellent in relieving dyspnea.

Sometimes scopolamine doesn't work on tracheal congestion. For the most part, suctioning is only done when it's occluding the airway.

The patients that I was referring to were in the active phase of dying, comatose. So they felt the justification was that death was iminient so they were so point in suctioning using sterile technique. I don't think there ever is a justification.

I have a question about standard nursing care on an inpatient hospice unit. I used to work on an inpatient hospice unit connected to the hospital. We often would get patients with tracheostomies...one of the nurses I worked with felt it was unneccesary to use sterile technique when suctioning and would often use the same suction catheter through out the shift. This question was posed to the hospice medical director and he felt that this wasn't a problem and was actually "okay" to do. Most of my fellow co-workers didn't see anything wrong with it either. It bothered me immensly...I don't think the dying should have different standards of care just because they are dying. Any feedback??

I agree wholeheartedly with what everyone has said. I've been in hospice for three years...and I believe it is a calling. All the nurses that I've worked with truly want to be doing this kind of work. But I must admit, I've been told by a few nurses that I work along side that I'm young (I'm 38) and somehow that has a bearing on my abilities as a hospice nurse (???). It is age discrimination...but I don't let it get to me. Melissa...good luck to you...I think you'd make a great hospice nurse...your heart is in the right place!

I tried both floor nursing and icu nursing...I now work in hospice and I think that's where I'll stay. In hospice, you're no longer experiencing the pressure of trying to keep someone alive. My hats to both icu and floor nurses..either way you look at it..it's a tough job!