jCLNC

Will be moving to Holiday FL in near future. Online there are very few hospice jobs; and almost nothing in papers. Is Hospice "saturated" down there? Are all the hospices truly well staffed with experienced hospice nurses? Have CHPN (certification) and 40 years nursing experience, 17 in hospice. Thanks for any information. I know that Suncoast is in Pinellas County; and has changed their name to Empath Health. We use their software and it's great. Pasco County is served by Hernando Pasco Hospice if I'm not mistaken.

It's too bad that the renal failure itself lends itself to so much nausea, itching and other unpleasant issues. I'd be sure that the patient doesn't have a problem with bowel elimination R/T to continued use of his Codiene first... I've had good results using Decadron for nausea, and it seems to help for other things too (bone pain, appetite...cures a multitude of sins...) Also you might try Ativan. A nice ABHR suppository could do the trick with the cocktail effect...(ativan 0.5/benadryl 12.5/haldol 0.5/reglan 10mg). With my renail failure patients, I ususally try to get them to keep the scopolamine patch on and then add things to it...if all else fails, NPO for awhile. You can also put in an N/G tube and let him use the suction only when he feels sick. (last resort). Don't you just love it when the MD says, "oh whatever you think..." If the MD is amenable, our director usually likes to D/C the amiodorone, it has a lot SE. I hope just one of these helps! Jen

Hi, My typical day starts at 8:30am. I do between 3-5 visits a day. This will taken up with the actual visit times, the travel and the communcatin necessary to the MD, absent family, and pharmacies. Also documentation and followup phone calls from the previous days. Does that help?

I work for a Hospice that has been established for many years in our town. We have home care and we have contracts with nursing homes, and we provide all four types of hospice care (routine, inpatient, respite, and continuous care). :idea:There are hospice regulations that you need to be familiar with and understand, but basically this is how one of my days goes: My hours are from 8:30am to 5:00pm but I am salaried, so if my job requires me to work a little longer, I'm still paid the same. My case load runs between 10 and 14 patients. I have some who are cared for in home by family or paid caregivers, and some in the local nursing homes. Acuity is based on the patient's condition, that is: co-morbidity of symptoms, how well they respond to pailliative treatments and medications, and how fast they decline. Our agency lets their case managers set their own pt-visit ratios. For instance, if I have a patient who is actively dying, I would visit them more often, even daily if the family needed that much support. (Usually they do.) In the nursing homes, you must make sure that the two charts match (yours and the nursing home...the orders, notes, etc.) Also, invite the staff to your IDT meetings, and attend their careplanning meetings. This requires effort...because sometimes times vary. I usually do between 3-5 visits a day, and that will take up my eight hours with: travel, contact with MD or absent family, followup phone calls to patients and family seen the day before, documentation...etc. Being a hospice case manager means that you are responsible for coordinating all the needs of the patient: if you recognize needs that the SW, chaplain, or volunteer can meet, pull them into the picture, don't try to be all for the patient...that's what being a team player is about. You also have to be a self-starter, a dependable worker, and an organized nurse to keep up with all the things that go on every day. But every nurses' job requires that! I hope this helps you a little. Jen

Will be moving to Florida soon and will probably live in Pasco area, but could work near by. Am certified in Hospice and Palliative Care (CHPN) and am a Case Manager with a case load of 10-12, doing home visits. Would like to know if this is the a similar situation in Florida, and what kind of salaries do they pay? I have looked on Salary.com and it says I will need to make 3,000 more a year to maintain my life style in Florida. Any advice or help would be appreciated.

[Did I mention it's also too danged hot here!!! :oWell, if it's warm temperatures that are driving you out of Florida, keep on going when you get to Georgia. In the midstate area, the temps have been soaring into the 100's for the second week in a row, and this is a pattern for Georgia summers. We have 100% humidity which makes the temps (heat index) in the 110's. Couple that with NO rain and you have it. :angryfire At least in Florida you do have some recreational places (beaches, etc) and good schools. My cousin has a home in NC just over the line from Georgia. They have more moderate temps there, but I'm not sure about the school systems. Good luck!!

Hi there! I've been a nurse for 31 years, and my husband is not a nurse. He's a landlocked (in GA) Floridian with big hankerings to get back to the ocean and waters for some serious scuba diving. I myself lived in Tallahassee for 4 years ('85-'89) and don't remember being deprived of that much. I do understand that prices of housing have changed. We were considering relocating back to the St Pete area. Any light you can shed on that? thanks!

Greetings! My husband, who is from St Pete, really wants to move home. I've had him landlocked here in Georgia for nigh onto 5 years now, and he's a scuba diver. I've been reviewing posts and can't find anything that speaks specifically to what I want to know...where is the best place to live (up and down 19 that is...) New Port Richey? Port Richey? Holiday? Any places that are have great things going for them (or...things to avoid?) Also would like some information about Hospices in the area. Good salaries? Case loads for Case Managers? any information would be appreciated! Thanks!

Good luck on your results Gator Fan! My husband is a huge fan, but he never attended the school. I'm an RN with 31 (eeek) years experience and am thinking very hard (appying for endorsement in case the thinking turns to moving) about moving to the Tampa Bay area. We are looking at homes in the Port Richey, New Port Richey area. My area of most recent expertise is HOSPICE and by internet search have seen there are a few in the area. Having worked in Hospice for 8 years, I am only considering that for my first job in the area. Any one got any feedback on Hospices around there? As anyone would, looking for decent salary/wages/benefits for a decent day's work. Any advice on where to live would also be greatly appreciated!! Thanks to anyone who contributes to my plea for information!! Jenny

Hi Jen, great name:lol2: (my name is Jenny) We have a permanent Intake Coordinator, and she primarily does all the referral taking, obtaining medical documentation, getting initial orders signed, calling physicians, and getting the Medical Director's approval. This is the first step for us before the actual admission visit takes place. Sometimes she actually does the visit, sometimes she gets the case manager to do it. The actual admission visit, for us, can take up to 2 hours for the visit and an additional hour for documentation/ordering equipment/ and/or communication with the MD for additional medications. We also do another follow-up visit within 48 hours to answer additional questions that come up after the first visit. It's a lot of information to get "heaped on you" in one fell swoop. Add to that their grief, their feelings of being robbed in many ways, or just general feelings of loss, and there you are. If we know it's going to be a complicated admission, we take a chaplain or social worker with us. Hope this helps. Jenny

I too have joined the ranks. My dad discovered his Type 2 Diabetes at the same age in his life that I have. I'm mirroring his progress, though I don't know that I ever heard him say that he lost the feeling in his feet. My story is one of denial and as a nurse makes me a little ashamed...but I am also human. I go to the beach every year and take my family...don't go on vacation without them, Ha. But you know how the surface around the pool makes you want to dance it's so hot? Well, from one year to the next, I lost the ability to feel the hot. Still didn't do anything. About 2 or 3 years before that, I noticed the Plastic Wrap feel to the bottoms of my feet as I would get up in the mornings. My fastings were not bad at this time and my Internal Medicine MD is excellent. She was keeping an eye on me. So all told, I've really been a diabetic for about 8 or 9 years, only 3 with treatment. I wonder if I will ever get some of this feeling back in my feet. I've done a little research online, but nothing speaks to that point...it's just that part of it really bothers me. I'm currently taking oral diabetic agents including amaryl, glucophage, and just started Byetta a month ago. My A1C was 7.4 last month. I know it needs to come down lower, but that was not even trying to adjust my diet...not that I am a constant splurger, but I don't go by the strict "3 pieces of bread a day...etc" diet. Bad nurse! Not taking care of herself. I need a spanking. I really think it's already affected my autonomic nervous system because I have gastroparesis, and I sweat a lot. My B/P is mildly elevated and controlled by diovan, and I frequently feel the pulse elevating "on it's on". Scary. It seems that even when you do it "right" with DM, you lose. It's such an insidious disease. A bad example for my patients, jen

I've been told there is no cure for any diabetes...once you are diagnosed, you are a diabetic for life, only controlled or uncontrolled. Am I right? Jenny

I too have joined the ranks. My dad discovered his Type 2 Diabetes at the same age in his life that I have. I'm mirroring his progress, though I don't know that I ever heard him say that he lost the feeling in his feet. My story is one of denial and as a nurse makes me a little ashamed...but I am also human. I go to the beach every year and take my family...don't go on vacation without them, Ha. But you know how the surface around the pool makes you want to dance it's so hot? Well, from one year to the next, I lost the ability to feel the hot. Still didn't do anything. About 2 or 3 years before that, I noticed the Plastic Wrap feel to the bottoms of my feet as I would get up in the mornings. My fastings were not bad at this time and my Internal Medicine MD is excellent. She was keeping an eye on me. So all told, I've really been a diabetic for about 8 or 9 years, only 3 with treatment. I wonder if I will ever get some of this feeling back in my feet. I've done a little research online, but nothing speaks to that point...it's just that part of it really bothers me. I'm currently taking oral diabetic agents including amaryl, glucophage, and just started Byetta a month ago. My A1C was 7.4 last month. I know it needs to come down lower, but that was not even trying to adjust my diet...not that I am a constant splurger, but I don't go by the strict "3 pieces of bread a day...etc" diet. Bad nurse! Not taking care of herself. I need a spanking. I really think it's already affected my autonomic nervous system because I have gastroparesis, and I sweat a lot. My B/P is mildly elevated and controlled by diovan, and I frequently feel the pulse elevating "on it's on". Scary. It seems that even when you do it "right" with DM, you lose. It's such an insidious disease. A bad example for my patients, jen

I have 30 years nursing experience in varied fields, and 8 of it in Hospice with a CHPN. I currently make almost 29 and some cents in Georgia. Do you think, and I know you can't really say, but do you think your company would meet that salary as Case Manager? that would be a comparable job to mine. thanks Jen

Here's the old diploma nurse chiming in to agree. I loved my uniform, complete with hose, shoes and cap as this lady wears. Now the only time it would seem to be appropriate in any cirmcumstance is at Halloween at a dress up party. I loved wearing my cap and the doctors used the different caps and uniforms to know who was the RN (this was at Georgia Baptist School of Nursing in Atlanta). I would vote for a return to white. The Director at Grady has done it, (Grady Memorial Hospital in Atlanta, GA) and has received so much positive feedback, both from doctors and others, that she has been invited to institute the change in other hospitals. I had an instructor who used to work in New York and always rode the subways. They were dangerous even then. She personally related to me that regularly, when "aggressive" people were discussing who to jump, she would hear them say "Nah, man, she's a nurse. Leave her alone." She believed the white uniform set her apart as someone special. They never touched her, and this was at night. Soooo, I vote yes, return to white, even though caps are probably long gone. Jenny:nurse:

amen, sister. i was scanning the replies given already and was a little amazed no one had mentioned this one. calling the state to report a complaint of any kind was something we were required to educate the family and patient " how to do" on the admission visit (when i did home health in it's "hey day"). the directions (for our agency) were in the patient rights and responsibilities. we emphasized our phone number in bold for calling first and the state 1-800 number was also given (not in bold). i'm sorry you have had such a difficult time, both with your health and this agency providing care to your family. remember, you are a consumer and you are your family member's advocate. if they are treating you this way, they are more than likely treating others the same, and some one needs to be alerted to the situation, someone who can make the difference. regards,:typing jclnc

I guess that I am going to be the "stick in the mud" on this thread. I am a case manager in my hospice, so I am the nurse that sees the patient most of the time. I have been doing Hospice for 8 years and am a CHPN. My families are so appreciative when I take the time (and can do so) to attend the funeral or the "viewing" as we call it down here in the South. As far as burn out, I don't think it's attending funerals, which somehow strangely gives ME closure also, I think it's not taking care of yourself spiritually and taking the necessary breaks from the job that you need in any area of nursing. I'm sorry guys, but on this one I'll have to break from the crowd. The funerals, the viewings, and the Memorial Services are all very important to my families and I attend whenver I can for them, as well as for me. Regards jCLNC

That's a pretty fair offer for Georgia. I don't know where you are, so I can't comment really. We only get 40 cents a mile. We have an after hours nurse so our call isn't that bad. Just think, you are starting pretty good and the only way to go is UP! Good luck Jenny:balloons:

As the other nurses have also answered, the meds covered should be the ones that related to the terminal diagnosis, but even then we differentiate. Ex: patient with end stage CHF. Has Lasix, Dig, K+, and Morphine. We cover the Lasix, K+, and Morphine. Not the digoxin, it's treatment. We cover all meds related to symptoms. We work with a pharmacy called Hospce Pharmacia, and they have a formulary which they have nicknamed MUGS (medication use guidelines). If we don't step outside of MUGS, we do pretty well on our medication bills. Has your hospice tried a formulary or a contract pharmacy? We also have a comfort pak that we place in the home, and if we order one on each patient the pharmacy gives us a discount (because in the long run, it's gonna save both of us money because we wont' be ordering things in a hurry, getting some locally, ordering extra meds at the end of the week....etc. I don't know if this helped??

Also along that line, what are Hospices paying in the central florida area, or around Tampa St Pete, clw dunedin area? thanks

I lived in Tallahassee in the late 80's, moved back to Georgia in 1990. I would have stayed gladly in Florida, I love almost everything about it. I thought Tallahassee was a beautiful easy to navigate city. Minutes from Panama City Beach and the flowers in the spring were breath taking. I vacationed with my family every year in Daytona Beach Florida and I would love to own a condo there. I have heard that the prices have gone up greatly though and I've also heard the taxes are terrible. I will probably end up retiring in Tampa St Pete because that is where my husband was raised. He went to Dixie High School. Well good luck choosing. Jenny

It took about 6 weeks to get my results...it might have been five. Start looking in the mail when it's been 4, if it was a paper/pencil test they take forever. I wish they would go computer, then you would have results instantly. Good luck! Jenny

Ahhhh, the days of the old operating room. I do miss them. Surgeons fussing, cursing, throwing instruments. But the worst were the nurses who eat their own. I was not a new graduate when I came to work in the O.R. and to have that added to your plate (being a new grad) makes it harder on you for sure. It's almost like a hazing when you first start unless you have a really good staff. I think it's because everyone is so conscious that sterile technique and sterility are such important areas, and a patient is very at risk. Anxiety is a factor for the established staff (speaking as a staff member who has been on both ends) and you have to prove yourself as a reliable competent and consistently dependable O.R. nurse. Many a day between cases I ran to the bathroom to shed a few tears, blot my eyes and head back into the fray because steely words hurt my feelings. It's rough in the beginning, but oh...the rewards. The comraderie is like none other I've found except for my Hospice team. I believe what makes it like that is that for a brief moment, everyone on the team holds that person's life in their hands, their really skilled and competent hands. From the person who mops the floor and gets the debri and yuck from the previous case making the room clean for the next case, to the scrub who honestly admits she touched her nose, to the circulator who cautiously observes every aspect of her room and keeps things moving through the day. All of the jobs are hard, demanding, but makes the surgical O.R. team one of the most cohesive in nursing. My friends from O.R. were some of the closest in life. Good luck in your Operating Room career, and you make me wistful and misty eyed about mine. sincerely Jenny

I was also taught to test. Have always tested. Will always test. In 31 years of nursing I've had some few equipment failures, majority have been fine, but the few that you would have to replace, as some wonderful nurse has already stated so clearly, will make the patient run the additional risk of UTI with foley re-insertion. Insertion in the first place (in a very small area) is an irritant...etc. Preaching to the choir here...but ain't we good?

I took the exam in 2004 after being a Hospice nurse since 1999, and found it to be easy. I did prepare by going to a seminar and studying my McCaffrey pain manual some. But by and large, I found it to be an exam for the seasoned Hospice RN, and one who has not practiced for long would not do well. The answers to the problem solving come with actual practice.