angieRN

I prefer nutty and corny to describe poop.

I can't decrease them because of company policy saying that we must provide 2 visits/week to facility patients to help communication and coordination of care. I think it's a bunch of bull if you ask me. We're supposed to provided the same level of care to home and facility patients, but essentially, we're giving a higher level of care to our facility patients.

I was a pediatric nurse for 18 months before starting in hospice (almost 6 yrs. now) Because of my background, I am usually selected to care for any pediatric patients. It is VERY taxing on the staff involved. I would do some hospice work first to see how you handle that before making the jump into pediatric palliative care. If that were all you were doing, I can see the burnout happening very quickly. Thankfully, we don't get many cases. I had 2 years in between my last 2.

My question is with a caseload of 12-18 does your agency require a minimum of 2 visits per patient per week? I have this requirement, so with a caseload of only 14, my weekly visits are at 34! There are some that could certainly get by with one weekly visit to ease the pain, but I'm not allowed to decrease them. I have 2 that need 3x week and one that is 5x week.

It could just be fluid collecting there from her CHF. Depending on the level of dementia...we've told patients with edema in areas that question why, that the fluid is being kept there like "money at a bank" so that the heart doesn't have to "look after it". It makes the heart's work easier.

I think what you did was the right thing and totally acceptable. If that particular employee questions your actions, you can explain to them that in order to be your best for all of your patients, you have to set boundaries. If that isn't a good enough explanation for them, I would pass it along to the appropriate supervisor.

Thank you so much! I was thinking on the low end of that and salary.com was a great help even though it didn't have a peds specialty listed specifically.

The first time I had to put a scalp IV in myself, I was horrified. I quickly came to favor that site if it looked to be the most favorable option. I also had good luck with them holding out longer. However, I always tried to explain to parents prior to insertion to minimize the trauma of seeing it the first time.

Hello! I have unexpectedly (but very thankfully) been asked to interview for a nurse manager position. It is a 27 bed pediatric unit in a magnet hospital. Because I did not seek this out on my own, I have not truly ever considered what a reasonable salary would be. Any input on the situation would be appreciated. I realize specifics are inappropriate so ballparks and the general area would be great. Thanks!

We also do 4 drops every 2-4 hours prn.

I usually say, "Yes, it can be a hard job at times, but very rewarding." That pretty much covers it! Angie

Hmmm..we're having caseload/visit issues as well. I don't think it's unreasonable to see your stable patients once weekly, and for a while, we did that as well. Now we're back to the same as your company. Twice weekly, no matter what. They want our caseloads at 14 per RN with only 1 LPN floating amongst 5 nurses. So that's at least 28 visits/week, plus team meetings, careplanning, etc. It's getting hairy! Angie:banghead:

In the home setting we do the same as above, usually 2-3x/wk and prn for the nurses. We're usually pretty specific on the # of days for CNAs. In the facility, we have to be very specific down to which days of the week and AM or PM for Nsg, CNA. SW and Chaplain can be a little less specific.

I ususally add in besides the normal "I can't discuss this information with you....blah, blah, blah" "I don't discuss my other patients just as I don't discuss [Name] and all of the private details of what goes on when I'm in your home." Most people are understanding and if they choose to be mad, so be it! Angie

I graduated in 2001 from the ADN program. I really enjoyed and was very glad that I ended up attending at Fairmont rather than WVU. I felt like the instructors gave a lot of personal attention. I know quite a few of the instructors have changed since I attended though. Enjoy! Angie

There are definitely some patients who would appreciate a gesture like this and some who would not. I say with the ones who will, go for it. It will probably brighten their day. Just make sure that the material you are using can not be interpreted the wrong way. If you're like me, I know which patients I can joke with and which I can't. Good luck. Angie

Fuzzy, If you would have read my earlier post that had this link in it, http://www.aahpm.org/education/arthy.pdf you would see that I was not making a specific statement about Terri, just trying to give a little additional info on what dehydration/lack of nutrition cause the body to do. I suggest you read the short article and then you will see why I made the statement that dehydration/lack of nutrition is not necessarily a horrible, painful death as many people perceive. Angie

I realize that she is not currently dying. I only wanted to point out that it is not a painful death to die from dehydration as some people believe. Angie

I am amazed at the comments with seeminly no concrete evidence to back them up. I am a hospice nurse and realize that this is a complex case and emotional for all parties involved. It seems a lot of comments are being made from personal beliefs rather than looking at best practice from a nursing standpoint. I do not feel the need to state my position on this case, but found a link that may be of some interest. It gives a little insight into the philosophy of hospice/palliative care regarding this issue. Artificial hydration/feeding, I suspect, will always be a very emotionally-bound issue no matter how much evidence is out there due to our cultural/religious beliefs. http://www.aahpm.org/education/arthy.pdf Angie

I have been in about 3 situations in the past year since I started as a hospice nurse that a patient has died only minutes after being turned, ususally for a bath. I don't think that this is an unusual thing. Angie

Not really a doctor name, but I went to elementary school with a girl named Billy Jo Dick and her nickname was B.J. At the time I didn't understand that B.J. Dick was something funny. Angie

I have always been told that it is because primarily vaseline-based products are potentially flammable. If I am wrong someone please correct me. I don't want to be giving out incorrect info. Angie

I am curious to know more about the ativan-benadryl-haldol-reglan suppositories. Do you have certain pharmacists who will compound? How would we get someone in your area to do this if they are unfamiliar? How much of each med is actually in this suppository? What symptoms need to occur for use of this supp to be appropriate? How effective have you found it to be? Is it more effective with certain ages/diagnoses? Our hospice does not use these, but I have been hearing more and more about their use and would like to find out more. Thanks, Angie

We have an "ER" kit which includes: 3 cc Roxanol 3 cc Haldol phenergan tabs levsin tabs ativan tabs compazine supp tylenol supp When the patient dies, all meds are destroyed in home and witnessed by someone whether it be other staff or family. We document all this on the discharge summary. :)

Have seen two instances of this just in the 1 year I have been doing hospice. One person who had it done, it was referred to as a TIPS procedure (Transjugular Intrahepatic Portosystemic Shunt). He had cirrhosis and it was connected to a colostomy type bag over where the stent was placed. There was no external equipment other than the drainage bag. It just looked like a little tunnel into his abdomen. Didn't get to know too much about it as the patient died less than 24 hours after admission. 2nd patient who I saw had the dialysis-type catheter with a clamp and IV cap on the end. I believe she was an ovarian CA with mets to multiple sites. She cleansed the insertion site with sterile gauze and saline and dressed with a drain sponge which she changed each day. Approximately every day she would insert an 18g. needle into cap and use gravity to drain all that she could into a container. Then she flushed the catheter with a 10cc to 1/2cc of saline and 100u heparin to keep the catheter from clotting. I would change the cap using sterile technique once a week. She was always much more comfortable after draining. Hope this info helps! Angie