smalltownLVN

Update: somehow we were able to work through all of his issues and he and his wife regained the closeness they had lost years before. They were able to spend his last weeks together in a way they hadn't in years. He passed last week just as he had planned with his wife, son, and I at his side. His wife gave me a letter he had written to me before he passed at the funeral thanking me for not giving up and for keeping the promises I had made to him. It's so hard when you have a special bond with a patient and their family but the reward of knowing the impact you had on their life and death makes my soul happy.

Thanks for all the advice, guys. He, of course, refuses the chaplain and it's not a topic that he feels comfortable talking about with someone he isn't close to. Luckily, I was able to muddle through and mainly just listened and asked open ended questions. I think just being able to talk to about it, finally, after 15 years helped some. I don't know that he will ever forgive that person but I helped relieve a lot of the poison that he had been hanging on to for so many years.

I have a pt that I have grown close to both he and his wife. Physically, I have gotten most of his symptoms relieved. The main problem is the emotional issues. My pt and spouse are only in their early '50s and are having a very difficult time dealing with his progression although his spouse is a nurse. My question is, has anyone experienced the death of a pt who would forgive his spouse, or whoever, and how did it affect their dying process? I'm trying to figure out the best way to get him to let go of his hurt and forgive not just for her but for him also. Also, he doesn't believe in faith or spirituality. Thanks

We have an oncologist that refuses to give terminal dx! He says we will put you on hospice to get pain under control then restart your treatment knowing full well they will never last that long. So frustrating.

Does anyone else have an issue with pts attendings wanting to stay on but not educated on hospice meds for comfort? It is so frustrating at times to care for pts that you know a med would help them but attending refuses to RX due to lack of education. Two examples: 1. COPD pt on 4.5 l/m O2 and anxiety. Attending says no morphine to avoid respiratory depression and buspar 5mg for anxiety. I know how miraculous a medication can be for pts with COPD and it kills me not to be able to bring her relief. 2. Advanced dementia with combativeness and extreme agitation. Dr RX lavender and chamomile aromatherapy and prayer. Are you kidding!! I am so bummed when I find out an attending wants to stay on instead of hospice medical director! Any suggestions? Thanks

That does make it hard but also remember just because they can say their name doesn't mean they are oriented x 1. That is a conditioned response they have answered all their lives.

I have to admit I am thankful I know nothing about the billing aspect of hospice except that our patients do not pay for our services out of pocket. However, our hospice has our aides provide care because they have been trained to be our eyes and ears. They have more experience with issues that arise with hospice pts than most CNAs. They report daily if ANY issue comes up that needs to be checked out. They have smaller caseloads than LTC facility CNAs and are able to spend more time with the pts. Of course anyone can refuse the aide as their right. I'm sure the assis living employees took great care of your mom but not all decisions are based on profit. At least I hope not.

My suggestion is to visit with a few hospice companies yourself for info and present it to the pt and family so they can make an informed decision. Let them know it's hard to think about going that direction but as a nurse who has the pts well being as top priority, it is something they should explore before out right refusing. I'm sure every hospice is not the same but the company I am an RN with has the ability to see them as often as needed as well as aides that go to the homes to care for the pt's ADLs as often as needed. The one thing I always tell people is that Hospice doesn't mean we sit and watch you die. We give antibiotics as needed, wound care, medical equipment, and medications for situations that arise during end of life. I have had patients and families who hated the fact that they had to go on hospice but they are always so grateful for the services once they start. Again, I don't think you should attempt to influence them in any way but let them know they should have all the info before turning it down. This has been the most rewarding job in my life and I hate that more people don't get to experience having a calm, well trained end of life nurse to ensure the journey is as peaceful, comfortable transition. Feel free to message me if I can help in any way. Good luck

I'm sorry that you have obviously had bad experiences with hospice in the past. I have been a mental health nurse for 8 1/2 years and just recently changed to hospice RN case manager 3 weeks ago. I have to disagree with you about hospice only being useful in few cases. The problem is that most people are not educated to what hospice really is or what it means. Most of the time, hospice is called in when the patient is already imminent instead of weeks ago when the problems started. I recently had a case where a gentleman had been in the hospital for over one month reviving chemo treatments. The last dose of medicine nearly killed him then. The family called us to do a consult at the hospital. While there, I witnessed a level of suffering that was ridiculous for an in-pt with a hospitalist as attending. The chemo had shredded his throat, he was able to talk very little due to the throat pain. He asked for pain medications but told the nurse he would like a shot instead due to his throat pain. The doctor refused to give him one. Also ignored the suggestion of B&O Supp for bladder spasms every 30 seconds. The only order the dr would write was to d/c all meds. Hospice stepped in, got him moved to nursing home, got comfort meds onboard, educated and calmed the family. I am proud to say that we were able to bring him the comfort and peace he and his family needed for the three days he was on services. SmalltownLVN/RN

I have been a nurse in mental health for past 8 1/2 years. Last year I went back to school to get my RN. While in school, I remembered what it felt like to be a nurse for physical health reasons. I am fairly burnt out on mental health and I applied for a job in the OR. I have always wanted an OR position, I am fascinated with everything that goes on in there. I am so ready for a new challenge. The only problem is I am getting paid VERY well at my job due to experience and my boss even offered me more when I told him about applying for the other job. I am not the nurse that takes jobs for the pay but, this would be a LARGE decrease in income. Has anyone been in the same situation that may have some advice for me?Thanks SmalltownLVN (now RN)

]Hi! I am new to this site and would really like some advice. I am currently a nurse in a psychiatrist office and have been here for 3 1/2 years. I am no longer challenged and would like to change my field. Being a scrub nurse really interests me but it has been so long since in the actual medical field I am having a hard time getting out of my current situation. Recenlty applied for a job at an orthopedics office but was passed up due to lack of experience. Hospital here is needing a scrub nurse but needing to be certified. I have been unable to find any place that offers that certification. I am not opposed to more schooling.