lantanaRN

1) we provide a comfort kit with Ativan tablet form, Haldol concentrate..for severe agitation and nausea/vomiting, oral MSIR solution, robinul (secretions) Tylenol suppositories. That being said first line of defense for agitation (terminal or otherwise) Ativan, followed by Haldol and for severe terminal agitation unrelivied by the former, phenobarbital subq. I will more likely see a need for the phenol in younger patients who are usually no where near emotionally ready to die. If the reactive to Ativan is increased psychosis obviously we move on to the Haldol

Welcome to the "new" hospice model Been doing this for 10years for a top 11 in the country large not for profit All was good until 2 years ago when they started transitioning with another hospice and another county Total census over 200 covering multiple counties When previously my load was 12-15it has steadiy creeped to as many as 28 All in homes, spend at least 3 hours in commute time, and the higher the load the more I feel like I am doing "hit and run" visits which is not what I want to provide The families and patients deserve so much more, yes some visits can take 30 minutes or less but soetie way more. Thank goodness we have admissions nurses who do only that But I do do CTB which can also take several hours as the goal is to get them out and into an inpt bed or home on crisis care. But it is still so emotionally/spiritually rewarding that even tho I get frustrated over the corporate bs at the end of the day it's all about making the transition rewarding at best, comfortable and at peace

Capt Kris, I do not want management but want to be the best in my field, therefore I take it. The ABC's behind my name tell my patients I am an expert in my field

Do the online review. How long have you been a hospice nurse? The exam is tough, almost tougher than boards, do not focus on what YOUR hospice does remember that others do it differently Know the medicare regs, drugs most commonly used etc. 4 years ago they were really focusing on palliative care, including labs we don't do, etc. If you have never taken the CHPN get the book, but did not know it was now 150 dollars!! Bad enough the exam is close to 400. My employer used to pay for the first exam, but to keep our encentive pay we had to retake on our own dime. Now they don't even take that into account, except to be an RN3 I must continue taking the exam every 4 years. The more experience you have obviously the easier it is. I have taken it 3 times, I do not study, never have, count on my experience and photographic memory

Jazziepants: you get it and you have it, paperwork and other tasks are a necessity, but showing love and compassion are what help these patients.

I'm having trouble understanding how non hospice trained personnel are even providing hospice care As a certified hospice palliative nurse I educate frequently on the myths of morphine and the actual signs of active dying process. Uneducated patients and families and other medical professionals buy into the myth and it is essential that they be educated over and over

The question you need to ask yourself is do you have the "hospice heart" Hospice nursing is a calling, either you have it or you don't

Dear Son: My heart goes out to you in this very difficult time. Your mom is beginning to show signs of shuuting down, which is usually the norm in a life limiting disease. However, your mother has also bounced back many times before so there is alsways HOPE. That being said, briefly what may happen is that she will continue to be very sleepy most of the time and her appetite will essentially vanish. All of which is normal in the dying process. You mentiona a new pain patch, which may be partly causing the sleeping..once her brain adjusts to the Fentanyl (which is similar to but stronger than morphine.) she may become more alert and functioning. Ideally her pain is managed..as gangrene can be quite painful. If she is comfortable than the rest of the process should follow a pretty predictable path. Your hospice nurse will be monitoring the effectiveness of her pain control, and ideally will adjust as needed to keep your mother pain free. God Bless you in your journey.

Wow, you'd think there would be more replies to this one. I feel that experiencing the EOL journey with my patients has enhanced my beliefs in life after death tremendously. I have always had a belief in life after death, but now feel that I know for certain that death is merely a new beginning. There are too many stories to tell, but suffice it to say that almost all see someone waiting for them, almost all sense weeks to days ahead of time that it is coming. Many are able to share if the right questions are asked. I do agree with the first poster that the ones who have no belief do seem to have the hardest time and suffer the most agitation towards the end. I also find it interesting that the more I am open to the more I experience, spiritually with these patients.

when they get that unmistakable look in their eye

You are correct on withholding a prn dose, however I am referring to a routine dose, and as many of the other posters have stated, that routine dose that you choose to withhold could cause my patient who appears to be pain free to be right back in pain again and harder to control because the point was to keep on top of the pain and not let it escalate.

BTW, if the order is for every 3 hours and YOU decide to withhold a routine dose you are making a medication error. A patient may be on routine morphine for many reasons, and to withold just because they are asleep or unconscious is wrong.

Heather welcome to Palm Beah County..I work for Hospice of Palm Beach County and love my job. Good benefits, and the pay, for me ,. is better than I made in Missouri 4 years ago. However the cost of living is outrageous. Good luck. By the way HPBC has an inpatient unit at JFK as well as 5 other locations.

Hi fellow hospice nurse: in answer to your question, I am a case manager RN,CHPN in Florida, I believe the other posters are correct..only RN's are allowed to do the initial assessment, implement or update the POC, and are required by medicare regs to visit the patient personally at least once every 14 days. in addition. continuous care (crisis care) cases must be supervised by an RN daily, LPN's can staff the case. Sounds like your hospice needs a few RN's

Pretty insulting to the nursing profession I think. Met a few paramedics like yourself too along the way who look down on the nurses. Wondering why in the workd you became one if we are so incompetent.

Having worked in LTC for several years, and having worked in a state where med techs were the norm, I do know that it is not in their scope of practise to pass narcotics. As of at least 5 years ago, Valium was a countable narcotic, meaning there was a shift to shift count between nurses, and someone should have noticed missing Valium way before 4 blister packs went missing. I have to agree with most of these posters..you're in some deep doodoo here, the one who hands out tthe narcs should be looked at and if you as a tech have the key to the narcs box there is a big problem at your facility.

Well said my friend!!!!

Unfortunately I Have already encountered ignorance in treatment of our gay population. It's 2007 for goodness sake, and I have had cases where nurses have walked off the job when they learn that the patient has AIDS..look folks UNIVERSAL PRECAUTIONS are to be used on all patients, and in this day and age nurses of all people should know how HIV is spread..it's by body fluid not throught the air. It is just plain wrong that a segment of our population is still being discriminated against.:angryfire

:welcome:I work for one of the largest not-for-profit hospices in the country and love it. Pay rate is good, I'm a case mgr, salaried, 30.00/hr with plenty of overtime if I want it. Am seeing a pattern of not hospice apppropriate admissions over the last year too..families use up the SN in home health and want the same from us. Case load should be 12-15 optimally, however our team has been carrying 78 patients for months, which gives us a caseload of 15-18, which can be quite demanding at times. Burden was lifted as of the first of this month, with the addition of a new team and the spreading out of the caseloads, however, it will soon be "season" and our census will continue to climb. Fortunately I feel very priveleged to be doing what I do on a daily basis, so when this happens, I just kick it into high gear, and take PTO when the emotional overload becomes too much.

I live and practice in S. Florida as well, also in geriatrics as well as Hospice..and I have to agree with the original poster..we are a melting pot down here BUT I find it unprofessional for people to speak anything other than english to an english speaking population of patients, and trust me the professionals in the field frequently speak in languages other than english when on the floor. I agree that english is the primary language and should be spoken in the field unless you are working with a population that does not speak english. I also get frustrated when the non-english speaking persons act like I'm the one in the wrong when I cannot understand them and need them to repeat themselves.