Never2L84Peace

Try to hang in there I'm in a small town also. When I started 5 years ago. I was the only RN out here. Now we have a team of 5 with a team leader. Try to get the word out. That helped here. When I had to call the clinic for things, I'd share "good things" about the job. However, the first 2 nurses that joined me out in this area...left. It is SO hard to get management to listen. I would repeatedly remind my manager that I was drawn to this job because of the co. reputation for caring and how sad that "I was wrong...because when you take more pts...you are telling ME that you care more about the almighty dollar than you do pts or your employees". That seemed to fluff a few feathers. I shared that not only with my manager but her boss also. The adds in the paper for more staff were more apparent after that. BE THE SQUEEKY WHEEL. Best of luck to you.

I had an incredibly sad situation with a glio. pt/family. She was only 60. Her spouse was her soul mate. Her daughter, amazing. The pt was a BEAUTIFUL woman robbed of her beauty by this disease which caused her head and face to swell. She developed petechia all over her legs/arms. She lost the ability to communicate. First she would search for words and say things like, "the cat hurts" when she wanted a drink of water. Then, she would get so angry that she couldn't communicate. She loved massage until closer to the end. Her skin became incredibly sensitive and caused severe pain to be touched. She responded very well to roxanol sublingually. She did have a few seizures near the end (small) so we began using lorazepam sublingual and that seemed to relax her very well. She was inct. near the end and we placed a foley catheter which she hated but family 'needed'. It is SO hard to shift from knowing all the labs, signs etc to focusing on the pt and the sx. This family was so incredible. The pt was one to always be outside. Then when she got worse (no ability to sit up d/t weakness and severe vertigo-managed with meclizine initially, scopolomaine later) the family moved a hospital bed by the living room window. Ever day a GOLDFINCH would come and peck on the window. So her soul mate decided to open the window and see if the bird would fly into a cage...it did. It sat by her bed and sang and they fed it and talked about the outside sunshine that had come to her side. Then one night, with her family all around her, they let the bird go free and told her to follow the bird home...she died within the hour. Even more bizzare...there was a goldfinch at the funeral home on the day of her sevice. Her spouse is crushed, grief beyond words over his loss. We still see him for support. GOOD LUCK.

If you have the option, check into home care. We see many CHF pts on homecare and can help them and the family and the MD make the adjustment and decision for hospice. With our agency, the pt/family can get to know the hc nurse and then with time, if they chose hospice, that same nuse can provide continuity--plus there is already trust. I've seen quite a few CHF pts so not ready to quit, yet their body is done. Ejection fraction, BNP, symptoms and QUALITY OF LIFE.

I've been working with hospice the past 5 years. I have had a caseload as high as 23 (home care & hospice-mostly hospice). Right now I have the lowest caseload I've ever had of 8 hospice and 3 hc. Acuity makes a huge difference. Sometimes 8 hospice, high acuity can be 16. I think I am one of the most fortunate hospice nurses ever as our agency is expanding by the day. We have a team leader for our area who is constantly looking out for us and making sure our caseloads are manageable. It all varies. But it is SO stressful when you miss things. Especially when you are fairly new. Hang in there!

I'm stumped on this one and could use some help. Mr. S has end stage renal failure (refused dialysis). He also has hx of reflux and has been on multiple meds for this. He has been throwing up every day. Sometimes he has nausea, sometimes he just throws up. AP is dropping and has been 48-52 the past week (thinking K+ is probably even higher) and has some jerking movements also. He has tried: reglan, compazine, haldol, scopolamine patches. He is on nexium. Has tried: zantac, protonix, achiphex. He takes iron which he feels is 'keeping him alive' and won't even hear of holding that. Over the past 2-3wks has lost 12lbs. His legs (feet esp) look like stuffed sausages with the extensive edema. He has multiple heart issues also. Taking amioradone, tricor, lipitor, plavix... His MD is of no help, with answers like, "whatever you think". He is allergic to many meds. APAP #3 is the only thing he can tolerate for pain (crawling sensation, chest pain, headaches) and it takes all of his pain away. He is able to sleep from 10pm to 1am with use of APAP#3, gets up to pee (still going about a liter a day, sometimes more) then and takes another APAP #3 and sleeps till 5am without nausea or pain. Then he dreads the day. I thought about topical gels but his only caregiver is slightly demented and I question her ability to apply gel or for him to figue it out. ANY SUGGESTIONS?