uahrn915

Your getting hosed and a half. My first assignment is in California and it is anything over 8 each day gets time+a half. Jeff

I work as a Clinical Director in a hospice in Alabama. Medicare/Medicaid are very clear when it comes to the on-call nurse. Have your non-clinical staff look at those regulations from your state's Medicaid website or PalmettoGBA so that what they are doing internally for on-call documentation is taking care of the questions that will come up in an audit. In our case, we update the log every morning. The on-call nurse from the previous night is expected to report any calls to the Clinical Director. Information is put into a call log showing who called, time nature of the call, if a visit was necessary and the outcome. Auditors get an overall picture of how the calls were handled and can then go to the chart to look for nurse's notes from that date. Auditors love it and are less likely to ding you if you are making their job easier. As far as deciding if the pt needs a visit, RN's were drilled on triage during school and especially on the NCLEX. Tell your non-nursing leaders about the ABC's of triage... airway, breathing, circulation (and C is also for comfort in hospice care). You could add P for pain, but usually, if your case managers are taking real good care of their pt's, on call nurses shouldn't have pain issues. Sometimes the caregiver forgets to try giving btp meds before they make that call and when you follow-up the pt is fine. As mentioned before, if you hang up the phone and feel that patient will be OK, you have done the right thing. If you hang up the phone and second guess yourself for 30 minutes, call them back and re-assess the patient's status. If it is worse, go. If the CG says she is resting comfortably, get some sleep until the phone rings again. The next call may really need you there. (God seems to always keep that organized for me.) If you went on every call, you would be costing the company unnecessary money. You will take the whole day's reimbursement on an un-needed call. But most importantly, you remove yourself from getting to someone else that might REALLY need you. Take the time to talk to the caregiver. Sometimes they just need reassurance that they are doing the right thing. Your calm soothing voice may be the only thing they needed. And as mentioned, always ask if they would like to have the nurse come out tonight, or would you like me to just let your case manager know the concerns in the morning. If they choose the latter, be sure to let the case manager know in the morning. Jeff

Sounds more like "stretching the truth". I agree with Mystery. A hard recert is a discharge. If the powers that be are pushing to recert and you feel the pt is inappropriate, ask that the patient be reassigned to another case manager. If that line of thinking continues, start fixing up your resume'. Medicare and Medicaid don't play. Jeff

There are many patients full code but many times this is due to lack of knowledge on the patient's part or the family's part. Counseling for the patient and family together on admission or on the initial case manager's visit should include this hard question: What comes after his/her CPR? I usually explain to them that I am willing to do whatever they decide, but I want that decision to be the right one. It can be very traumatic for the family to see CPR being done on the patient for even 2-3 minutes and I have gone for 10. Let them know that after CPR compressions, the patient will still have the same terminal dx, along with some very painful broken ribs that can't be mended and will hurt with every breath. Hospice counseling should be ongoing to prepare patient and family for the inevitable. If this is being done, eventually the family will sign the DNR/DNI. Afterwards, they will need your assurance that they made the right decision. In some cases a patient can pull out of a crisis after CPR, but most are not hospice patients. Jeff

I know this is late, but someone else may be looking for help on their upcoming interview and I just finished responding to a similar private message. Copied my reply and thought I would copy/paste them over. Maybe someone will benefit. The most important things to look for in a hospice company: 1. The company's owners and management must be in the business for the right reason....and I feel the only right reason is to provide the best patient care (that will be the common thread throughout this note) without greed. It ain't about the money or what it can buy, it is to provide a service that is sacred because of the sensitive nature of the services. You are going into the homes and lives of people getting ready to send someone off on that glorious final journey. 2. If the words "God" or "faith" aren't mentioned by you in the interview, they may not be mentioned at all as to "not offend someone or show descrimination". Bring up the subject if you are a Christian and if they don't offer any back, go to the next interview. If God is not in the heart of your hospice organization, the life expectancy is greatly decreased. 3. You can not work alone in a hospice so be ready to be a team player. Ask about the teamwork in the organization. It must be strong. If you don't see cooperation during your tour of the facility (and you can ask for one), then you don't want to be there. If you get held up with a dying patient, you want to be able to call a fellow nurse and say HELP! and hear there concern for you when they say "how can I help?" 4. If you don't feel comfortable with your first contact inside the office, chances are the public will be just as dissappointed as you are. If you go in and ask for an application or ask if you can drop off a resume', they should be falling over themselves to get it to you. If they act rude or inconvenienced, just say never mind and walk. 5. If you are an RN or LPN with a year or more experience, you have a ticket to the world, but you have to ask for what you want or feel you deserve. I have never hired on at the company's "starting rate" of pay. After a couple of interviews, you can usually determine about what you can get. Hello, there is a nursing shortage. Ask for it! 6. Have a list of questions for the interviewer. This blows them away... I pull out a list of questions that is 2 pages (with spaces for notes). I ask all those questions that they "forgot to tell you" in the initial interview: What is the rate of pay? is overtime allowed? what is the OT rate? what is the mileage rate? is there any bonuses (sign on, christmas, end-of-yr profit share)? Do you provide cell phone? company car? Will I have to take call? what is the rate on call? does on-call time start with travel time from my home? How is vacation earned? Do I get Medical, Dental, Eye Insurance? if so, do I pay for it? how much? how much does the company pay? When was the last state survey? How many deficiencies were out? How many standards were out? {If you would like the whole Word doc let me know or do a internet search for "questions to ask during a hospice interview".} As far as companies to look at, take a resume' to all of them knowing what you now know from this note. Every area is different. One of the Oncologists in Birmingham, AL had a patient in my territory around the Huntsville area. He recommended Odyssey Hospice because they were so strong and took great care of their patients in B'ham. Two weeks later, the patient's husband called me and switched because the nurse had not drawn labs for 5 days post-hospitilization for hypoxia r/t PE. Patient had been on coumadin. When the nurse finally got the lab done, her PT was 65 and the INR was over 8. When I contacted the MD he couldn't believe that the level of care was that different from the same company in two different cities. Two weeks later Odyssey in Huntsville sold their patient load to AlaCare and Wiregrass. The point here is that I can't tell you which hospice will fit your needs or meet the criteria mentioned in the 6 points above. You make that decision, and it starts when you walk in the door with your resume'. Hope that helps.

I too am going on my first assignment in a couple of weeks. It is very scary and you just don't know who to trust. Would love to meet any fellow travel nurses in Long Beach/Southern Cali area. I start 9/24/07 and finish @ Christmas. Send me a message if you are in the same area:idea:.

tencat I wish I could come help you. My ship is going down for the opposite reason, marketing is not bringing in the patients. Of course the owners blame that on the clinical side because we don't admit all of the referrals. But when the lady is driving, she doesn't meet criteria for DEBILITY! lol Anyway, would love to restart with a company looking for a leader. Right now, though, I have decided to see the country and do some hospice travel nursing. California here I come!!!

I work as a Clinical Director for a hospice in Alabama. Our nurses are capped at 12 patients. If everyone is full we hire another nurse and I see patients until new nurse takes over. The advice about organization is the best. It can seem overwhelming but if you take some time to organize patients, tasks and paperwork/puter work, everything will eventually get easier. Best of luck, and remember that everyday is a blessing. Jeff

Many elderly pts are knocked for a loop by pain meds/anxiety meds, but if they are truly appropriate hospice pts, you don't want to see them with RR >30. Use that PRN med and have the standing order to increase dose by 50% PRN when you really need it. Our hospice pts have responded extremely well to compounded medications to help with pain & anxiety. Ativan/Benedryl/Haldol (ABH gel) works fantastic and is absorbed thru the skin over the carotid. mso4 can also be compounded and applied this way.

My career is going up but the company is quickly sinking and have decided to do travel hospice nursing. There are so many companies out there and they all seem about the same on the surface. Please post what worked/didn't work for you in your travel experience in any position. Jeff Hornbuckle, RN, BSN