shrinky

Normally they like you to have one year of experience before going into Hospice because it is such and independent work environment. However you do have the life experience and feel the calling so if you are able to ride with a Hospice nurse to get a feel for it then that is a good place to begin. It helps if you know your own feelings about death and dying, and have been exposed to it in your circle of friends and family. Hospice is one field where you either love it or hate it so it helps to find out as much as you can before going into this field. I applaud your desire to work in this field because I love it and will work here until I retire.

Absolutely not, I am near retirement and have been a nurse for a very long time. For me it was a calling and I am quite happy doing what I do now. My jobs have not always been easy nor fun and some have been downright cruel. However I know that there will be a reward for me when I leave this earth behind because not only was I obedient to the call but have helped humanity over the years. We do serve in this profession as Jesus served on this earth, not that I am comparing myself to Him. Those of us who are older nurses did not go into this for money, just think about how much we made way back then. Nor did we go for the glory, we did so many things that we don't have to do today. There is nothing else I would prefer to do with my life than to be a nurse and wish I had found Hospice nursing a long time ago.:redpinkhe

No I do not get yearly TB tests, I am allergic to them after all these years in nursing. If they promise me, which they can't, that I won't have an allergic reaction then maybe. But to make it mandatory, no way, I will retire first.

That pretty much says it. I am a Hospice nurse turned Palliative Care nurse, but I am on the Inpatient team. We also do Outpatient Palliative Care in the homes. We get most of our OP referrals from the Oncologist to assist with symptom management while her patients are receiving treatment and we bridge these patients into our Hospice program. We also get referrals from our Home Health team for managing pain usually, either chronic or acute. In the hospital I get referrals from the units to help families with end of life decisions, from docs for help with symptom management or to transition them to Hospice because they are not quite on the page. Our IN team consists of my doc, myself, MSw and Chaplain. We usually try to make the initial contact together but I am the only Palliative Care member who does not do other work for the hospital. So we help care for patients anywhere on the life scale from onset of symptoms until Hospice come in, some teams follow to death especially in house. We don't because we can do inpatient Hospice as we are hospital based. Sorry for rambling, this is my favorite topic to discuss. Hospice is still dear to my heart but I enjoy, at my age, not having to drive so much now.:redpinkhe

I agree, having been on both sides of the team. I would not want to be a manager again, but I respect those who do want that job. Our team is like a family mostly, but you'll always have one or two who don't play fair. We have fun days every once in a while to relieve stress, bereave the team and build relationships. Remember birthdays, put them on your team calendar if only to say happy birthday. Feed them occassionally if the budget allows or involve your volunteers, they love to bake. Importantly, listen to all sides. I once was written up for some stupid thing , but the boss did not know the entire story and when she heard my side she ripped it up. That bothered me more than anything else, she shot from the hip before I could tell my side. I have worked for this organization 9 years and am one of her best. Get all of the facts, that would be important to me. The team deals with so many dysfunctional families that we can just sometimes need to vent and be off the record, no fear of reprisals. Treat everyone fairly, there cannot be anyone treated special from the others. Good luck and let us know how you are doing.:heartbeat

Amazing responses and it could not be answered better. I find the greatest barrier to referrals to our Palliative Care program are surgeons and cardiologists. Surprisingly the Nephrologists and Oncologist refer most often. It is difficult to even get a referral from them when the family is struggeling to make decisions for the dying patient. We could be of help in presenting the picture and options so they can make the best decision for their family member who is on the vent and unable to wean off, who is 90 years old and riddled with cancer and does not want anything to be done. I had one MD call me to tell me that he needed to talk with the patient and family about DNR but didn't know how to approach them so asked for my help. So many physicians are unable to "give up" as they see it and call PC or Hospice, they really feel as though they have failed. We are trying to educate them about this very topic, but it is hard. I have discussed my wishes with my family and made a living will, but so many of our patients have not done this and then there are those with terminal illnesses who want everything done and so need education, but from who? That is another part of our role but I hesitate to overstep a docs' toes unless I am called in on consult. I think I have digressed, but at my age I can afford it. Good thread, great .com.

It is a very rewarding job for those who love itand as said can be emotionally difficult. Some nurses burn out quickly when they become too close to a patient and give so much of themselves. I wear scrubs because they wear well, are loose and comfortable and I don't wear out my clothes. Also if body fluids touch them they can be washed more aggressively. Sometimes it can be physically challenging if the patient has a difficult wound or many wounds to dress or is very large. One great aspect is that you spend one on one time with one patient at a time, and care for the whole patient. It is the type of work that you either love or don't like to do and I think we are special people.:heartbeat

Congratulations on passing the exam. I have not taken it yet because of the cost, at present we do get some compensation once a year in the NERD program but next year it will help on the ladder program. I heard from others how hard it is and I am close to retirement. I'm not sure I want the stress and cost for 1-2 years more of work.

Definitely agree with the other replies. If she is taking that much Roxanol she needs the MS Contin now in addition to Nebulized Morphine which will not be absorbed as much as oral. We have also used nebulized Lasix when none of the above help.

Sorry for your loss, you did an excellent job caring for her. Some of our nurses give out their cell and home phone numbers to patients which is not my practice. There was one patient I gave my number to, but her caregiver did not call me after hours. She went through the call system, but I knew she would not abuse the trust I gave her. We can get so caught up in our patients and them in us and burnout occurs. So glad you took care of yourself and never feel bad about taking a break. Take care and good luck.:redpinkhe

First of all I need to know what she is on for pain medication already. There are a multitude of pain meds, some specific for bone pain, nerve pain, etc. Sha may need a combination of meds. Have you tried Lidoderm patches to the are rather than the spray? Please write back and give us a list of meds.

You may have to be wiiiling to relocate to find that first job.. I just looked at ouy RN job openings and found at least one in every department and we hire new grads. We are located in SC and there are a lot of sick people here and we did get raises this year. We just sucessfully passed our TJC review and are progressive for a rural area. The lure of night life and the big city is understandable when you are young but if you need a job, widen your search. Good luck froma transplant, gotta love the winter here.

We are also a hospital based Hospice but we get our meds from our Cancer Center where we have our outpatient pharmacy for Hospice. We also count all meds each visit as we have to reorder their meds for our next visit. We ask the family to keep a record of meds given so we basically know how much pain our patient has so we can adjust accordingly. If we suspect diversion we take out only a few days supply at a time instead of 2 weeks supply. We also have them sign when meds are delivered and that is a part of the record.

Usually people will praise me for doing what I do and tell me that it takes a special person to do the job that I do.. I simply tell them that it is a calling that I am honored to be a part of. I tell other nurses that this is what I went to school for, to care for the whole person, body, mind and spirit and it is fullfilling. I think that most people have a difficult time dealing with death or even talking about death so they become uncomfortable thinking about the event. We will all die sometime but not everone wants to think about it, it is really not morbid and can be beautiful and peaceful. Be blessed and proud of what you do for all of your patients. I'm sure you are a blessing to them.:redpinkhe

My stories are too numerous to count but I will say that as people are getting ready to leace this world they become closer to the spiritual world and do see what we cannot see. Most of them see loved ones who have passed on and others see angels, the gates opening or other beautiful things that cause them not to be afraid. I had one lady who had had polio as a child and was now dying on Hospice and she was a good lady, believed in God and went to church and wanted me to sing to her every time I visited ( I was her Hospice nurse). She started seeing men in black with big dogs and snakes and this concerned me so I would talk with her about what was happening and praying and singing hymns. At one time she told her husband that he was keeping her here and he eventually told her that it was ok to go, they do need permission. She did become peaceful before her death but it was a struggle before that time. People do need permission to die and I have seen people hang on because the family tells them to hold on and as a Hospice nurse I have had to help the family let them go. Death can be a scary experience and I believe God sends loved ones to us to help us not to be afraid, especially someone who was very close and loving to us. Maybe I'll tell more stories at another writing. Great thread.:heartbeat

I've had this happen once for the same diagnosis. We have to call the coroner when a patient dies and give them the diagnosis and the patient died of Liver Cancer with Hepatitis and HIV as co morbiditites. The coroner chose to put all on the death certificate and the mom was furious. Anyway he asked us if it was ok to remove it because only he could do so and we didn't have a problem. However in your situation that was the primary diagnosis. Some of our docs write cardiac/pulmonary arrest but also put as a result of________. So I think that it has to remain as a leading cause of the death or why would the person have died of CP arrest? I feel for the families because there is still a stigma attached to the diagnosis in most areas and people are sometimes cruel. Good luck.:typing

I had that same feeling while I was out on medical FMLA for 3 weeks after lap chole and R-CTR and was writing evals and reports with my left hand, I am R handed. I didn't want to go back to my job as a manager, hated reports, time sheets, etc. I went back but did not stay long and went to Hospice and that was 9 years ago. I still love what I am doing and realize that this is what I went to school for, holistic nursing, independent work and the respect of docs and peers. Good luck in your new job. :redpinkhe:yeah:

Here in Orangeburg, SC our hospital recently hired 30+ new grads in all areas of care. It is a good place to get experience and we are not far from the beach and mountains. Go to www.trmchealth.org and there should be a job link. Good luck.

It is amazing that in all my years of nursing the one thing that has not changed is that we are our own worst enemies, meaning nurses. We should support each other and be professional enough to confront one another rather than going to the boss and finger pointing. Sending a general notice of lost charges then talking to individuals would be the more acceptable way of dealing with this soooo important issue. I realize in the economy we are in that it is important to recoup charges, but patients still come first in my book. I sure hope that somehow this situation gets resolved for the better so you no one leaves. Has anyone gone to the boss and told her how this is affecting morale and how some people want to leave? Sometimes it is good to have a gripe session and clear the air. Good luck and it isn't like this everywhere so hang in there.:heartbeat

In all of my 40+ years in Nursing I have seen shortages, then an over abundance of nurses so many times. There are jobs out there, we just hired 30+ new grads at our hospital. You may have to be willing to get experience at rural hospitals, the Navy as suggested, Army, Air Force, etc. I did the Navy thing many years ago and got great experience, of course it was during Viet Nam and we had many injuries to deal with, but I saw things I would not have seen in civilian hospitals. They serve families of military also so Peds, OB, Clinics, GYN are all available, and you can get to travel if thats your thing. So think about checking outside of your area if able to relocate and look for work in under served areas. So many of us will be retiring soon and there will be a major shortage then again. We are located between Charleston and Columbia in SC, the weather is usually warm, the mountains are not too far, neither is the ocean. Our night life may not be great but it is not too far away. Think outside the box and maybe you will have to call recruiters or go online. You may not get your ideal job the first time but it is a step to it. Good luck on your journey.

Oil of peppermint is very effective for bad odors, cancer and gangrene are the worst. When I change cancer wounds I use Vicks under the nose and it helps. A bottle of the oil with a diffuser or gauze strategically placed should do the trick.

Geriatrics has been a specialty that requires 2 more years of residency but he may get some in the next years. The founder of the Palliative Care Service at New York Mt. Sinai did a residency in Geriatrics before she changed to PC and is now head of CAPC. In all of her 9 years after college she never had a lecture or course in pain management, so how many other docs have any? No I did not think you were bashing docs, but I felt like I was maybe because I am so frustrated that our PC service is not being utilized for assisting with pain and other symptom management. Keep asking questions as that is how we learn and get smarter.

I can relate, my grands threw a book ,one at another, and guess what? It hit the screen of my laptop and fractured it. I do have insurance that covers it but I have to drive 40+ miles to take it to the geeks to have it fixed. May take a few monthes he says. It was a gift from my sis and I dare not tell her yet. Good luck with your move and sorry about your laptop.:angryfire

I am the comforter and help your pain by giving meds, holding your hand, singing to you or just listening when you are anxious. I am your family member when you have no one who visits you. I am your teacher and help you to learn how to care for yourself and take your meds or teach your family how to take care of you. Yes, sometimes I am an angel who sits with you as you go gently into the next life to help make your transition peaceful. Thank you for starting this thread. We are worth so much more than they will ever be able to pay but I am counting on my reward being in heaven.:redpinkhe

Some do and some don't and most fail to utilize services available to help them manage their patients. Most have never had a lecture let alone a course in pain and symptom management yet they think they can manage all types of pain. Most don't know all that's available except what the drug companies bring to them. We have a Palliative Care team, not Hospice, available yet our referrals are few and far between even though our Press Gainey pain scores are in the 80s. Most docs think they can handle all by themselves and rob the patient of needed services. Sorry for rambling. I truley am not a doc basher.