sandygator

The fact that there was SO much fraud in Hospice has prompted CMS to take a closer look at and beef up regulations concerning Hospice care. Unfortunately, they have gone overboard with their regulations (as per usual when the government is involved). The closer scrutiny is both a good and bad thing. The bottom line, of course, is that Hospices must follow their regs or be denied payment. There is no negotiation. I'm glad to be retiring soon, because I do NOT like non-nursing entities dictating our practice....ever since the beginning of JACHO!

I was CN in a large University Hospital PICU for 20 years. I am now a CHPN in an 18 bed inpatient Hospice Facility for nearly 5 years. Talk about 180 degrees! I was ready for this change, but even so, it took some adjustment. As one responder said, letting go of the numbers is a biggie. There are few emergencies. Comfort is the basic need of most of our patients. For that I am SO grateful! So many years of futile treatment, causing so much pain. I'm so glad I can now face the reality of death which our society so vehemently wants to deny. And to help my patients and families along that inevitable journey. I will be retiring after 40 years of nursing next July. But I will continue to work with Hospice patients in some capacity. It is very rewarding when you know the facts and can impart them with compassion to patients and their families. I always had people say, when I was a PICU nurse, "How can you do that? I would get too attached." And I would answer "If you don't get attached, you are not being the best nurse you can be." Same exact thing with Hospice. Get attached! Cry with them. Love them. Your life will be better for it. :-) I wish you and your patients all the best!

I work in an 18 bed house. 2 LPNs And 1 RN mostly, depending on census. Sometimes just 2 nurses, usually 2 cnas.

I am a relatively new (3 years) Hospice nurse but have nearly 40 yrs nursing under my belt. Enough to know how to research meds. It is my understanding that Octreotide reduces both bowel motility and production of secretions and we use it to decrease pain associated with bowel obstruction. It seems to me that administering laxatives concurrently would be contraindicated. Can't seem to get a satisfactory answer from our MD. Wondering what your experiences have been with this?

I have been a nurse for 37 years. The first 10 as an LPN. Most of my positions have been in the field of pediatrics, mostly ICU in large University Medical centers. I retied complete "burned out" When I wanted to return to work I started with an agency and was sent to a Hospice Care Center. WOW...I knew this was what I wanted to do right away. No more hurting people (or children) for the sake of curing them. Just a very lovely and loving way to help families and patients through one of life's most difficult aspects. Now I could treat symptoms physically (Pain, N/V) and address spiritual, social, and psychological needs at the same time. Hospice is about LIVING every minute you have left. Living in peace and comfort. Resolving issues, facing obstacles, making amends...so many things! Perhaps "upstairs" it's about the money, but at the bedside, it can be tremendously beautiful and rewarding. I thank God for this last calling for me. :-)

Allimariee, I read your post celebrating 2 years of sobriety..that's wonderful!! People tole me that if I could give up alcohol I could certainly give up smoking...boy are they clueless. I did, however, use an AA slogan to finally quit after trying everything known to man. "Let go and let God" I was only able to quit when I told God that if He wanted me to quit then He needed to do HIs will in my life. Today, it is still my will to get that pack. But I don't, and I know it's because of His will! Best of luck to you! Sandy

Alli et al, Welcome, congrats, and talk anytime you need to! Sandy

Dear RN, I am struggling now with so many effects from my not working...money, guilt..mainly. I started out with a counselor thru work (EAP) but did not find her helpful, then went to a Psychiatrist who only wanted to give me pills, with no counseling...not the help I sought. I am afraid of where my depression would take me so I am trying again to find counseling that I would benefit from. Not all styles or personality are fitted to everyone. Keep trying! e-mail me if you would like to talk, commiserate, whatever. God bless you, Sandy

I'm pretty sure my first post here was maybe in 1997...as a newly recovering addict. After 34 years in this profession, mostly in PICU and nearly 98% pediatrics, I realized today that I am indeed traumatized by my past. I came online looking to see if I was alone. But it is not abuse within my family....today I remembered a 4 yr old... lifeless, so pale, except for the bruises which covered his body. I remember so vividly the parent who angrily confessed that "the boy just refused to walk right"...so he beat him to death. I thought about the terror that child must have felt just before he lost consciousness. I remembered the tiny little boys we (PICU RN's) referred to as 'the blues brothers' because of the constant 'blue spells' requiring resuscitation, who all ultimately succumbed to their respective disease states. So many infants born of addicted mothers....left...just left...in the picu to be cared for by us. No family, ever. How many mother's faces did I look into as I laid their already lifeless child in their arms after I took them away from the machines which made them seem alive for a while...sometimes very long whiles. How many times I hurt a child in the name of treatment which we all really knew was futile. Oh my God that one hurts. I remember feeling guilty about the joy I felt as one family lost a perfectly healthy child to a gsw to the head because another child would live ...perhaps...even tho it would mean a life-long regime of medications, lab tests, fear of rejection. The broken hearts of family members over a brain dead child due to shaken baby....the sorrow I felt because he really didn't know....the rage I felt because she lied about her boyfriend and the baby to protect him. I am thinking how there seems to be an invisible wall which surrounds the bedside of a dying child. All the cacophany of picu noises dulled by broken hearts. So many times I was so angry yet so helpless to make a difference. There were miracles, yes. There were triumphs, many. But today I realize, I am traumatized. I will not return to substance abuse...which is how I suppose I lived through it all. But I am asking for your prayers as I learn how to begin to deal with this realization. Thank you all.

In the early 80's I was working in a Miami Hosp in CCU. I was taking care of an intubated young black male who had the most forceful productive cough I've ever seen..when I would disconnect the ett to suction him he would cough huge luggies all over everything, including me. Well, I was grossed out and tired of changing scrubs so I had what I thought was a brillant idea; I took a pillow case, cut eye holes and placed it over my head when I suctioned. Then a young black nurse gently explained why this was not really a good idea...she told me I would give the poor man a heart attack if he woke up to find a white hooded person standing over him! We both laughed so hard at my stupidity. I did look funny in the pillowcase tho *grin* (P.S. Please do not think I believe there is anything funny about the KKK)

Originally Posted by burn out This is why I do not like to work with nor do I think rehabiliated drug users need to be floor nurses. I am a recovering addict/alcoholic, and a 33 year veteran of nursing. Celebrating 10 years of sobriety, thank God for that! My patients are lucky to have me, and you'd be lucky to work with me.

htp://www.townhall.com

I have recently returned to the PICU after 7 years away. To my surprise our unit is also now the pediatric CICU. We currently have one 9 yr old who is day 49 on the berlin heart. He is doing very well with usually bid electrolyte replacements, q week teg studies, off heparin on coumadin. Nutrition is a bit of a problem, but his appetite is improving. The bedside RN is responsible for Q 1 hr. inspection of the BIVADS as well as recording of the pump settings and pressures Q 1 hr. We have also a perfusionist (who is ultimately responsible) on call 24/7. Our pt ambulates at leat QID with one nurse pushing the pump and another pushing the chair behind in case we need to rest. We have 1 other pump kept for emergency back-up. The FDA has not approved the heart for use yet, so it is being used on some special mercy plea (I'm not at all sure exactly what the termionology is), and we too are sort of making it up as we go along so to speak. We currently have a second 9 yr old patient listed 1-A in whom they are thinking of placing a THORATEC VAD because we only can have the 1 Berlin. The VAD class I attended taught us that earlier use of the devices is yielding better outcomes..placing it before the child is so seriously comprimised due to decreased perfusion for a long period. What do you think?

I purchased "Unlimited CEU's" from this website...my bank shows payment...but the site still asks for payment for certificates. E-mail inquiry begat auto-response about how busy they are. Any one else having this problem?

I have been asked by the manager of our 24 chair chronic unit to formulate some hard data criteria to use as indicators for use of the crit lines as we only have two to use. What specifics (if any) do you all use? Some ideas are % of deviation from Tx goal, increased incidence of IDM's (which is not hard data), post hospitalization, etc. Any helpful hints, ideas? What criteria do you all use? I love the machines, but we need to prove their usefulness and also establish QA guidelines for their use. I am having fun with learning since I am still relatively new to dialysis. Also, I was wondering if any one uses profiles with crit line and how does this affect your 'A,B, or C' graph line? Thanks in advance! Sandy