Ginapixi

yes! it is done with gloves and i have done plenty of blood draws in the hospital setting as well as in the home (though MUCH less!), port access etc, always with gloves - However, i have started nursing back in the day when gloves were for the OR, may be (!) dressing changes and guess what, we used to clean and sterilize syringes as well as hypodermic needles and had less infection rate than we do now! so don't get your panties all in a bunch if some one does it with out gloves - patients at home have their own home germs IF the nurse does excellent hand washing the infection danger is probably way less than in a hospital setting

nicely done!

I hear a lot of agencies will pay per visit, especially off hours; a case load of 15 should be manageable if there is back up if needed; who covers nights/on call? and how large is the area you cover? I used to work for a company who paid salary to RN, hourly for HHA and LVN; case load of 30+/- 2 RNs, 1LVN one admission RN who ran under marketing and had to fill in for nursing when ever needed (which was more often than not); on call (from after office close to the next morning and the weekend) was on rotation between RNs and the DON, so one week/month; this was not too bad 90% of the time; but once we were to cover continuing care, some times up to 3 days - you work the night and were expected to be back on day shift the next day! no extra pay mind you ..... turnover there was rather huge!

seriously, the med dir should have talked to the case manager as well as at least one of the family doctors where i worked patients always kept their family physician or other doc as attending, the hospice med dir was only a back up and support; other physicians is no reason to discharge a dying patient! if i was family or a doctor friend of that patient i would report that hospice!

I have seen similar cases quite a few times. Some times it was denial on the side of the family, some times over-protectiveness, some times selfishness... the reasons are many and for those working with death and dying on a regular basis often hard to understand. Over the years I have come to the conclusion that each family has their patterns of dealing with unpleasant events. Those patterns are not easily changed and much less broken! It takes a lot of patience and understanding, listening and feeling for the right moment, when some family member (or the patient) dare to open the door a crack. The patients often know and do not dare to talk about it either. As long as we value life on this earth more than honesty, as long as we play pretend games, we as the caretakers of patient as well as family have to be patiently and gently pushing toward a place of rest for all. Not an easy job!

yes it is - or it seems so to you - and me, and many others a regard for people, alive or dead not every one has it laws, regulations and the understanding of death do not make the scenario any easier at least here the police and ambulance called out and then heard it is a hospice patient do minimal if the person has passed, no heroics until hospice staff arrives and then hand it over - then again there are a few wannabe heroes joining the EMT force who no matter what.... unless they have a DNR in hand (and then it is hard for them not to jump into action) if the basic understanding is missing, be it in the patient, the family/caregiver or any other involved, your story will repeat! Sadly! keep teaching, do not be discouraged! the poor patient got his deserved rest after all - not the way we would like to see it happen, but he finally reached his destination.....

over the years i have come to the conclusion that yes, the company needs to treat you right, but they are about all the same; the difference ? The colleagues you work with! they are the ones that either support you or... burden you (no one has stabbed me in the back really) If you are OK with what the company gives you in terms of benefits and pay then it is really up to the people you work with; on call can be overload or not bad; i hope it works well for you!

remember why you changed job fields!

seriously what ever happened to nursing care? does an enema in the case you state not fall under basic nursing care? what in the enema is medication? I got out of hospice care because we could never care properly for patients after hours (had orders but no meds and so on) and I cannot work with human beings who suffer based on all protocol and no compassion! How can you stand working under those conditions???? tewdles makes a good point!

we live in such a fake world! most patients know very well that they are dying! some may deny that fact, but they know once hospice is involved. Some families try to spare the patient, some patients try to spare the family, but the longer one works in Hospice the more one realizes no one is spared that way; so yes SW to the rescue! it sounds to me like the woman neither reads nor speaks English, so you also have cultural believes to consider....

yes, I was not implying they are no good, they can be helpful, I just think we put too much emphasis on them; I am so sorry to hear about the shortage of beds, but we used to have to pick and chose (unfortunately many times the choice fell to the ones that could pay, but not always) and thanks for not misunderstanding :)

I can see that some may take offense at my comment, but it has bothered me for quite some time that nursing, even hospice nursing, has become such a business. We need to fit people into categories in order to get the needed support for them; some patients really need the help but are not willing to accept it even if they qualify; others really need the help but we cannot get it for them because they do not quite qualify; then we get the ones who will take any thing because they qualify. How many times have I done the "aid's work" because it was needed at the time of my visit, then was told I spent too much time there, yet we are also not allowed to give help off the time sheet. To me it will always be a financially driven business (and i worked for a non profit!) and not a patient driven care service as long as we have categories and constantly growing regulations.

stories like yours "by Marties" just make me wonder! thanks for sharing!

we used to have some when i still worked, usually they were in such a state that transport was not feasable or not wanted and death was most often within 24 hrs - we basically made sure the symptoms remained controlled (nothing the hospital staff could not do, however some physicians seemed to listen to hospice recommendations better than hospital staff)

back in the seventies when i was in nursing school, we had a pt who declined over the weeks and was actually exhibiting all the text books signs of dying; the floor nurse took us newbies in and did a wonderful job in caring for the patient as well teaching us how to respect the deceased; it was touching and left a life long impression! to this day i remember the man's name! and yes tears at times still flow, this is life and death!