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!

Thanks for sharing! I enjoyed it!

I too have encountered this vocalization a few times; in one case it was more an expiratory "hummmmmm"; with enough pain meds on board and no signs of pain at rest as well as with care and talking with the family to put them at ease, we just let it continue; at times it reminded me of how different women go through labor though, they hum with contractions and will tell you they feel better that way (not so much because of pain, but to deal with the situation) But what do i know, those are merele observations;

Suncoast can be what the company makes it! initially ours was dreadful! later on, once we got an IT person who knew the stuff, it kept getting much easier! entries carried over from one page to another, and we actually saved time! if you switch from what ever to some thing new it will always take longer, just because it is different; once you learn the little short cuts and things, it is not so bad! However the suncoast training person, who came to introduce the new and great changes was a waste of time! Out IT person worked so much better in tweaking and changing the fields to fill in per our requests (get rid of things we did not use, put in fields we needed) but i am out of the rat race for now and do not miss charting ONE TINY BIT!!!

too funny... FYI some banks still give out free pens!! and never mind the free bag! my company ordered bags for the field staff: they are way too small, tip over when you set them down and NEVER hold my stuff; they knew the bags were not user friendly! now that we hired more staff they ordered more of the same stupid bags.... free is not necessarily good; i use a leather bag; looks like a camera bag or a large mens toiletry bag with 2 larger and several smaller compartments, zippers and all - even a place to put my glasses in; the side "cell phone" pockets is great for pens or scissors and hemostats! and my papers and laptop i carry separately and do not always take into every home, depending on need; but i like a lot of the bag suggestions on here and am going to look for a "perfect" one :)

I don't know about other people, but don't ever come to my house and put news paper on my couch to put your bag down! especially if it is a rainy day..... We are supposed to use news paper as well, i cannot stand it! however i have plenty of plastic bags from the grocery store and will gladly put that under my bag - and put all my trash in before i leave and throw it away; i have used chucks at times; as for bags, i did buy a nice wheeled one, however they are too much fuss for me to put in the car (too heavy to heave to the passenger seat, too cumbersome to put behind the driver seat on a rainy day and no access to my phone and note book i put in) and it got way too heavy once you climb several flights of stairs, the wheels don't do so well there; also hated dragging wheels through dirty streets so i would always carry it; yes it fit every thing including a pal top, but my back did not appreciate it; i found the same with any bag and now carry 2; one with all the tools and one for papers and lap top and i am balanced and depending on the visit i only take one in; if this helps.....

don't feel bad, most nurses are "suckers" i know first hand! at least you tried and it is not your fault the "project" failed! if the expectations are humanly impossible... i know, it always looks good on paper, until reality hits...

good for you! set boundaries! yes! i am still learning to do that myself - if the job eats you alive it is not right, no matter how much you want to do the job! and if you are ON CALL you should not have visits planned for you already, be it routine visits or admissions; on call should NEVER have to do admissions! ours had to do one once in a great while, now that we have 2 evening RNs on call only does an admission if she fills in outside her on call; our weekend on call never does admissions; don't let them abuse you!!!

there is the saying "we die as we lived" - in some cases may be if we did not finish our clean up jobs we cannot die in peace? and all the pain is partly emotional in origin.... i had one patient who was alert and did not want pain medication, became more and more confused; out of bed, back to bed, into the wheel chair, back to bed..... the family was at his service and did what ever he requested; yes he wore them to a frazzle, and thankfully it was a large family so they could take turns; i felt badly for all involved BUT the daughter told me after he finally died that it was a great experience: the pt had seen other people in the ones that were present and had talked about different occurrences in his past and asked some for forgiveness for what he had done, others he just told old stories to them and on and on; after he was finished he settle and died; that family was grateful for not having used pain meds - go figure so yes, if that patient could work on her issues it would be the best, however.... if she is so resistant then she will have to die like she lived..... we all make our own choices when i first read the original post i had one thought: may be instead of all the meds we need an exorcist here? much prayer could not hurt! my prayers are with you who care for her!!!!

yup, once in 14 days --some times we have new pts who still do well and they only get a visit q14 days (however they usually decline fast and go on a every week schedule with in a month or 2)

our census is around 150 and we have changed our evening on call nurse hours to 12 - the 16 hr on call can be quiet but can be nonstop and exhausting! we used to have one evening RN on overlapping with on call nights until 2300; now we have 2 full time evening staff and on call nights Mo-Thu 2000-0820 and a weekend on call for the same hours; our on call RNs do no longer do new admissions, thus 2 Evening RNs Mo-Fr 1500-2300 and we need it! more and more admissions are after 1700 and we had Fridays where 3 RNs were out doing admissions; needless to say we complain, because we also need to cover phone calls--- IMHO 16 hr shifts with new admissions is too much, but it all depends how many admissions they expect you to do; tewdles put it very well: set clear boundaries! if you burn out it is not helping any one!