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Emergency, ICU, Psych, Hospice
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Em1995 has 21 years experience and specializes in Emergency, ICU, Psych, Hospice.

ER nurse for MANY years along with psych...now, full-time hospice

Em1995's Latest Activity

  1. Em1995


    I noticed you mentioned "legal", Carolyn. I chuckled. One of my 20 year old patients with stomach cancer experienced intractable nausea and vomiting. I had tried everything under the sun from diet change to meds: Zofran, compazine ativan...you name it, I tried it. One day, I met her mother out in the driveway and she was acting very nervous. She stammered that her daughter's friends had been over and that she had smoked some pot which totally alleviated ALL nausea and vomiting and allowed the patient the ability to visit with her friends and even enjoy some chocolate! I was thrilled! I told her mother that it is medically indicated and to go ahead and let her do this. I did try the pill form of Marinol with her....horrible stuff, doesn't work and it's about 90.00 PER pill! The pharmaceutical industry is really scamming the public by claiming this stuff works. To me, good ol' home-grown is effective. Once her daughter was no longer able to do this, I resorted to haldol suppositories which were very effective as haldol is directed at the vomiting center in the brain.
  2. Em1995


    The word "addicted" doesn't ever enter into my vocabulary or thought process. Pain is pain and whatever the patient says it is. Our mission is to alleviate that pain.
  3. Em1995

    mileage guidelines

    Does your agency specify a time for driving? For example, I heard one agency specifies 2 minutes per mile.Your thoughts?
  4. Em1995

    Unsafe Discharge?

    I applaud him or her, too...but, why complicate matters and continue futile interventions (lopressor). With good family support, (I assume the hospice admitting nurse was at the hospital to assure support to transfer the pt home), usually the family can be educated and supported to d/c unecessary meds/procedures....or, maybe I missed something.
  5. Em1995

    Unsafe Discharge?

    I agree with Leslie on this. But, have some comments. Lopressor will DECREASE blood pressure, if this patient is actively dying, why continue it? I question a medical director who would approve of the patient going home with IV Lopressor. And, the unsafe part....well, to me anyway, is the snowstorm! Given that I live in Massachusetts, I can confirm that it IS a safety issue when driving in these recent snowstorms! Just a week ago, someone passed me, going WAY too fast in a snowstorm, and lost control and crashed into a telephone pole in front of me....the person was fine, but the car was totalled.
  6. Em1995

    Tips for New Hospice Nurse

    SweetSue...you cannot recertify a patient if they are not showing a decline. Do you find anything that indicates a decline? Any weight loss? Increased sleeping? Increased infections? UTI's? Decline in mobility? Increased confusion? Do any of the co-morbidities effect the patient's status? Whatever....if there is no measureable decline, you cannot re-certify this person. If your agency is telling you that you "have to keep this person on your service" and you cannot document a legitimate reason, then I would look at working for another agency as this would be fraudulent.
  7. Em1995

    Use of an Oxymetor

    I have some strong feelings about the use of oximeters in hospice. As a long-time ER nurse, and now a full-time hospice nurse, I have often seen these measurements to be inaccurate and over-used(and, I saw those inaccuracies many times in the ER). Oxygen satuation measurements can be inaccurate for a variety of reasons: excessive movement,anemia (a biggie and one we see a LOT in hospice), hypoperfusion(blood loss or poor perfusion). I often recommend to discontinue all labs, diagnostics, weights and oxygen saturation measurements in my patients...and, especially in facility patients.We treat the patient's subjective symptoms, so we ought to be looking at and listening to them instead of a number. I've found too many patients who were inappropriately intubated secondary to a nurse doing this reading and calling an ambulance!(Makes me cringe....we need to look at and listen to THE PATIENT!) What happens in facilities is that although we do educate the staff re: hospice philosophy and care, the turnover is high and many times agency nurses are working who are not familiar with the patient nor with hospice.So, if they do an oximeter reading and get 75%, the patient gets shipped out to the ER! So many times, in so may clincial settings, I have seen nurses and docs get so wrapped up in the damn numbers, that they failed to see and hear the person/patient. Sorry....stepping off my soapbox....
  8. Em1995

    Feeling Frustrated with LPN on my team!

    Ktw...What I meant to say was this: if another nurse, social worker, volunteer, whomever...doesn't discuss his or her ideas with their co-worker, then no, they are not being a team player. This is all about communicating WITH each other. It doesn't matter what role they play on the team. Problems arise when there is a communication breakdown. For instance, when I change meds with one of our patients, I notify my social worker and the HHA's on the team. That way, we are all in the loop. I also ask for their input and we work together for the main mission of patient and family comfort.
  9. Em1995

    prenursing student

    Good for you! Leslie gave you some excellent advice! Also, learn all you can about physiology as the "art" of hospice nursing is truly an art when you come into this field with an excellent knowledge base with which to assess your patients. The more prepared you are, then the care you provide will assure comfort.Also, a good knowledge of family dynamics is a must.And, it goes without saying,compassion..... I really think volunteering is a great idea! I wish you much joy in your career.You will find that your patients are your best teachers.
  10. Em1995

    National average for pt caseload

    Just wondering if anyone knows the answer. Do your full-time home care nurses carry about 12 patients? And, what about facility nurses? To me, it seems like they can handle more as in facilities the facility nurse carries out the work and the hospice RN assesses and makes recommendations, not to mention less driving when patients are in a facility compared to homes which are greater distances.
  11. Em1995

    pt's husband and sublte threats

    Thanks...I will proceed with extreme caution. The patient is still hospitalized, so I have asked this nurse to bring this to the attention of the powers-that-be and to have security available. I think a psych consult is in order as my hunch is that this man has an underlying psychosis. And, given that his wife is dying here in the north and he is originally from the south, his fears are exacerbated by being so far away from home. I'm afraid that if she does die, he may get tipped over the edge and become violent.He also made a comment that the "9/11 people should have killed more New Yorkers" and "should have finished the job".I told this nurse that this is a very dangerous situation and that an ethics and psych intervention needs to take place asap. I'll bring this up at team tomorrow morning. I am very acutely aware of the danger here. As an ER nurse, I was on the night a young man took an AK-47 and killed a teacher and a student at a small college in Massachusetts. I took care of 4 of the wounded students who were still able to talk and they all told me he said similar statements like the man in the above paragraph...only no one listened nor took him seriously.
  12. Em1995

    pt's husband and sublte threats

    Can I please have your input?During an informational today, one of our nurses related the following. The patient was passive and quite weak and wanted her husband to do all the talking. He was described as intently staring at the nurse the entire time, "quietly angry" and made remarks, several times, that he "has all kinds of guns and knives." He made comments that we, in the north, gave his wife cancer. Expressed anger at the morals of the northerners and again made reference to "I have guns and knives and I usually carry one with me". Said that he'll return to the south once she dies.He did not sign any consents and said he'll see the nurse again tomorrow. Ok, maybe I'm making a mountain out of a molehill. But, with my background in psych...and, just as a rational person, the red flags are waving! I suggested that the nurse bring the social worker with her tomorrow (the patient is in the hospital) and to never agree to meet with the husband as a lone staff member. It sure sounds like he has a lot of unexpressed anger...and, to me, a heck of a lot more bubbling up inside. Quite honestly, just from the description I received, I suggested they have hospital security near by. I also wondered why this man wasn't reported as he told one of the hospital nurses he "always carries a weapon on him at all times." I don't understand why this wasn't addressed! So, am I over-reacting? I don't think I am and would appreciate your input.
  13. Em1995

    Tips for New Hospice Nurse

    Nursegirl...I sent you an e-mail!
  14. I agree with everyone. Take your time and read and think a lot. I became a hospice nurse 3 months after my mom died of breast cancer. My dad had also died a bit earlier before my mom, along with my aunt(12 weeks later) and we nursed all of them at home. But, I was able to step back and can be objective with my patients and families.(I'm also a psych nurse, so that education/experience plays a big factor). Also, being a former ER nurse who is used to chaos and drunks swinging and spitting at me...well, let's just say, I can easily step back and be objective after all these years!Families deal with dying in many varied ways, some which you will like and some which appear very strange to you. But, it's their gig.Family dynamics can get very complicated and if you're not astute, they can "pull you in" and before you know it, you're "taking sides" and some even end up staff or family splitting. So, take your time. Read a lot and hang out with us! All the best!
  15. Em1995

    Feeling Frustrated with LPN on my team!

    Hi Moe...I know what you mean as many times an e-mail can sound much different than what you really mean in the spoken word. But, I also understand the point you are making as I know many RN's who look down on LPN's. Quite frankly, we're all a team and no one is superior to another! The same RN's who look down on LPN's are also the ones who complain the most about doctors looking down at THEM. I think it all boils down to people feeling badly about themselves and making themselves look better by putting another down. But, to me, that also shows a severe lack of insight and intelligence....emotional intelligence. All the best...
  16. Em1995

    Looking for articles on nebulized lasix

    Lasix. Nebulized lido isn't so cool as it can really potentiate aspiration(I'm a former ER nurse).But, I have read some old studies re: nebulized LASIX (furosemide)which state it is very effective in dyspnea.