Em1995

As a family nurse practitioner, I certify patients for medical cannabis. Those who see it as evil are not educated about it. It has greatly helped hundreds of my patients. Studies also show that THC may attack cancer cells. However, they are not complete studies yet. The history of cannabis caused many myths that are still alive today. Racism and greed played a huge role in criminalizing cannabis.

I'm also working as a Family Nurse Practitioner and as a faculty member. It's the best of both worlds!

I put in about 3 hours driving time today and saw 6 patients. There was no time to stop for coffee and forget even 10 minutes for lunch. Had I stopped I would never have been done on time.However,when I mention that I put 100 miles a day on my car, my manager tells me I'm complaining. We are paid 44 cents a mile.I am salaried at 32 hours and have a caseload of 10, but have also done admissions this week.Some of my patients are one hour away and others are at the opposite end, so there is LOTS of driving. I am tired, but am told I am the only one who is complaining. Plus, I am on-call tonight, all night until 8:30 am. We are not paid for this and told we get it in comp time.I also have to work tomorrow. Your thoughts?

I cannot believe I found this one particular post! I resigned and gave a one month notice. The management THINKS I am going to another hospice, but they do not know for sure. They did not allow me to see my patients either and asked me to leave. One of my patients called me at home on Saturday(she looked my number up in the phone book). She profusley apologized, but was hysterically crying saying that my boss called her and told her I would not be back! I assured her I was working the last 2 weeks of my resignation. On Monday morning, I realized I had been locked out of our laptop. I asked one office nurse what happened. She said:the boss asked me to lock you out. I went to the boss and he lied! He said"oh, everyone's computer is acting up." He didn't have the guts to tell me he ordered this. This confirmed my decision to leave this place. I find their behavior to be not only unprofessional, but also VERY lacking in compassion!

Are you guys serious? Our nursing home nurses are expected to see only 4 patients a day in a nursing home. I was told by someone at work that the national standard is 4 nursing home patients in one day. I have fellow colleagues in hospice nursing in different parts of the country and they have told me our nursing home expectation is extremely light.Most nurses in other hospices tell me they also see 6-8 nursing home patients per day.

Does anyone know the average # of nursing home hopsice patients seen in a day? I find 6-8 very do-able.

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.

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.

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

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.

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.

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.

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....

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.

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.

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.

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.

Nursegirl...I sent you an e-mail!

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!

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...

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.

If you send me your snail mail address, I'll send you a copy of ours! All of our patients benefit when ALL of us share our pearls of wisdom with one another! Just send it as a privatge message.

Nursegirl...welcome to Hospice Nursing! I've found a lot of sharing amongst fellow hospice nurses on the internet. This is a great forum in which to learn and to share. Does your agency have a protocol book for symptom control? It's good to have one available, but as you know hospice nursing is much more than this. I wish you many blessings in this heartfelt career!

HospiceNurse LPN...I hear you. I came from psych and the ER into hospice...and the death of my daughter, my mom, dad and aunt(all within a very short time of one another...not to mention 5 close friends (all in their forties..all at once...a story for another day). My ER experience really helps with assessing(and resolving) physical problems....but my life experience was most fruitful in that it has given me valuable life experience in dealing with transition issues.! I look at all of us on the team as connected and united. No one is more important than the other. In fact, if my HHA's calls me because he or she sees a change and believes I need to make a visit...I do. Each one of us brings unique gifts and talents to our patients. You are very right re: those nurses who come to hospice thinking they know it all.I've found that most of them thought hospice was "simply about symptom control". They are the ones who don't last (thankfully). I can't get out to see my patients for another couple hours. We had another storm last night and the roads are nothing but sheets of ice! It is supposed to melt by noon....I hope.

I didn't get the flavor that you were questioning her because she's an LPN. What I understand (and please correct me if I'm wrong) is that she's not being a team player. It sounds like the last nurse had the same problem. Have you sat down with her and asked her about this...one on one? Have you told her how this makes you feel? I would initially suggest that and ask her input and ideas. I know with our home health aides, whom I cherish, we often meet and discuss our patients. We exchange ideas and really work well as a team. I find that directly and honestly speaking with our colleagues is always the best policy If, after talking with her, she continues to go over your head and not speak directly with you, I'd go to your nurse manager and discuss this.She may have personal issues that relate to an inablity to be a team player. The RN is the one who is the case manager and she really should be working WITH you. Keep us posted....all the best!