coogabooga

The program's name is laptor. It was developed by our company (first mistake).

Now before some may see this thread and think "another nurse, not computer savvy, complaining of computers..." think again. I've worked with computers all my life and charted with computers throughout my experience in the hospitals. Some good, some better than others, some not great at all. My hospice agency has recently switched to laptops and POC program charting for the last two weeks. It's awful. I've managed to be somewhat proficient to a certain degree but it is horribly long and tedious. The families want to talk with my face to face, not have me staring at a computer screen. The forms are longer and the navigation is clunky and archaic. So I'm ending up doing a lot (1 1/2 hours +) of work at home spent charting. I'm so down, I'm already a bit overwhelmed at the task at hand, much less feel like my "time off" is no longer. I tried making it "fun" and did it "watching" a movie with my fiancé. Bad move. I absolutely love my job, get multiple compliments, and I think I just do a good job, however, this isn't going to jive. Immediate management is aware we (nurses) are struggling, but since it's corporate call we can't do much. Sure, I can send a long winded note to corporate, but I don't think that's going to be all swell. Would love to hear from nurses with similar experiences or any words of advice. How many of you use computers? How much work is being done at home???

Yes her bowel habits obviously changed, but most of the time she can't take her meds. Can a body stop making stool of it's only clear liquids they're taking in?

If a patient has only been taking clear liquids for several weeks +, should u still be having bm's?? I have a 74yo ovarian CA that hasn't had a bm in over a week and a half. She's not impacted, stomach concave, soft, and very hypo active bowel sounds. She has very severe nausea from a tumor pressing on intestine (hense the nausea) and most times cannot take her laxatives. Obstruction? Should we still have a bm? Kinda lost for this poor woman. We are giving abh cream and phenergan for nausea

Yikes, with 8 feet of colon it doesn't seem like there really is much to do. I wonder why they just give her a colostomy? What does your medical director suggest? Maybe u just need to play with doses and find a happy medium? Let me know how that works out!

Not a pharmacist or a chemist, but wouldn't the narcs being excreted through the urine be broken down into simpler forms, as though they pretty much no longer take the form of the drugs themselves? I haven't done much to speak of the issue, but I do have a bit of a problem flushing volumes of narcs down the toilet that potentially can be recycled into our water supply.

I'm struggling in general with therapeutic communication... Especially younger patients and their families. I've found myself in those awkward silences where I NEED to tell the families what to expect and those symptoms of dying, but then what?? They stare at me and I can't think of anyway to lighten the mood... The questions they have for me never have a good answer and I try my best to help in other aspects but I'm feeling so inadequate... My manager says there isn't anything else to do, that I've "done" everything, but surly there are a few key phrAses I can use to comfort them, just not the "god has a plan" because I've noticed younger generations are not as receptive to that... Would love some therapeutic communication pointers from any vets out there!

Eh?...

I think it's really dependent on the situation.. Remind yourself what are the goals? In a perfect nurse world, that patient would have been turned q 2 hours BUT this is hospice. The goals are equally as important to the patient as it is to their families. If he has no pain/discomfort issues with the long stretch of no movement at night then u are probably meeting their goals. It sounds like the spouse is doing the best they can, and to ask her to interrupt her sleep to make sure he is repositioned might cause her to burn out. If she gets to a state where she can no longer care for him effectively while meeting their goals you might want to discuss looking for alternatives to care services. But again, it's dependent on the specific situation As far as vitals go, my company needs to keep record for purposes of documenting decline. VS are much more than numbers. Putting them with clinical assessment can give u clues to pain, discomfort, infections, and so forth. Sometimes it feels unnecessary, and maybe it is, but VS give you a base for your assessment.

Haven't been a hospice nurse very long, but I will say I do MUCH less lifting than in the ICU, for example. I understand, however, that I must be prepared for the occasional 250+lb body that needs post mortem care.... A lot of times it seems appropriate to ask for help from an aide or family member. I must say that my back has felt 150% better ever since I switched to hospice nursing... But my emotions and brain become the ones that are strained. In nursing, it seems there is always a tit for tat.

Funny, I had no idea that I developed such an awesome debate issue ;-) Please, take my title to another thread. I'm sure it would be helpful there too :-D

I've been reading a few posts on iv therapy with patients on hospice and I'm a bit confused.,,,why? Our company considers it "aggressive" but too me it's not so much aggressive as it is another thing for families to focus on aside from just comfort... And does it really help? Enlighten me and share cases where this is considered appropriate :-)

Those are great responses. I often find it isn't the patient obsessing over the sugars, but the caregiver. Teaching (over and over again) about the hospice objective is imperative.

I too have only been in hospice for several months and I like using humor... Very light hearted and even a little goes a long way.

Hi, I just wanted to see if anyone had a few words of wisdom in regards to glucose control in hospice patients: what's considered appropriate and what's not. I sometimes have a difficult time convincing patient's families that it is unnecessary to stick the patient 5 times a day... When did you warrant sugar checks and when did u not and also, how can u best communicate with the families? Could use a few pointers from some seasoned hospice nurses :-)

Feeling very overwhelmed.. New hospice nurse with about 3 years icu experience and I have 17 patients. I've done 2 admits in the llast two days and take on call once a week. This is my 3rd week on the job, not counting the first week I spent doing computer training. I have a few, what I consider, very difficult patients too... If they see u have a moments rest they want to put other assignments on u from other nurses that are sick or overloaded as well so I feel like I can never get a break til the weekend. The patients spin in my head all day and night...

Thanks everyone for the input.

She is a new patient to hospice (1 1/2 weeks) and the pain is constant and an achy pain in her hips and down her legs. Strong 7. Increases with mobility... I sincerely appreciate the advice. Going over her goals is a good idea. Small trial, maybe smaller doses to see any effect. I will try that this week, at least just talk to her about it more.

'm totally at a loss with a new hospice patient of mine. Hx: breast CA with mets to bone, lung, liver. She was given the wrong chemo and it messed up her kidneys and hearing. She states she has 20 percent of her kidney function and has 7-8/10 pain to her hips and legs front the CA. I'm very new to hospice and can't seem to come up with anything to manage the pain.. She takes oxycodone IR 10mg q 3 hours PRN and dilaudid 12mg q 3 hours PRN. She says it doesn't help the bone pain but either "knocks her out" or just makes her feel apathetic. I'm told that NSAIDs work best for bone pain but she is too afraid to try because of her kidney function.... When I talk to her she seems miserable. She's a highly intelligent, fairly young (57) lady.

Yeah, I'm pretty sure it is not a legislative issue at all. Hospitals run like businesses and the timing of employment is based on a supply/demand. They know that at the end of the semester there will be a surplus of new grads. Or it could be completely unrelated and be a budget thing.

He must be chronically anemic and lives in a low Hgb state. What is his admitting dx? I guess if they can find no active bleed, the patient is sufficiently oxygenated, and perfusing then there is no need. Sometimes I think doctors jump to blood transfusions too soon because there are so many risks involved. I'd be interested to know more about this patient's history and status since yes, that is a very low Hgb.

Hello, I've been a nurse in the ICU for a couple of years now and I've recently moved from Texas to Maryland. I've noticed quite a difference of atmosphere, however, I've been drawn to the seriousness of documentation. For example, obtaining consent for a procedure MUST be discussed and explained with the patient/POA by the physician. Yes, I realize that in Texas this is a law too, however, sometimes when we did telephone consents for central lines and what not, we never put the physician on the phone because it was so hard getting ahold of them. It was no big deal, we'd leave the consent in the chart and eventually the physician may or may not sign it. It is not like that in Maryland (and I'm very happy for it). This is just one example, but I've heard several nurses say that people in this area are "sue happy". Now with new technology, nurses seem to be getting more anxious about possibilities of increase liability. So the point of this thread is how many nurses do YOU know have personally been sued? Not just appeared in court because they were associated, but actually suffered repercussions (i.e. job loss, financial burden) because their of poor documentation or because of an honest mistake. I know this seems broad, but I'm very curious to hear examples. I've only been a nurse for 2 years, but I have yet to meet ONE nurse whose gone to court or been sued.

Did NOT take an NCLEX review course, but I did spend the equivalent in review books. I actually thought the NCLEX for dummies was really good. You really need to just be confident in the way the test is set up

"I'm getting tired of newspaper articles and TV news telling people that healthcare is where the jobs are. I think our job market will be flooded in a year or two." I think that's the silliest thing I've ever heard. Nurses are needed and this shortage will last for years. Currently the ANA is asking everyone to urge your representatives "to restore the $600 million to address critical health care workforce shortages". This shortage is real. Sure, elective surgeries and procedures will go down, therefore so with operating room nurses and so forth, but other areas will be bursting at the seams. Plus, if healthcare gets reformed as our new president proposes, we will soon see the workforce even out again, thus, the shortage will continue...