RNWithAHeart

Hello, I am looking for any Core Measures Auditors out there or anyone that is familiar with this type of data collection. I am an RN ASN who has been performing WAH Core Measure Auditing for the past four years. Due to many different variables, the auditors with our company have had their current workload reduced. I am at about half of my normal workload. I am wondering: 1) Do you know of any companies that hire WAH Core Measures Auditors? 2) Maybe this is a good time to go back for more training. What would the natural progression from this job be? Doing this WAH for the last 4 ears, I have really been "on my own" so to speak, so I am not sure where to go next. Telehone Triage? Coding? BSN? MSN Infomatics? There is so much information to sort through, just trying to get another professional's advice. I am also in a non compact state so that seems to have an influence for availability for telephonic positions. Any help or guidance would be greatly appreciated. Thank you!

Hi there, Patient does not qualify based on evaluation, however, I am told that she has advanced ESRD....with labs to back it up that should qualify her. But, I am not seeing that picture just by the visit without any documentation. Non compliant in many areas.......missed frequencies....non compliant with many of the COPs (one example....medical director not being present for IDG.......maybe over the phone and then somehow he is there to "sign" the paperwork without stepping foot in the building. Patients are well cared for and the benefit portion of the COPs is followed well........most of these issues are with in the office with documentation, care plans, idg updates, etc. I should be supervising these things, but spend the majority of my time out in the field seeing patients, doing admits. I am DCS, but have a patient caseload.....am on call 24/7....if not directly, always back up, but have been doing call about 20 days out of 30. Also working 60+ hours a week. I just cant keep up.

I am going to cut to the chase here. Working for a private hospice agency.....1 year old. Very good people/intentions, but very poor upper management skills. Think business plan was not well thought out......have been extremely short staffed.....because..."this is a start up"....blah, blah. Now the company is out of compliance with regs in so many areas. Upper management is aware but not making corrections. Last straw, I was asked to do an admission with NO records. Just told the lady qualifies.....go out and admit her. I literally did not have 1 sheet of paper on this woman. Oh, did I mention I am the DCS? I know I need to get out of this company and fast......do I report this company? It is SO sad because we give excellent patient care.

Hi, I am a RN Case Mgr who has a pt and wife in their early 50's, both with mild MR. His hospice diagnosis is pancreatic ca. He is independent at this time. He wants a "meeting" with his RN, MSW and the Chaplain and his family to "talk about cancer." We are planning to meet with him later this week. His wife does not want to discuss cancer. As I said, the pt has mild MR and I have tried asking him what specific things he would like to discuss about cancer, he just says everytime "to talk about cancer." The MSW, Chaplain and I are not quite sure how to proceed with this meeting, we are all fairly new to Hospice (within the last 6 months) and we woulod appreciate any insight/suggestions/input you could give us. Thanks:redbeathe

Hi, I am a hospice nurse and have a 50 year old end stage renal patient. My question is, she has alot of pain (from other co-morbidities) and has prescribed pain meds for Q4 hrs. She is usually at dialysis for her runs for around 6 hours, and she is not permitted to take a pain pill while she is there, she cannot have 1 sip of water. In fact, according to the patient, she had to fight with the dialysis nurses in order to be able to take her scheduled insulin. I have prior tele experience and when our patients went up to dialysis, we would send up their breakfast and they would eat while they were having their run. This patient says she has seen the nurses literally pull a piece of hard candy out of another pt's mouth. Is this standard practice during dialysis, and if so, could you tell me the rationale so that I can explain it to my patient? Thanks for your help!:redbeathe

Hi there, I am sorry that no one responded to your post. You are not "only an LPN" you are a nurse no matter what initials follow your name! I agree that I do not understand why people need to hurt each other, some people are just malicious. I think that most hospice nurses that I have come across are very gentle, kind people, but I guess there are a few bad apples in every group. I don't know what advice I can give you, other than to try to stay strong and keep up the prayers. You are in my prayers and I am sending you big ((hugs)). :heartbeat

Hi, I took the position of RN Case Mgr. Can't talk alot right now, getting ready for work, but I have been there for a month. I think the company has their head on straight. My branch is growing like crazy and had a census of 27 in Dec....we are now at 78. So, with that comes growing pains. But, I am happy so far. But I can tell you.....I have lots more paperwork than I ever expected! Good luck with your interview, let me know how it goes!

This is Hospice (in home) call.

Hi, Anyone have experience in working straight weekend call only....Fri at 5p until Mon at 8a? I am not sure if it is salary or per diem. They are offering this position at our office and was just wondering if other companies do this and what kind of pay should be expected for that type of shift? I am sure that there would be scheduled visits on Sat.:loveya:

Hi, Here I am again, begging for answers! New to Hospice for only a month. Is it standard for Hospices to have standing orders/protocols? I was told we have none and I think that is strange. If you have standing orders, could you tell me what type of things you have them for? Thanks again:redbeathe

I have just entered into Hospice, came from a telemetry background. I have seen many occasions in tele where a pt is being discharged to Hospice and the ICD is turned off before they are discharged from the hospital.

Hi, I just started with hospice a few weeks ago. I am an RN who had 1 year of telemetry experience prior to this. You can get a job with no hospice experience. Hospice was my dream job.....I had a very specific plan.....I was very sure of my goals and I had researched hospice and its philosophies and I feel I was chosen/hired for my beliefs. I wanted a year of hospital nursing first, and honestly I started in Hospice 1 year to the week after I started in the hospital. There is also an RN in our company who I graduated with that was a LPN prior to being hired and was hired right out of school. Best of luck to you with school (focus on that now, you need all the energy you have to get through) and then follow your dreams.:heartbeat

Thanks everyone for the responses. These pts were non verbal as in 1 has end stage MS and has not spoken a word in 10 years. 1 is Alzheimer's, 1 is post CVA, and 2 are dementia patients. As far as training, I have had 5 days of training with 3 different RN's. We saw pts in the home setting, AL facility and LTC. These pts that I saw on Friday will not necessarily be on my caseload, they are having me go out on my own now to get "routine visits" down. I am evpected to be given a caseload in about a week I guess.

I guess my main question is how to get the LTC staff to work WITH me in this situation, it just seemed like they did not want to have any input with me regarding the patient visits. I understand that maybe I need to gain their respect as a new nurse coming into their facility, but I just couldn't believe that there was nothing to report at all for these 5 patients. Can you offer me suggestions of how to present myself and my assistance to engage the LTC staff in supporting my role there as a Hospice nurse so that I can be of help to them and their patients?

Hi, I am new to Hospice and went out on Fri on my own for the first time. I had 5 patient visits in one LTC. All 5 of these pts were non-verbal. I felt like I was really no help to these pts at all. When I spoke to the RN regarding each pt, I would ask "Have there been any changes, do you have any concerns, do you have any needs" In each instance the answer was one word "no." Maybe bacause I was new to the facility, but I felt like they didn't want to be bothered with me? How can you have 5 pts in a LTC that have NO problems or needs? The wife of one of the pts was there, so I was able to speak with her and comfort her for a while. I spent 7 hours in this facility and felt useless. I am sure that these pts knew that I was there and hopefully I was a comfort to them. Any words of advice/suggestions?:bowingpur

Hi, Well, my first year is over and I am changing positions from telemetry to hospice. Anyone else leaving your floor?

This article was posted as the lead story on MSNBC.com today: Most cancer doctors avoid saying it's the end http://www.msnbc.msn.com/id/25176326/ One look at Eileen Mulligan lying soberly on the exam table and Dr. John Marshall knew the time for the Big Talk had arrived. He began gently. The chemotherapy is not helping. The cancer is advanced. There are no good options left to try. It would be good to look into hospice care. "At first I was really shocked. But after, I thought it was a really good way of handling a situation like that," said Mulligan, who now is making a "bucket list"-things to do before she dies. Top priority: getting her busy sons to come for a weekend at her Washington, D.C., Many people do not get such straight talk from doctors, who often think they are doing patients a favor by keeping hope alive. New research shows they are wrong. Only one-third of terminally ill cancer patients in a new, federally funded study said their doctors had discussed end-of-life care. Surprisingly, patients who had these talks were no more likely to become depressed than those who did not, the study found. They were less likely to spend their final days in hospitals, tethered to machines. They avoided costly, futile care. And their loved ones were more at peace after they died. Law requires straight talk Convinced of such benefits and that patients have a right to know, the California Assembly just passed a bill to require that health care providers give complete answers to dying patients who ask about their options. The bill now goes to the state Senate. Some doctors' groups are fighting the bill, saying it interferes with medical practice. But at an American Society of Clinical Oncology conference in Chicago earlier this month, where the federally funded study was presented, the society's president said she was upset at its finding that most doctors were not having honest talks. "That is distressing if it's true. It says we have a lot of homework to do," said Dr. Nancy Davidson, a cancer specialist at Johns Hopkins University in Baltimore. Doctors mistakenly fear that frank conversations will harm patients, said Barbara Coombs Lee, president of the advocacy group Compassionate Choices. "Boiled down, it's 'Talking about dying will kill you,'" she said. In reality, "people crave these conversations, because without a full and candid discussion of what they're up against and what their options are, they feel abandoned and forlorn, as though they have to face this alone. No one is willing to talk about it." The new study is the first to look at what happens to patients if they are or are not asked what kind of care they'd like to receive if they were dying, said lead researcher Dr. Alexi Wright of the Dana-Farber Cancer Institute in Boston. It involved 603 people in Massachusetts, New Hampshire, Connecticut and Texas. All had failed chemotherapy for advanced cancer and had life expectancies of less than a year. They were interviewed at the start of the study and are being followed until their deaths. Records were used to document their care. Of the 323 who have died so far, those who had end-of-life talks were three times less likely to spend their final week in intensive care, four times less likely to be on breathing machines, and six times less likely to be resuscitated. About 7 percent of all patients in the study developed depression. Feeling nervous or worried was no more common among those who had end-of-life talks than those who did not. That rings true, said Marshall, who is Mulligan's doctor at Georgetown University's Lombardi Comprehensive Cancer Center. Patients often are relieved, and can plan for a "good death" and make decisions, such as do-not-resuscitate orders. "It's sad, and it's not good news, but you can see the tension begin to fall" as soon as the patient and the family come to grips with a situation they may have suspected but were afraid to bring up, he said. From an ethics point of view, "it's easy-patients ought to know," said Dr. Anthony Lee Back of the Fred Hutchinson Cancer Center in Seattle. "Talking about prognosis is where the rubber meets the road. It's a make-or-break moment-you earn that trust or you blow it," he told doctors at a training session at the cancer conference on how to break bad news. People react differently, though, said Dr. James Vredenburgh, a brain tumor specialist at Duke University. "There are patients who want to talk about death and dying when I first meet them, before I ever treat them. There's other people who never will talk about it," he said. "Most patients know in their heart" that the situation is grim, "but people have an amazing capacity to deny or just keep fighting. For a majority of patients it's a relief to know and to just be able to talk about it," he said.

Hi, Any tips/advice tools that you use to keep your car and day organized for home health? Thanks:heartbeat

Any advice on tools/ways to keep yourself and your car organized while going about your day as a hospice nurse? Thanks! :redbeathe

What "Pearls of Wisdom" could you offer a RN who is changing fields...I have cardiac experience and will start with Hospice later this month. Thanks! :heartbeat

So it seems there is no "professional standard" for RN's?

Hi, Question....how much notice upon resignation is required for a regular staff nurse to give? I have heard 2 weeks, and then also 3 weeks. Thanks:heartbeat

Hi, I am a tele nurse and just interviewed with Hospice this week and I got the position! I start in 2 weeks. I am so estatic, just had to share my joy. I am sure I will be coming here often to ask questions/advice. I love reading this thread. Can any of you recommend any reading for a new Hospice nurse? Any recommendations/advice will be greatly appreciated.:heartbeat

Hi, I am a telemetry nurse who is interviewing with Hospice (my ultimate goal in life job) tomorrow. I have read some posts about a .doc file of questions to ask during the interview, but am unable to locate it. Can anyone direct me to it or give me any interview advice....interviewing for telemetry is a long way from hospice and I don't want to miss anything or make an uninformed decision because I missed a topic that I should have asked. The company is owned by HCR....Heartland Hospice. Anyone have any thoughts or experience with this organization? Thanks so much for your help.:heartbeat