sclpn

Since my original post we have hired an lpn and she has been a godsend. She helps with on call with an rn backup for deaths, she can work as the cna in the field and fill in as the aide or assist the nurse in the inpatient unit

PPS ECOG FAST

I agree with everything nutella said except be careful using fentanyl patches as they don't absorb well if there isn't enough subcutaneous fat...our MD will not use them on any patient that weighs 100 lbs or less and shows signs of muscle wasting.

Same here....Hospices are under great pressure to turn a profit, whether they are for profit or not. In my area the hospice competition is very fierce and I see "patient seeking" so much. I also see doctors sending referrals when patient/family keeps pressuring him for "help" in the home. The doctor knows the patient won't qualify for home health so he sends them to hospice and if hospice turns them down for services the doc office plays 20 questions on why the patient wasn't appropriate for hospice. It's sad but it's everywhere.

I feel your pain. I too, am leaving my hospice job of 6+ years. I've done case managing/on call, hospice house and clinical director/with 24/7 call during this time. Being a hospice nurse is my identity. I don't know how to change that and wonder if I will be happy in any other field of nursing. I have no answers for you, only more questions...I do hope to return to hospice nursing one day.

The company I work for has a 12 bed IPU. We have had a difficult time keeping beds filled, particularly with GIP patients, at times de-staffing due to no patients. Our choice was to close or contract with other hospices that does not have an IPU. We contract with them for respite and GIP. This has been difficult but it has kept the doors open and staff working

Most of the time if the haldol didn't work it's because the patient needed a bigger dose

I would imagine the op is asking regarding finding hospice nurses to work for that agency....and if that's the case, I don't know either. We have utilized ads in the local paper, online, job fairs etc and still find it difficult to secure applications for employment of hospice experienced nurses

Hello I'm a inpatient manager and I've done homecare and inpatient nursing. I did not rewrite anything that was already some place else...I didn't rewrite the prn meds given in my narrative because they were already on the MAR etc. I didn't rewrite my assessment in the narrative either. You are correct in thinking that the nurse should "paint" a picture of the pt however, documentating in multiple places will get you in hot water when DHEC/Licensing shows up. I encourage the nurses to document along this line also but find previous hospice nurses can't let go of this heavy documentation. How to fix it is another question... I have revised our nursing forms to take away things that are in multiple areas or on another form. Not sure about your facility but here the Medical Director is sometimes the driving force behind heavy documentation and/or documentating in multiple places.

Our medical director will not sign for pts comfort kit (crisis meds) anymore. Said she must have a "pt relationship"to write for c2 meds. She will do it in the occasional emergency but then she must make a face to face visit to establish that relationship. Can make for a difficult admit on an actively dying pt

Hi Would your hospice hire a new grad RN? We are a small nonprofit hospice with a hospice house facility. I'm considering hiring a new grad RN for the hospice house...thoughts??

My company hasn't allowed us to use debility in over a year. We were also told AFTT would have to stop being used over the next few months.

Hi Everyone I work for a not-for-profit hospice,and as most do, we struggle with funds/money. I was wondering what type of fundraisers your hospice does? We currently have an annual butterfly release and a bike ride that is very popular. Both, usually raise some much needed money that we use to care for our charity pts. What do you guys do to help raise funds at your hospice?? Thanks in advance!

Hi Im wanting to start some type of employee appreciation/reward program at my Hospice. Hospice can be very rewarding when dealing with our pts and families but I would like to find creative and inexpensive ways to show the employees that management cares also. Does anyone have any type of program in place, if so, how do you select which emplyee receives the award/recognitation or do employees nominate each other, how often do you present it, any info/ideas would be greatly appreciated! Thanks

Located in SC. no pay raises in 3 years not even a cost of living raise. Medical insurance has tripled over 3 years. I expect that it will increase again in March. (open enrollment). accrue PTO at 12 hours a month depending if you work 12 hr shifts or 8 hour shifts. Most 8 hr folks get 40 hrs per week while 12 hr people get 36 hrs per week. So that amount affects how much you actually accrue each pay period. Mileage is at the IRS rate and only changes if the IRS changes the rate they pay. Over 3 yrs low was 50 cents/mile. High is 55 cents/mile. I work for non profit. I dont know the answer to the money problems that all hospices seem to face but it doesnt make it easy to continue working without pay increases, especially since the cost of living keeps climbing..

Absolutely nothing wrong with perfering one kind of nursing over another! Some nurses dont think hospice nursing is "true" nursing (because you arent saving lives) but I say "its the absolute best kinda nursing for me" I make a difference for my pts, I may not be able to make them "well" but I can make that day(or that hour) better for them! Hospice and palliative care are 2 different kinds of nursing but both do have the same end result. Palliative care usually just allows for more expensive/invasive treatments.

Where I work pts in the home setting are not forced to be a DNR because pts/families know that 911 is a life line and they will call even if they have been told to call hospice first for anything. In our Hospice House it is our policy that the DNR has to be singed for pts to come there, even for respite or symptom control, even if the plan is to return home later. Ive had a few actively dying pts on admit/scheduled visit or that just started crashing right in front of me. I offered to call 911. Most every family decided to forgo CPR and make pt comfortable,as they knew CPR was futile and wouldnt cure the cancer or whatever they had. Ive also had families to find the pt expired and call 911. Most of the time EMT's saw the debilited condition of the pt and called ER doc for a verbal order of DNR. CPR is against the hospice phillosphy. Hospice doesnt treat death. Most pts/families have already had the whole CPR/DNR conversation prior to being refered to hospice. Its usually the younger pts that have problems with signing it and sometimes even talking about it. Essentially, I believe, its up to the hospice if they force their pts to sign DNR.

Your welcome!! I actually went back to nursing school to do hospice. (Not a LPN anymore but a RN just cant figure out how to change that on here;) You sound like you already love hospice! Hospice is a passion not just a job! The best advice I can give is take care of youself!! You can get burned out super fast in hospice. Keep snacks in your car. Stopping to eat lunch isnt always doable. Take a vacation day every now and again. And if your off the clock dont answer your phone! Best of luck! you will be a great hospice nurse

1. Where I work we wear scrubs. Everyone doesnt keep a nice clean house. 2. Worst part is taking call especially after you have worked 8+ hours that day. Paperwork for the visit isnt too bad. Usually just one page but IDG/IDT paperwork is terrible and so are recertifications. 3. Working hospice in LTC facilities can be a challenge. Some nurses/staff follow hospice and understand it...others dont get hospice and do resent you being there. 4. Case loads depend on the census and how many case mgrs there are. We have 2 therefore case loads can be 5 to 15 pts a piece. 5. 30-60 min visits is the normal. Some families dont want to bond with you. They only want your medical advice and then want you to leave. Others get to know you and treat you as part of the family and you will find yourself in those homes much longer than 30 mins. With that said, you may not be able to stay an hour at every pts home because admissions get thrown in and daytime deaths happen. I love being a hospice nurse. I love teaching/educating my families and pts. I love being able to care for one pt at a time. Hospice isnt for everyone and you absolutely have to do it because you love it not because you need a job. Good luck with your job!!

Im mostly wondering about LPNs working in the field. (seeing pts in their home) giving meds is usually done by pts or family members.....was considering if they could be used for on call or seeing pts when one of the case mgrs needed to be off

Does your hospice use LPN's? The hospice I work for doesn't. Im wondering how we could utilize them since they can't assess for death?? We have 2 fulltime RN case mgrs that work mon-fri and take call. Also have 1 RN that only takes call a couple days a month. We are a small hospice.....census 15-30 pts and usually only cover one county. Call is usually quite except when a pt is actively dying and then the family can get antsy and may call more especially if its the weekend.

been in hospice for lil over a year and none of our pts have had iv's. im in south carolina

i agree!!! bone cancer can be one of the most painful cancers there is. you sound like a hospice nurse in the making. thank you for being there for this man. appropriate orders totally. and yes, in my experience, when pain is relieved the disease process can take over. I wouldn't say you coworkers are in the "save the life" mode b/c of working in the ER....in nursing school we are taught interventions to save lives and fix problems. this is very hard to "let go" of.....by that i mean, understand that there isn't always a solution to fix the problem and now we need to make this person comfortable and just treat the symptoms that arise from the disease process. i have been working with hospice for a little over a year now and love every minute of it. wouldn't want to be doing any other kinda nursing

in our facility social workers have 5 days to do initial assessment

sorry....no writing courses were required at my college???