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  1. jeannepaul

    Reflecting on the Above and Beyond

    Never give up hope!!! I think the difference is you were not demanding things, and did not expect what they did, and were grateful. It's the families that come in and expect, demand and complain that the nurses are not doing enough, that really bother most. Kudos to those nurses, but also Kudos to you and your family, because your family is the type that nurses want to go above and beyond for.
  2. dang, what state are you in, that's alot higher than what they are paying in Texas!
  3. jeannepaul

    Odessey Hospice

    I just spent 20 min. typing up relpy and lost it when I decided to read comment policy because I didn't want to get banned. I have a lot to say about the way they treat their employee's so if you want to hear it, pm me. I worked for Odyssey in San Antonio for 6 years, Both as case manager and on call. they cannot keep nurses for very long and there is a reason.
  4. jeannepaul

    Nurses with Rheumatoid Arthritis

    I actually went to apply for a home health position and was talked into hospice, I had asked if I didn't like it could I go to home health, but I never asked! It seems there are always positions open here in San Antonio, most people do not think about hospice unless they go through it with a loved one. as a case manager, we are given around 12 pts. some are in nursing homes and some are at home. we usually see them 1-2 times a week, depending how they are doing. We make our own schedule so there is flexability which is great when you have small kids who sometimes have "bad" mornings. I'm not worried about being late and punching a time clock. We don't use a lot of skills, when we go see a pt, we do a head to toe assessment, check their medications, and talk to the family. Some visits take 30min, but if a pt doing really bad, we could be there for a few hours. We use certain medications to get symptoms under control, but sometimes it is the family we are talking to for so long. We explain the disease process, what is going to happen to them, and just reassure the family that they are doing a good job caring for their loved one. HHA go out 3-5 times a week for the bath, so we do not do not clean the pt unless he/she has a wet or soiled brief, and then like I said before, I always make the family help me. I do not get the pt out of bed. we have social workers and chaplains who visit the pt. also. its not all roses though, alot of medicare paperwork, and you get mad at management rules just like in a hospital. i look at it this way, there are going to be tmes you get angry in any job, but would you rather be mad in a hospital where you cannot get away and cool off, or be mad in your car drinking a soda listening to the radio? it is emotionally draining, but not physically. my feet do not ache, or my back doesnt kill me when i get home and i actually feel like i make a difference in peoples lives. I dont save anyone, but i help the pt stay comfortable on their journey, and help the families. its the best job ever. ps. sorry about any typos. im doing this one handed while holding my little girls hand with the other til she falls asleep.
  5. jeannepaul

    Nurses with Rheumatoid Arthritis

    I have RA and take methotrexate and enbral, it helps just enough for me to keep working but I live with the pain everyday. I also take hydrocodone and ms contin when needed. I work in home hospice and it seems to work out well, not too much standing, sitting or walking. Most of what we do is teaching and the few times I do need to do something with the patient, I make the family help me, they need to know how to do it anyway. The hardest part of my job are death events. after pronouncing the patient, I usually give them a bath and just bending over the bed is hard to do, but I take advil before I go in the house and that helps. I actually work as a weekend on call nurse and it seems to suit me as I can't sleep much anyway without getting up in pain and being stiff. we use computers so writing isnt a problem for me anymore. I never thought I would like hospice nursing, but I was about to quit nursing until I started in hospice 9yrs ago and now I wouldn't do anything else. I think its a great career for a person with RA. I refuse to be a disease, if you want to be a nurse with RA you can do it, you just have to find what suits you, there are all kinds of nursing jobs. telephone triage, working with insurance company's, if you want to do it, it's just a matter of finding the right fit for you.
  6. With the gas prices increasing, what is your Hospice paying for mileage, has anyones gone up? I live in San Antonio and gas is around 3.65-375 and I am getting .50 a mile. There has not been any mention of it going up yet.
  7. jeannepaul

    question about visits

    I've worked with 3 hospices in the past 9years, and the physician does not usually make home visits. They will visit if there is a problem but we usually try to do visit with physician. Now the new rule is a face to face at a certain point to recertify but it can be done by NP. I would just do your usual visits and if a special visit by physician is made I wouldn't count it as your visit.
  8. jeannepaul

    Discharge a patient because they go to er?

    if the pt is a cardiac pt. and he goes to hosp. for cardiac, we do not discharge, but they have to revoke or they will get a bill. Medicare will only pay for either hospital or hospice but not both. The problem at my agency is if pt is admitted with anything, we have them revoke, I dont understand this, and I think its a big waste of time and resources to turn around and readmit.
  9. jeannepaul

    Did I make the biggest mistake of my career?

    wow, sounds like Odyssey!
  10. jeannepaul

    Medicare To Pay For End-Of-Life Discussions

    I just wonder how much the physician will correctly tell about hospice, they seem to need education themselves. I dont know how many times the family says " the doctor said we need more help at home so hospice will come in and help us" without saying anything about dying. they actually think we are going to come in and take over care 24/7, supply meds, equipment, all for FREE. can't blame marketing on this one, because I get this when I go do either eval or prehospice.
  11. jeannepaul

    How Much Does a Hospice Nurse Make?

    Im in the San Antonio Area, base salary 30+ an hour, .50 a mile. i am on call so if i work mon-thurs it is time and 1\2. it depends on the company, one company i worked for paid hourly and anything over 40h = overtime, however, they expected you to do everything in the 40hours which was impossible. one hospice i know pay case managers a flat 150-200 a weekend for backup call. others pay 3 an hour to carry a beeper. one hospice pays 50.00 for an on call visit + mileage, another one pays your hourly wage from the time you get the call to time you get back home. all are so different, but the staff and management make all the difference in the world. In a large company I have found they dont care about you as a person. the smaller ones are more like family. I will never work for a large company again, regardless of the pay.
  12. jeannepaul

    Changes to On Call Job Description

    I work for a large for profit hospice as an on call nurse weekends. I am sick today or I would be already out. I used to love my job, but it has gotten so bad, I sometimes fear one of these weekends I will end up having an accident and kill myself along with someone else. we are treated like as mom used to say "redheaded step children". if they could work us every hour of the weekend, they would. we have over 300 pt, 2 full time on call ( 4 openings but we cant seem to keep anyone) we have case managers on also. we also have a triage nurse and an admission nurse on sat. sounds good on paper, but in application it is an impossible job. On fridays we have around 6-8 admissions, so saturdays we have to see each one, we also have crisis care pts to see which average 6-10 cases, then the case managers can put their pts on the schedule if they think they need a visit on the weekend. the triage nurse has to call and get permission to use a case manager, because they are getting overtime. friday evenings we also get carry over from the day that the cms couldnt get to. On friday I already had an admission waiting on me at 5p, finished that one, then I was sent 46 miles for a visit. got home and sent back out 47 miles for a death. I got home at 5am. I am already starting to feel sick, but I think it is because I am tired. I get 4 hours sleep and get up to get out again. I tell the triage nurse i am sick but I dont want to put the other on call nurse in a bind so I will try to keep going as long as I can. I still have 2 pts to see and I get a call for an admission. I have already worked 10hours and have 2 pts left, so I have to either call in sick or do this admission. I tell her Im going to finish these pts and call in. I end up working 14hours and still have to "call in" for 3hours for sat. had I not called in i would have been out all night again. I dont have a problem working, but how many hours can a person work without a break. at 15-16 hours straight without a lunch or dinner break, with few pee stops, a body just cant continue. I end up driving 250+miles a day. I have been on call for almost 5 years and it is always the same thing. Its not the amount of visits, its not the overall time worked, but it is working many hours straight without a break. why cant management understand this concept. also on call is for emergent visits, but a chronic cough in the middle of the night is not emergent. we are sent out on calls and by the time we get there the pt is sleeping. Or the familys are told just to call for anything and we will come running and if we dont get there fast enough we hear about it. management acts like we are lazy, and continues to say "well when I used to do on call....." The two of us that are left are looking for another job, but i would like to continue to work the weekends, but is there a hospice out there that treats the on call staff like they are human? they need to understand that this is a job people usually do not want. they also need to not freak out if there is a slow weekend and we only work 12hours a day. they just need to understand it is the price of doing business and everytime the on call staff is low, the cms have to do more and they start quitting, it is a never ending cylce. Im just tired of all of it and just want to do the job I loved. thanks for listening, Itook some meds and now I must sleep!
  13. be aware that according to the department of labor, unless you are an exempt employee and most cast managers are not, you should be getting time and a half for anything worked over 40 hours. also check your state laws, some states are very employee friendly like california. they go even farther in regulating overtime breaks, and lunch. you should be tracking every hour and submitting it. there are exemptions for hospital employee and nursing homes, but I know hospice IS required to pay overtime. there are conditions that must be met to be called an exempt employee, sometimes they call you exempt but it is incorrect and when called on it, they must pay. there are also particular laws for on call workers and what can be considered work time. protect yourself, read the laws.
  14. jeannepaul

    Narcotic management in the home

    We never carry meds to patients homes, the pharmacy delivers them. No, we do not count each med at the visits. the only time a count is done is if the pt is on crisis care or at the death.