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jeannepaul has 12 years experience and specializes in hospice.


jeannepaul's Latest Activity

  1. jeannepaul

    This isn't the hospice I used to know

    When I started in hospice 13 years ago, we had certain diagnosis we could use: ALS, dementia, renal, cardiac, et al. There was specific criteria which had to be met. They could see their attending but could not see any specialists for the diagnosis we admitted them for. If they were still wanting to get treatment or voiced they would go to hospital, they were not ready for hospice. We used Roxanol, Ativan, scope patches, phenergan, bisacodyl, Tylenol and ABH in our comfort kits which were sent to every pt admitted and these meds worked great at controlling symptoms. when families called after hours, it was because the pt was sob, in pain and/or scared and their loved one was dying. I would do a lot of teaching about signs and symptoms, calm the pt and assure the families they were doing a great job. It was a hard job time wise and emotionally, but very rewarding and I thought I would never do anything else but hospice. fast forward...... They got rid of adult failure to thrive, but now the diagnosis of protein calorie malnutrition is used. Many other diagnosis which in years past, the medical examiner would question and has no disease specific criteria, is used all the time. The criteria seems to be recommended but if the doctor thinks they qualify, they get admitted. Pts who would never qualify before, are being admitted. The medications we usedto use are no longer allowed because they'd are compounded and cost more, but trying to find something that works ends up costing more. And not everyone gets comfort kits on admission. i get called out for itching, dressing changes, constipation, all on pt's that are not dying anytime soon, and more than likely not within 6 months. They can come on for "palliative care" and basically see and do anything they want and still receive the benefits of hospice. we are managing diabetes, Coumadin, doing PT/INRs and other labs, IV antibiotics. i feel this is not hospice anymore but level of care above hospice, but below home health. It takes an act of congress to get our c 2 meds, when before I would call up the local pharmacy, give them the order and the medication would be delivered. Now, we have to call an intermediary company enclara and they mail the medication after they receive the c2. If I need it now, I still have to call them so they can enter it into the computer, then wait before I can call a local pharmacy. They have to get in touch with doctor to get C 2 and then the pt will get their meds. It ends up taking up to 45 min to just make all of these phone calls. i don't know if I'm just getting burned out, or just getting old but I don't like this "new" hospice. It's been the same with the last 3 hospices I worked at. I thought it was the company itself but it continues wherever I go. I also wonder why do I care so much that people who don't really qualify, are getting on service, I should be thankful I have a job in this economy, but I do care. anyone else having issues with the changes or is this localized? Or am I over reacting and just need to accept the changes or do I get out. i would like to hear about some of the changes you are experiencing and how do you deal with it? sorry so long, but thanks for reading!!
  2. jeannepaul

    Nurses in: Fla, Tenn, NM, TX--help needed

    Is there a rule about giving wages? Competitive doesn't mean much when you don't know the baseline. I work in San Antonio, hospice for about 13 years, I make over $30.00 an hour plus mileage is .52 a mile. On call visits over 60. Per visit so if you are willing to work, you can easily make over $100,000. A year, I have done it for several years. I live out of the city and san Antonia's radius is 50 miles around the city for most hospices. I used to work for Odyssey, which became gentiva. I left before gentiva so I don't know what it has become but there are several people still there that I worked with. They just got rid of the person who ran everyone off so if the policies haven't changed, it wouldn't be bad. Alamo may be another one to look at, they have an easy computer system to work with and supply iPads, at least they did a couple of years ago. i do think caseloads can be high at times and I would look for one that has its separate admit nurse and on call staff. housing depends on where you live. The north side of SA is more expensive but there seem to be pockets of wealthy neighborhoods next to poor ones. Balconies heights had the highest crime rate last time I looked about a year ago and I forgot the site, but there is a website that shows crime rates in the different areas of the city. I hate the traffic on the far north and west areas but it is still not as bad as Austin, houston and Dallas. good luck wherever you end up. I would like to live by the beach, but I'm too old and fat to actually go to the beach!
  3. jeannepaul

    Question re: FT on call and small case load

    I think they are wanting you to work 2 jobs and paying you for one. A normal on call position, at least where I come from, is either Monday thru Thursday 5p-8a. OR Fri-5p-Mon 8a. not both. When do they want you to see this case load, in the middle of the night, or are they wanting you to work before 5p also. No way would I accept this. I don't mind working extra, but they better expect to pay for it. I am weekend on call fri-mon. after 8a on Monday, if I see a pt, they pay me per visit. If they want you to carry a case load, that would mean alot more paperwork, going to IDt meetings, recerts. Are they going to pay you for your extra time? It sounds like a great deal for them, but a very bad one for you. It would also put me on guard about this company. It sounds like they do not care about the employees, just how much work they can get out of them.
  4. jeannepaul

    How Not to Die - new article featured in The Atlantic

    Yes I do see hospice care be "all about the money". In recent years, I have seen services cut, supplies decreased, medications covered decreased. We used to do the right thing for the patients and meet the patients and the family's needs. Now, as a hospice nurse cannot get the medications I need for a calm and comfortable death. I cannot get a special mattress to prevent bed sores, and I cannot even get crisis care for the pt when it is indicated. I really hope it is the hospice I work for (for now) and not all hospices participating in all of these cuts to care.
  5. jeannepaul

    Non Funded Patients

    Does your hospice take non funded patients? I have worked for 3 in my 11 years in hospice, 1 non profit and 2 for profit. All 3 took non funded patients, but I am ashamed to say, that one discharged a patient because their insurance ran out. Do you think it is ethical knowing a patient qualifies and really needs your service, too young for medicare, and their insurance say's no, to basically kick them off? The one's I used to work for would just switch them from funded to non funded and most of the time the patient didn't even realize it. I never would have thought a company would only "care" until the money ran out.
  6. jeannepaul

    PAY rate /FOR HOME HEALTH SERVICES with Hospice Agency

    as a new grad, I started out at 14.75 an hour, but that was in 2000, so I'm sure the amount is much higher now. What I do not understand is why home health is going to give morphine?? If he is on hospice, and too sick/demented to take it himself, what is he doing there alone?? Whomever he is living with should be giving it to him. If he is in assist. living, the pharmacy can draw up individual dosages in syringes that they can give. Where is the hospice company in all of this?? of course, hospice is not a caregiving organization, and we are not meant to go out every time he needs it, but we are to teach the caregivers how to administer the medication safely. liq. Morphine, or sometimes called Roxanol, is a quick in, quick out medication. It doesn't last that long so are you going to be staying with this pt or are they expecting you to go out there every few hours to give it? something just doesn't seem right.... be careful..... it is easy to give, but make sure you get the whole story and exactly what they expect you to do before taking this on.
  7. jeannepaul

    New LPN Seeking Info On How To Become Hospice Nurse

    Most hospice companies where I live will only hire lvn's to do crisis care where you stay at a pt's bedside for 8-12 hours. We have a few that work in the office. Only Rn's are hired as case managers. I did work for one company about 8 years ago that did have lvn's working alongside RN's, they would team them up, so it may be possible to do field nursing. good luck.
  8. I don't really think you have to have a "calling" to go into hospice. I actually had to be talked into it when I applied for a home health position, I agreed with the understanding that I could go to the home health side if I didn't like it....of course that was over 10 years ago and I don't think I will ever do anything but hospice now. I am working 7 days a week right now because we need hospice RN's and because I love it, it doesn't seem like I'm working that much. I work full time as the on call, but still see 13-17 pt during the week. Love the money, still home at night during the week with my kids and daddy watches the kids on the weekends. If I was single and no kids, I would probably work 7 days a week forever. It can be emotionally draining at times, frustrating and never ending paperwork, but what other job pays me to drive around listening to books on tape, drinking a soda, and going into peoples houses and visiting with them. What we mostly do is talk, teach and listen. Best job I ever had!!!!
  9. jeannepaul

    Expiratory vocalizations at the end of life

    This is the way I explain it to my pt's. as long as it is rhythmic each time they breath out, it is usually not pain. I usually tell them it is coming from the throat constricting, and usually with some ativan, it may decrease, but it is normal and nothing to be alarmed about. It alway helps if you mention everything that could happen before it does, it takes the panic out and instead of them going "oh no, what is that"? it is, "oh, that is what she was talking about" it is scary enough for the families going through this, but they need to know what to expect. Always try to keep them ahead of what is going to happen next. Most of the time when I do the pronouncment, they tell me it happened just like I said it would and they are comforted. I even demonstrate the breathing they may see or hear and although it is different, it is normal for them. The secretions is what is the most distressing for most of the families, but if it is explained what it is and how it will sound, they deal with it better. It's all about education. Of course there have been times the pt has done something that is totally out of the norm and even distressing for me, but on the outside, I stay calm, explain it is normal, even when the inside of me is saying, holy crap, this is not normal. lol ie. a lung cancer pt copious secretions, nothing seemed to help, in taking his last breath, he sat straight up and brown/black stuff came shooting out of his mouth all over the place. I just calmly asked for some towels, reassured this was normal, and cleaned him up, but inside I was a little freaked out. In 10 years in Hospice, I havent seen it like that again. I have had secretions come out, but not like it did that night.
  10. Recently my hospice company decided to stop covering antibiotics for these infections. I am just livid as I feel they are for comfort. We don't pay for OTC including tylenol, dulcolax, cough meds. For 10 years at each hospice I have worked for (just 3) we have always covered them. of course, if they are on our formulary, I still call them in at our expense. I will wait until I'm called in to stop doing it. We also used to get each admission a comfort pack to include dulcolax, tylenol, ativan, roxanol, phenergan and ABH. Now only pt's with a cancer diagnosis get these upon admission. and it takes an act of congress to even get ABH. we cannot get any compound meds, gels, and they don't want us to get liquid either. What is wrong with these people....... I can always make it come back to the hospice diagnosis, so I just don't understand how they cannot see it. Are any other companies doing this?
  11. jeannepaul

    d/c'ing routine meds,insulin

    I do not ask to dc any meds upon admission. for one, I don't know this pt. and to just dc them to me is unethical. To me that's like stopping the feedings just because they are on hospice.. Now, after doing a few visits and getting to know them and get a baseline, then I will discuss in IDT about dc'ing some of them, depending on what the pt or family wants. Most of the time, they want them to continue to take their meds as long as possible. I will explain the meds we cover and if they still want them to take the ones we do not cover, they will just continue to get them as they already are doing. When the patient starts having difficulty swallowing, I help the family prioritize which ones to give first and eventually, they all have to stop most of the time except sl, pr or topical meds.
  12. jeannepaul

    Confused and scared...I need advice...

    I hate to say it, but you are getting screwed!!!! I am an on call nurse and there is no in H@ll I would to that schedule. Not to mention at 150 pt's you should have at least 2 on call nurses at all times, possibly 3. It is usual protocol to go to deaths even in nursing homes, we have to stay until the funeral home picks up the body even if the family is there or not. but going out for every call, no way.. Our policy if they call twice for the same thing, we need to go out. We have to go out for falls, (but if its the middle of the night, no injury and they are back in bed, I usually go out in the morning. regs are it must be within 24hours) It is my understanding that Medicare pays one flat rate per month regarless of how many visits you make, what meds they get or equipment, someone correct me if I am wrong. the only time they would get more money is if they are on crisis care or GIP, then it is a higher rate. I work Friday 5p until Monday 8a. We have a little over 100 pt's and I have a case manager backup. I have to do admissions, deaths and visits. Somedays even with both of us, I still end up working anywhere from 14-16h straight, no breaks except what I eat in my car on the way to next visit. What happenes if you get fired? If that would break the contract, I would do what I felt like and if I didn't think they needed a visit, so be it. It sounds like a very toxic work environment. Possibly hostile, and if it is hostile, maybe you have something there to work with. You need to document, document, document and if possible, have somelse attend any meetings they have with you. I have known people to lie about that they say, or get a tape recorder and and record it every time you talk to them. CYA. Sorry this is such a mess, our work is stressful enough, without that kind of BS. Good luck.
  13. jeannepaul

    Yet Another Pre-Employment Drug Screen Thread

    I also thought it was a great post. I once applied for a position, took the test and the testing company called me when I came up positive. She asked for the pharmacy I got the med from and did a conference call with that pharmacy to verify it was my Rx. After it was verified, the lady from the testing company said all that would be sent to the hospital HR would be that I passed the test. I took the test at the hospital, so you may not have to tell anyone you are working for about it.
  14. jeannepaul

    Getting time in when far from office

    That is the way most hospices work. I live an hour away from the office and I don't get paid anything to that 1st or last pt's house either when I work during the week. The weekend is different, being on call it is paid mileage door to door, thank goodness, or I would be out alot of gas and money! Each company makes their own rules, so I would sit down with them and see what they will be willing to do. good luck!
  15. jeannepaul

    Did i really do anything wrong?

    Man, you people are brutal. I'ts funny how at times I read about something, and it's all love, and then other times, you rip into the OP. Personally, I don't see anything she did wrong, it sounds like this DON has something up his/her ***. I don't really have any advice as I don't know how the nursing homes work, but it sounds like you didn't deserve what you got, sorry about that, it sucks when crap like that happens. Good luck to you.

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