Jack Hazz

Nice one and spot on Nurse Beth. There was a survey done in one of the hospital system in my area recently asking who patients trust the most when they are in the hospital. I was not surprised when the number answer is NURSES. Near the bottom are DOCTORS, which made me laugh. The patients reason for them picking nurses as their choice is "always there", "truthful", "caring"...all the good stuff. The biggest reason why they do not trust hospital MDs (they trust their PCPs) was "only saw me for 5 mins and always in a rush". It is funny but true. And as much as I love the company I work at and feel the support compared to the other places I've been, the fact remains that nurses are just an afterthought when it comes to policy making. This is true even when our department (I am a hospice nurse) is basically a nurse-driven entity separate from the hospital itself. We remain at the mercy of doctors and paper pushers (who never even stepped out in the field yet they are "experts" compared to us). And to make it worse, some of those paper pushers are RN by title but always conforms to what their peers and higher-ups want.

I did, but did not go in depth. Maybe I should. Thanks for the advice.

6 years RNCM here...Let's do that!

It is more likely mottling. Cells die mostly due to lack of oxygen at EOL, especially if they are imminent and they develop purplish...or sometimes looks like bruising...on their extremities and can sometimes spread all over, though I only saw that once.

RNCM here. I am hourly and see 4-5 pts daily on the average. Normally, at least where I work, 4 is the usual number of pts per day. Anything above that or if a pt has a lot of needs and we stayed maybe 2 hrs and over for that visit, is OT. That is our unwritten rule. With that said, I prefer hourly. We are always busy and have hired maybe 20 RNs just this year. We are practically begging for help, so at where I work, I don't think hourly or per patient matters. And we have a low turnover rate so we know most of the RNs, HHAs, Chaps and MSWs are contented and happy. My supervisors are salaried and they're SUPPOSED to work 8 hrs a day. Emphasis on the SUPPOSED. I think they work maybe 12 hours a day and they do not get OT, though of course, another unwritten fact, and no one speaks of it, is that they "get" bonuses at the end of year if the budget given to them has leftover left...again, I absolutely don't know anything about that...wink wink...LOL!

I have been a hospice RNCM for 6 years now and planned to take the CHPN certification for the longest time but never got to it. I finally decided I'd review, shell out the $415 and take the test early next year. I am more of a hands-on, visual nurse and retain information pretty well. That is why I'd rather do practice tests than read a book or flip through index cards. Anyone recommend a website for CHPN online practice tests as a review tool? Thanks in advance!

Its more of the misinformation started by someone they look up to and perpetuated by people that are, surprisingly, mostly vaccinated, that the vaccines do not work without even knowing how vaccines work. People who I spoke with say they HEARD that healthcare workers refuse the vaccines, but DO NOT KNOW anyone. Most of the time, these stories are the usual "I heard it from my uncle's hairdresser's boyfriend's lover's wife's pimp's cousin's bodyguard's mistress" type of facts. Several surveys on nurses garnered data that 88% all the way to 96% of US nurses are covid19 vaccinated.

Well, welcome to my world, where I play a part-time job of being an MD, pharmacist, social worker, hospice aid and chaplain. Plus when patients and family are frustrated, grieving and emotional, you also become a sponge to absorb it all, their anger, their fear, their anxiety...And to top it all off, despite signing on with hospice, you should be a miracle worker and treat their love one and make them well. And that is because their agitation or pain or sob or anxiety got better because you administered the comfort meds they oh, so declined to use for the longest time because it will kill the patient....oh well.

I'll be honest, I have coworkers who are not vaccinated. And yes, I look at them with tsk tsk tsk running through my brain. But then again, it is their choice. We can argue all day about trying to keep not only our patients safe, but family, friends and COWORKERS safe. But at the end of the day, no one here wants to be forced into doing something they don't want to do. They chose to have swabs crammed into their nostrils every week, so be it.

don't get discouraged and goodluck!

Depends on where you live in Ca. I live up North and cost of living is half less that of Bay Area...and I earn almost that amount stated above. What Bay Area workers do is they buy houses far from the Bay Area...problem is their commute is 2-3 hrs...

I am lucky enough to currently work in an institution that gives great support to the staff, at least in my department. The pay is up there, though not in the $100/hr (I wish) and usually just work 40-45 hrs weekly. I've worked in this comlany for the past 6 years and we have low turn over rate. But the OP should not be hating on the travel nurses. They are just doing their job like every one of us. This is a company issue, so maybe the OP can bring that up to the management.

I have been applying at Kaiser for so many years until I finally decided to quit. What I learned from friends and relatives working there is basically, they hire from within or that dreaded "its who you know, not what you know". I've seen that "application submitted" multiple times before. I never really wanted to be in debt with anyone for a job so I never asked my friends and relatives even when they offer to recommend me. But I hope that you guys have better luck than I did.

Looking at my PTO hours right now and I accumulate about 9.5 hrs every paycheck.

A lot of advice can be given, but only one thing you have to remember. At the end of the day, you're main focus is patient comfort at the end of life, not the family's nor yours.

My highest case load was 18 too. For me, 15 is pushing it. I am comfortable with 12-13. Good thing the hospice I work with cap it at 15.

Depends. Here in Northern California, particularly in the Sacramento County, I can name major hospice companies, both independent and those affiliated to hospitals. Vitas usually offers $35/hr, less if you are not an RN but I think they started just hiring RNs now. Pretty big, last time I heard, they have 400-600 patient census. I actually think they are the biggest in Northern California. Bristol, I think, goes pretty much that route about $30-$40/hr, plus they have a $1000 sign-in bonus. Just saw that in an ad. Kaiser offers the biggest, I think they start at $55-$65. But their hospice is small and it is hard to get in, unless you already know someone that can recommend you and even that is not sure. Mostly they only offer per diem. I know someone there that said they have been asking the management to expand hospice services and hire more but so far it was a no-go. They've been sending the patients that they can not handle to Vitas, Bristol (though I think they are having issues with them right now) and Sutter, and that is actually a lot of patients. Sutter offers around $45-$55. They are bigger than Kaiser, hospice-wise, and like Kaiser, your chances of getting in is better if you have good experience and/or you know someone that can recommend you and vouch that you are a good RN. Mercy/Dignity Health also offers $40-$55. Its easier to get in compared to Kaiser and Sutter, but based on my experience 3 years ago and those of other nurses in facilities, they have the worst support and service among all of the above. I do not know if that changed already. Again, this depends on your experience. They usually want at least 2 years of relevant experience, better if it is home health or hospice experience. They all offer mileage. Best benefit is usually Sutter and Kaiser. I think only Sutter offer retirement and they pay for it for their employees and you get vested in 2-3 years. Those are usually the big hospice companies. There are other smaller companies and those that just started. There is Snowline, Hospice of the Valley (I think they got acquired by Sutter), etc. This is just for the Sacramento County/some Northern California. I believe its different down south.

I agree. Most of hospice patients with TPNs are already on it prior to being admitted. I recently had a patient on TPN and I was horrified as my last TPN experience was 2 years ago. Good thing she uses CADD pump which I am familiar with and it all came back to me and went like a breeze. We rarely have TPN patients but since I became the CM for that patient and the family told my supervisor how great I was with the TPN (LOL!!!), we got 2 more TPN patients after that and curiously, they all went to me...yeah, I was very surprised (with one eyebrow raised all the way to the ceiling)!

I feel for those who work unsupported by their supervisors. I've been in 2 hospice companies, one that is for profit and the other, non-profit. I've always gotten the support and help I needed and it probably is a horrible feeling to not have anyone when you needed help. The only time help takes a long time to come is when my supervisor is on vacation, so I am glad and appreciative of my boss.

I would like to disagree very strongly with the one that said hospital based hospice has nothing positive. I worked for a FOR PROFIT hospice like vitas before and then moved on to a NON PROFIT hospital based hospice and I would say it was a great move. Dont get me wrong, I liked my time with Vitas, but I love my work at my current job. And turn over rate is low. I do not know how the hospital based hospice in your area works, but ours is great, thank you very much.

Yeah, I've asked some of my seasoned collegues here and we all came to the same conclusion. Break it to them gently in the most honest and acceptable way of telling them based on how and who they are. And I have been doing this mostly... But I definitely still have the sad feeling of being the bearer of bad news... I always thought, though, that everyone in hospice SHOULD feel the same way, as we are human, and feeling that way only shows we care and we are compassionate. As long as I get over it afterwards, then I should be ok. I've decided that when the time comes that I get numbed with deaths, I would be looking for a different job. I hope I am right with this chain of thought...

So far, I have yet to draw blood or start an IV. Hospice frowns on IV because the disadvantage actually outweighs the benefits by a lot for someone who is dying. Plus medicare (if they have medicare, which is most of my patients) does not think hospice to consider IV therapy (though I heard medicare has changed their position on this and given hospices more leeway). My current hospice company does consider IV but we have a dedicated infusion team to do it for us. I'd love to do it though as I sometimes miss the time when I started hundreds of IV when I was still at the ER and ICU before.

I love hospice...I love working and developing relationship with my patients and families. Some are hard to deal with over-all, but most are loving and understanding and easy to deal with. But the hardest ones for me are the families that are still in denial and unaccepting about their love ones transitioning, especially the ones that do not realize that they do, and it does not even matter is they are pleasant or nasty. I had a patient's son once whose mom was dying and he said he knows and accepts that he is dying soon. But he told me he wants to keep feeding her despite the fact that she is has been refusing food "to give her a FIGHTING CHANCE". He even went and bought her ensure and facility staff in the ALF she is staying at told me he basically makes her eat all her food even if it takes them 3 hours to do so. Everytime I talk to him about end of life and transitioning of hospice patients, he gets defensive and literally closes his mind on anything. I'd say that I'm quite a good listener and very good at addressing questions and concerns of my patients and caregivers. I say that based on the very good and encouraging comments about me by probably 90% of my cases. Of course, I am not perfect. But the biggest challenge for me is on how to tell the family that their mom or dad or uncle, etc is dying. I find myself always stopping at the point where I am about to tell them, yes, your mom is dying...actively...and you might see these horrible symptoms before they pass. And if I did, I kind of think back and wonder if I shouldn't have told them, or if I said the right things, or if I showed enough empathy or...I just kind of starting to doubt whether I did the right thing. I know I did the right thing telling them, but I still feel horrible. I get over it, but still. How about you guys and girls, HOW DO YOU TELL THEM ABOUT EOL? PS Sorry about the long story for a simple(?) question...

Lol... Rearview, I would like to agree with most of these wonderful nurses that posted in this thread. Hospice is a different kind of animal, but the main idea is the same as all other kinds of nursing... Taking care of our patients. I guess I am more forgiving as I used to work in the ICU and ER before jumping ship to being a facility nurse that is more office based than hands. I dealt with a lot of hospice and home health cases though in my facility that I was very intrigued and thought about how hard can it be. So I jumped ship again and yes, it is hard but enjoyable and fulfilling in hospice. You will never leave the hard labor part of nursing, bedside care always presents itself every visit, family and medication issues are always by the corner waiting to jump on you. But you get to be independent, manage about 10 to 20 pts a week (yes, I had 18 before... Thats was hard...esp when I had 2 actively dying ones Ive put on CC), but i do get real breaks, think independently and get home on time. I love what I am doing now... Hopefully, you will too.

I'd love to get that POC flipbook... But our tablet already has all the accepted POC that our hospice company wants used. It was developed prescreened by our supervisors which are mostly nurses.