andre

Our agency is on an EMR so it's really only consents, port DNRs/copies of advance directives and pharmacy auths to turn in. The expectation is to turn everything in within 24 hours of the admit. Or 24 hours of the revocation/discharge. And ok to fax and then turn the originals in next time you're in the office.

arggggggggggggggggggggggggggggggggggggh.:banghead::banghead::banghead::banghead: I can't possibly be the only one trying to figure out how we're supposed to have any time left to see patients with all the new documentation requirements??????

What we have done in these scenarios is explain to the pt and family that if they call 911 or go to ER without calling us first, they are revoking their hospice benefit as that is outside our plan of care. There are occasions where we will ok hospitalization if the diagnosis is treatable and clearly outside of their hospice diagnosis (such as a recent patient with new onset seizures.....hospice diagnosis is cardiac). I think rather than making a blanket decision to discharge the patient in 30 days, now is the time to once again educate the pt and family about hospice philosophy, reevaluate patient goals, and establish a plan of care where it is clearly documented that all are understanding that 911 calls/ER visits without first discussing with hospice team means you are choosing to revoke the hospice benefit. Hope that helps, Andrea

I had this same experience when I had the flu a few years back....missed two consecutive days of work and was required to get a doctor's note. I went to my MD's office but saw a covering MD who, when I told her why I was there shook her head and said, "Wow, what are you, three? I can't believe they're making you do this....I'll be right back". She did no physical exam, just left the room, wrote my note, came back in and said "Feel better....go home and go to bed." Her note said: "Andrea has the flu. She may return to work tomorrow if she is feeling well enough, otherwise she may return at her discretion. Thank you for wasting an office visit by making her come in." :chuckle:chuckle:chuckle:chuckle:chuckle:chuckle It just makes me burn....I agree with you completely. We take care of incredibly sick patients--why is it so difficult to see that we do, in fact, know when we just have the sniffles and are capable of safe care versus when it is unwise, unsafe and generally a lousy idea for us to come to work? Andrea

Ok. I totally understand that nursing is a 24/7/365 operation. Really. And I knew when I went to nursing school that I'd be working weekends and holidays, and planning my vacations six month in advance, at least while I worked in the hospital setting. But seriously, why bother even giving people the opportunity to earn sick time if you are going to punish them for using it? I myself, though never warned or terminated for it, was routinely "dinged" on my annual evals for "excessive absenteeism".....though I only took sick time I had earned. Every year I had the same response for my manager: "I understand your policy, but I disagree with it. If I am sick or I have a sick child, and I have sick time to take, I am going to take it. I call in well in advance of the shift so I don't leave anyone in a bind. I have also been known to come in when asked on my day off because of other staff sick calls, or to help cover vacations. I disagree that it's excessive absenteeism if it's within the limits of the time I earn." And every year we'd agree to disagree, and I'd go back to the floor.... Now I work in hospice. I work very few weekends, I have paid holidays, and if I call out sick I am told "Feel better....take care of yourself." In fact, the few times I have gone to work sick because of the expectations I had absorbed that that's just what you do as a nurse...and I was told "Go home! You're sick! We don't want you seeing patients like that!". It just makes me so angry that so many of us are made to feel like criminals or bad employees for taking more than 2 or 3 sick days per year! Sometimes life just doesn't work that way! And no one should be made to feel bad about that! Ok, rant over. Andrea

I'm not case managing any longer, but when I did I carried a caseload of 12 and generally did 4 visits and several phone calls per day. Five visits was BUSY and happened sometimes, but I never did more than that.

Our agency is now on Road Notes, which is fine but is not terribly intuitive. I hear GREAT things about HealthWyse (have a friend who is a project manager for that company). I've heard very mixed reviews about McKesson, but have never seen it.

I graduated in NH (NHCTC Stratham) in May of 2005. Took my boards June 7th, 2005. Could have tested sooner but I wanted a few more days to study. It is do-able, IMHO. Andrea

Clearly I didn't read your first post very closely! Somehow I thought you had said she was moaning with care.... Your other post about not being able to auscultate heart sounds, along with the wet breathing would lead me more toward fluid overload.....still, if she's that "wet", and even with no grimace but some moaning, I might use the morphine more often than q3hr.....

I'd rather suspect she is either in pain or anxious--anxiety may be r/t dyspnea. Is she on any morphine? I think she needs to be medicated!

I went to hospice directly from tele! Well, unless you want to count the 8 weeks of misery in outpatient oncology before I ran screaming to hospice (oh I loved onc--the patients, the work itself--it was the nastiness of the other staff I just couldn't stomach)... Actually, my experience sounds a lot like yours....spent five years as a unit secretary on tele, then was a new grad on tele--had just under two years as an RN when I went to hospice. If you've got any experience on your unit with palliative/comfort care only patients, that will be helpful.

I am going to respectfully disagree with that statement. Pain crises happen at all hours of the day and night. This is not a reflection on how well case managers are taking care of their patients. Otherwise, I agree with the rest of your post! Andrea

Can you ask to shadow for a shift before accepting the position? This would give you a better "feel" for the unit.....

I could not agree more with this post! It isn't that LTC nursing staff don't want to provide excellent end of life care...and obviously in many cases, they do. But given the LTC nurses' patient loads, and that the focus of hospice is really very different than your SNF patients....well, for all of those reasons having a hospice program in LTC facilities is a necessary adjunct to the care those residents are already receiving.

Welcome to hospice! I've only been in this specialty for five months, but I can't imagine going back to tele/stepdown now, at least not full time (I'm still per diem at the hospital). I do home hospice, and the acuity even in the home can be unbelievable--versed gtts, morphine and fentanyl and dilaudid gtts, tube feeds and ports to access....initally I worried about "losing skills" in home hospice, but in fact I feel like my skills are actually sharper now. (Especially with ports...I was always scared of 'em before!) Look forward to hearing more about your new position! Andrea