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andre's Latest Activity

  1. andre

    In the Field: Turning In paperwork question

    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.
  2. andre


    LOVE my Ultrascope! I hear much better with it than my (double the cost) Littman.
  3. andre

    Patient Navigators

    Anyone work in a clinic that has a Patient Navigator? Any experiences to share with how that model works? TIA, andre
  4. andre

    Lather, Rinse, Repeat

    So my usual morning routine goes like this: print my report sheet, and start putting in my little boxes for med times, assessments, etc (yes, I'm the OCD nurse), while I wait for the night nurses to be ready for report. Get a face-to-face report from the off-going nurse(s). Then we do walking rounds, so we can meet the patients....and make sure they're still breathing (true story: not long ago in walking rounds we discovered a palliative patient had just died...imagine if we had skipped rounds and I hadn't gone to assess her first?). As soon as I've met my patients and made sure there's nothing that needs my immediate response--patient crashing, in pain, etc--then I go back to my computer. At this point, I take a good 20 minutes to look at the last set of vital signs, any a.m. labs that are back, and the last nursing note. By this time I feel "ready" to decide who I need to see first and start passing my meds. And it's probably 8 am by now. Generally, I find it helpful to have looked at vitals and labs before pulling meds, so that I know if the patient's BP is low enough to hold meds, for example. Or I know what their K+ is before I pull out a big dose of Lasix. So anyway, I pull my first patient's meds, and do my first assessment when I go to give them. Lather, rinse, repeat. I usually pass all my morning meds and cover fingersticks before sitting down to document any assessments. Of course, by this time docs are rounding and writing new orders, too... So. Back to my patient. After hearing in the report that he's full of cancer, we go to see him first and he needs pain meds. So right away I pulled his Oxy and gave it. He said to me, "you girls are soooooooooooo nice". About a half hour later, after seeing my next patient, I went to re-assess his pain, and he was much more comfortable. I asked him if he needed anything, and he said, "oh just a few ice chips if that's ok". I said, "Of course" and then suggested some ice cream. His whole face lit up, and he asked, "I can have ice cream?" Oh lordy, you can have anything you want. As far as I'm concerned, when you're dying of cancer, ice cream for breakfast is not only ok, it's medicinal. So I went to see all my other patients, gave meds, sent folks for Xrays, talked with some docs. Then I went to see him again. With an ice cream in hand. He beamed from ear to ear. All day he kept thanking me for being so nice. Honestly, he was an easy guy to like, grateful for the most trivial of things. One of the things I like most about palliative patients is that the focus really is on the small things--fluffing pillows, backrubs, clean sheets, cool cloths. Pain meds. Ice cream. Lather, rinse, repeat.
  5. 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
  6. andre

    High Blood Pressure At End Of Life?????

    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.....
  7. andre

    High Blood Pressure At End Of Life?????

    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!
  8. andre

    Experience required for Hospice RN

    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.
  9. andre

    Handling On Call

    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
  10. andre

    Should I return to the ER?

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

    Is a hospice program needed in LTC?

    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.
  12. andre

    New Hospice Nurse says HI!

    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
  13. andre

    Paper or computer documentation???

    Road Notes is what we'll be using! I asked the question because so many of the RNs in my hospice are sooooooooooo negative about the change over--and I am personally looking forward to it! I came to hospice from a hospital with a fully electronic medical record, so going back to the reams and reams of paper, with stuff falling out of charts and missing or mis-filed....and not to mention often illegible...well it made me want to scream! I start learning the program next week.....can't wait!
  14. I am curious, is your hospice using computer documentation, and if so, what program are you using? do you like it? If you have done both paper and computer documentation in the hospice setting, which did you prefer and why?? This should be an interesting discussion.....
  15. andre

    Insightful answers please. . . . .

    I agree with this response as well.....my hospice job is much more flexible and family friendly than my 12 hour shift work in the hospital setting.
  16. andre

    Having a hard time with boundaries

    I refuse to believe that hospice requires us to be "on" 24/7. In fact, in my hospice I am encouraged not to even think of checking my email on my day off, or on the weekend. I am salaried at 32 hours per week, and yes, there are some weeks that I work more than that--but never more than 35-36 hours a week. My personal life is busy in and of itself, and I refuse to allow my job to eat into my valuable time with my family. IMHO, that work/life balance is even more important in hospice than in other areas of nursing, because as the hospice case manager, you already feel so RESPONSIBLE for everything that happens to your patients! I feel sad that you have a team leader that doesn't support you in this. Additionally, I think putting limits on call time is also a good thing. My hospice has a dedicated call team, but with some recent staffing changes, asked case managers to take some call--I took a few shifts I felt I could handle, but also made it clear that it's unreasonable to ask someone to work 8-430, be on call 4pm-8am, then come work another full day. If people are asked to take call then there must be some grace allowed to take a day off the next day (assuming the pager is going off.....if you have a quiet night, maybe it's a non issue). My point, I guess, is this: if you enjoy the work of hospice nursing, maybe this just isn't the right company for you? I don't know if you have other choices where you are geographically, but I'd encourage you to think about it at least.

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