Meliss214

Does a pt automatically qualify for GIP when lopressors are discontinued?

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Yes, the doctor that I consulted with is employed with the hospice company. The other reason that they are using to justify my termination is that I called in an order for lorazepam which is part of comfort kit. However, when the doctor refused to approve the order, I promptly called the pharmacy to cancel the order. The pt was having severe dyskinesia and dyspnea as a result of ES Parkinson's. The true motive for my termination is that I'm advocating for the pt and upsetting the doctor's ego. My supervisor has chosen to protect the doctor at the expense of the patient's safety because she's more concerned with growing the census.

Thank you! This was the first time in 4 yrs as a hospice nurse where the hospice doctor refused to let me send out a comfort kit. I know the company was desperate for referrals, but I didn't think they would stoop so low as to compromise the care of the pt. I'm contacting an attorney on Monday. The district manager even recognized me as being a patient advocate during my termination. I'm still stunned.

I was terminated yesterday for calling another hospice doctor at our company for advice on how to handle a pt's unmanaged symptoms. I disclosed the pt's age and her dx of ES Parkinson's and the symptoms that were not being managed by the pt's physician who was new to the hospice company. I called her after my supervisor continued to overlook the negligent behavior of the pt's doctor because they want his referrals. My supervisor wanted me to keep quiet and just call 911 if they pt experienced another episode of severe dyspnea. Do I have a case?

I commend you for surviving so long in those conditions. I love hospice, but have not been impressed by the business side of it. I tried case management after starting out as the weekend oncall nurse and have found that the CMs are exploited beyond belief. So I'm on the search for a weekend oncall position once again. Good luck in med/surg!

I currently work that shift. Definitely prefer these hrs compared to the m-f schedule. I'm responsible for doing admissions also so I usually work Mon and Tues doing paperwork. The worst part of this shift is having your sleep interrupted to go out on a call and then being expected to go full speed the following day with only 3 hrs of sleep. But fortunately that doesn't happen every weekend.

Thanks for responding. The pt and his wife prefer increasing the oxygen instead of increasing the morphine dose.

I received orders from the Dr to give a pt with COPD and lung ca 15 L of oxygen because the pt is experiencing respiratory distress and the ativan and morphine were insufficient. The pt was previously on 5 Lof 02 until the family bumped up the oxygen to 8 L which allowed the pt to sleep. But my supervisor wants the pt to go down to 5L of oxygen because of the COPD. How would you handle this situation?

What if the pt has lung cancer along with COPD, and prefers hi flow oxygen instead of high doses of morphine?

I had 6 mos of nursing experience when I was hired to work as a hospice RN. I spent 1 mo shadowing the case managers and assisting when possible. Fortunately I had a supervisor who was just a phone call away so I never felt like I was all alone. I've been working on call for 2 mos now and love it. Once your learn which meds to administer to control sxs and master the art of changing a foley, you're good to go. Hospice is more about educating the family regarding pt care and how to handle the stress of caring for the pt. I had no prior experience in changing foleys before I started hospice, but let me just say, it's much easier than starting an IV any day.

Yes, the patient is on hospice and since I am new to hospice and this company, I didn't no that I could order cipro without the DON's permission, although she would like me to think that I need her permission. I was informed yesterday by the on call nurse whom I will be replacing next weekend that since we have standing orders from the MD, we don't need the DON's permission. The DON stated that cipro is considered aggressive treatment since the pt is already receiving amoxicillan for another infection. To me and the other nurse, it sounds like a budget issue. This company is having a difficult time retaining nurses and I'm beginning to see why. I just left another hospice company after 3 wks of training because the DON was not knowledgeable about how to treat the pt's conditions. This DON is up to date on how to treat conditions, but then tells me I can't do anything without the CM's permission. Keep in mind that the CM for this pt is also new to hospice care and has failed to make a scheduled visit to the pt because of the distance. I also found out yesterday that this CM removed a comfort kit from another pt's house. I'm trying to give her the benefit of the doubt by saying she has not been trained on how to dispose of expired meds, if that was the case. Please pray for me.... I love hospice and will stay as long as possible for the patients' sake.

I'm beside myself right now because my DON won't let me call in an order for cipro to treat a UTI in a pt with bladder cancer because she considers it to be an aggressive treatment. Am I overreacting?

I left the hospital scene after enduring "bullying" behavior from the veteran nurses. I now have to drive all over Houston to care for hospice patients, but it's worth not having to watch your back from disingenuous co-workers.

Congratulations on making it this far! I only lasted 4 mos at my first job as a psych nurse and 2 mos as a day surgery nurse. I couldn't stand the nastiness of the other nurses. I'm 44 so I'm ready to leave the high school mentality. I'm excited about starting my new job as a hospice nurse and relieved that they are willing to spend at least 2 mos preparing me for this job. Yes, the hours are rough as I will be working on-call from 5 pm on Fri to 8 am Mon, but I was exhausted working M-F at my last 2 jobs. Please consider another position since ortho is a tough gig. I did it for my 8 week internship and was exhausted trying to constantly assist the patients with hip replacements.

Thank you Lotlie for your response. I've read that being on-call involves less paperwork than being a CM. My main challenge will be finding time to sleep. I've been told by my manager that if I get a 2-3 hr break, I'm good to go for another 12 hrs. I will pull over and catch a power nap in my car if I'm feeling exhausted because I'm not willing to endanger my patients with poor nursing care as a result of fatigue.

I've just been hired to work the weekend on-call shift which begins at 5 pm Friday and ends 8 am Mon. I'm wondering if anyone has any tips on how to survive this type of shift. My area spans 100 miles and I'm wondering if I should get an apartment that is centrally located since my fiancee's house is at one end of the area I'm responsible for. I'm excited about starting my career in hospice, but I'm concerned about getting some sleep.

I too have quit 2 nursing jobs in my 1st year. Both places have a high turnover rate so I'm trying not to take the experiences too personally. Do I have to list both jobs on my resume?

I got hired at a hospital today by bypassing HR to meet the nurse manager on the unit. The hospital that hired me has a reputation for hiring new nurses and my friends told me that you have to meet face to face with the nurse managers in order to get interviewed. HTH.

Only if your license was suspended. A former employer is restricted from sharing any info regarding your job performance.

At least you weren't suspended like I was for failing to notify the attending. I left that toxic work environment since my supervisor believed the nursing is an autonomous job even though my charge nurse and I were equally responsible for all the patients on the psych unit. Living and learning...

I just resigned as a psych nurse after 4 mons because the NM suspended me for failing to call the attending regarding a patient's bp that was not responding to the meds that the medical dr was ordering. I had mentioned the pt's bp problem to the attending the week before and she she quickly retorted, "Tell the medical doctor. I don't deal with blood pressure." So I know the NM was not getting any heat from the attending. Also my charge nurse was fully aware of this situation since he was sitting next to me in the nursing station each time I called the medical dr for new orders and the charge nurse in the psych hospital is responsible for giving report to the next shift. So I now the NM was targeting me. I had to resign because my license was at stake. I had an interview yesterday for a LTC position, so I'm hoping I hear something by tomorrow. Btw, I was never written up prior to my suspension.

Some of my friends took the initiative to meet the nurse manager and ask if they could schedule an interview for the posted position. I recently resigned from my position as a psychiatric nurse, and if I don't get the job that I just interviewed for, I too will resort to making face to face contact with the nurse managers. HTH

I'm working at a facility that was recently purchased by UHS. So far nothing has changed except the incidence reports.

I so needed this thread. I too have been accused of being difficult to work with. So now I'm going to ask for specific examples. I would love to quit and start off fresh somewhere else since I feel that I have been labeled.