Maryann RN

I should count my blessings. I've been feeling discouraged lately but after reading these posts I am pretty lucky. I work M-F 8-4:30; no weekends or holidays. No on call ( we have an on call team ). My average caseload is 12 and my travel is about 20-30 miles max. I have had to do on call with another hospice and it stressed me out so much I spent the day before worrying about it, couldn't sleep the night I had on call and was exhausted the next day. As I said in an earlier post, I won't work for a hospice where I have to do on call.o those of you out there who are overworked and stressed, please be safe.

Been there,done that and I now absolutely refuse to work for a hospice where I have to do on call. when I interviewed with the hospice I currently work for the first question I asked them was if I had to do call. Fortunately we have a wonderful on call team of nurses who do just that. We also have a weekend team. On rare occasions we have had to cover just our own patients from 4:40pm - 8am. this was only when the on call nurse was ill and thre was no one to cover for her. I agree it is an unsafe situation. Are you an on call nurse or do you also have a case load? Bless you and sweet dreams.

It has been interesting reading all the responses you have gotten. It just bothered me to hear the anger and vindictiveness in some of the e-mails. As I said before, hospice is difficult and challenging enough with patients and families without having conflicts with team membrs. I had a MAJOR disagreement with a SW a few months ago. It caused me alot of stress. the next day we went to lunch together and were able to talk about it. It wasn't easy but it was resolved and we didn't have to involve anyone else. We have a great working relationship and the incident has not been mentioned since. I hope for your sake that you are able to put this behind you. It can be challenging working with a team, lots of different personalities, beliefs systems, roles. Hope you have received some good feedback and positive support. Maryann

I guess I am playing devils advocate here but I'm really not understanding where most of you are coming from. My experience has been that ALL hospice team members are patient advocates and protect patient privacy. As the nurse/case manager I know that I am responsible for the team but have never considered my role more important than anyone elses. In the case mentioned, once the patient agreed to have the SW present it was a done deal. I never totally uncover a patient even when I am alone with them. We need to protect their dignity and modesty. We should all have been taught this in nursing 101. I can do a complete assessment, bathe a patient and keep them covered the whole time. You only uncover the part of the body you are working with at any given time. Part of the role of a SW is to be able to identify pain, depression, anxiety, delirium and mobility when with a patient. I frequently get calls from the SW, who is with a patient, describing what they are seeing. they have called me about new skin tears, possible pain, anxiety etc. with the patient. Our aides and chaplains do the same thing. Of course they are not medical and do not do a medical assessment but know enough to call the nurse. I do feel the SW in this situation should have discussed her feelings with the nurse after the visit was over. If they could not have resolved it then they both together, should have taken it to a higher level for help in rsolving this. Hospice nursing is challenging enough without having the stress of internal team conflicts. I hope you can resolve this and let it go. Take care of yourself and appreciate that what you do can be difficult, Your team needs to be there to support each other.

I do home care and the SW on my team does alot of joint visits with me. Both of us wear street clothes ( not scrubs ) per my hospice's policy. I do all kinds of personal care and procedures in street clothes so the type of dress someone is wearing really doesn't matter. I am grateful that the SW is not squemish about assisting me when needed. We do always get the pts permission. For example: she has assisted me to turn and reposition a pt.; hold a flashlight for me to do a cath. etc. She is well aware of what she can and cannot do and is always willing to assist if possible. We have developed a great working relationship which I am grateful for. The example we set for patients and families that hospice is a "team" concept has served us well in some difficult situations. I would never expect her to bathe a patient but she certainly can assist in helping to turn and hold a patient. I always keep the patient covered except for the area I am working with. The hospice team has alot of different roles but none is more important than another. We need each other to be able to effectively meet the needs of our patients and their families. Families have told me it is reassuring to them to see us working together.

I traveled for 2 1/2 years and always took the stipend. Would stay in a motel when I first arrived and if not satisifed with that I would then start looking for something else. My husband traveled with me on 3 of my 4 assignments. I took an assignment in California which extended into a year. We lived in 2 different motels until finding a small, unfurnished house. We furnished it with some cool, deco furniture we found at Salv. Army. When we left we donated the "cheap" furniture to a family who were having a very hard time financially due to medical expenses. They were thrilled and we wre happy to recycle our treasures. I found that when traveling it was helpful to look at each new assignment as an adventure. It was fun to be creative and to find ways to make the best of sometimes less than desirable circumstances. Flexibility and being able to "go with the flow" are key elements to be able to travel and enjoy it.

I just wanted to confirm that the detergent must be liquid. Guess everyone figured that out but wanted to make sure. There doesn't seem to be any ideal way to do this to keep things environmentally safe. Another suggestion that I have heard of is to add quick setting concrete mix and water to a zip lock bag with meds.

I absolutely agree with the last writer. I've been a nurse for 19 years. I worked in med/surg, L&D, day surgery and psych ( even did a couple of years as a travel nurse) before I went to hospice. It is a wonderful fit for me now but I am grateful for the prior experiences, which helped prepare me for hospice. Hospice requires good assessment skills and the ability to communicate comfortably with doctors as well as work on you own. the autonomy is one of the things I like about hospice, but it can be intimidating. I would recommend at least a year of some type of medical and a year of psych if possible. I started in a hospice inpatient unit which was a good place to begin. I am now a hospice home care nurse/case manager. No way could I have done this right out of school. Good luck and congratulations on your graduation. You've chosen a wonderful and diverse profession.

I just recertified. My company gives $1.00/hour for certified nurses and also reimbursed me for the exam. I am a diploma nurse and don't have a degree. I feel certification is a way to show my competence and demonstrates my desire to go the extra mile in my specialty. It's a personal thing for me.

We place medications ( liquid, tabs and capsules) in a plastic zip lock bag and add dish or laundry detergent. the bag is closed and then placed in regular trash. Detergen must be a regular detergent and not a natural product. The regular detergent turns the meds into a gel.