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Hospice RN

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  1. anashenwrath

    What is a bad day?

    Getting called to leave an actively dying patient with grieving family that you've been taking care of for a month to admit a 60-something year old who lives at home independently and who you didn't find eligible in the first place. bcs it's all about the census. ...not that i'm bitter today or anything.
  2. anashenwrath

    Should I feel bad for not picking up extra shifts?

    Sweet summer child. They will say ANYTHING to get you to pick up a shift. It will never change and it will never stop. Screen your calls and rest easy. You are under no obligation and they are lucky to have you. Nurses are made to feel bad for saying no. And it works, because we are compassionate people who want to be there for our patients. You know who else you need to be there for? Yourself. Your family? Your pet? Your... succulent plant? I dunno. Other things! I stopped agreeing to every overtime request when I ended up on a floor I didn't know, on a shift I didn't know, with an agency nurse who left halfway through the med pass. Oh, and it was after working the night shift the night before. I was tired and stressed and I ended up making two med errors. Not worth it. You are NEVER a last resort. You are the FIRST line in keeping your patients safe. And you can't do that if you are overworked and stressed. Screen your calls. Mute your phone. Whatever it takes. You're worth it.
  3. anashenwrath

    Opoid crisis and providing hospice care

    I'm on Cape Cod (ie, that place where HBO did a documentary about the opioid crisis) and find overall it's not too bad. Like anywhere, different prescribers prescribe differently, but it's not necessarily about the opioid crisis... it can just be ignorance about dying or symptom management in general. Same old same old. I think it's actually become easier with families because I can be very upfront about checking meds. "Sorry I have to count your pills every visit; it's just the way things are done these days." People who may have taken it personally back in the day totally understand it's just the climate of our times. I have had to manage comfort kits when there were active users in the house, which has challenges. We usually deal with it via lockboxes and trusted family members. I had one lockbox broken into. That really upset me. I'm pretty sure I know which family member did it, but couldn't prove it. We ended up double-locking the next kit and only the hospice crew had the combination. THAT was annoying. I thought we would have to do continuous care, but the patient actually passed very quickly and peacefully. Oh, but what really cheeses me is, at least in this state, nurses aren't allowed to destroy meds in the home (or take them, obviously). Usually, families are more than willing to destroy them right there in front of me, but sometimes I will get a family that will be like, "Ehh, thanks. We're just going to hold onto these." THAT concerns me. Even if they do dispose of them later, if they just chuck them in the garbage, someone might notice and pick them out! I feel like dumb protocol like that contributes to the ongoing crisis.
  4. anashenwrath

    I made a medication error. What will happen to me?

    As others said: not sure what your working environment is, but I think you'll be fine. I remember when I made a narcotic error. And I didn't catch it, my supervisor did the next day! I was horrified, mortified, and thoroughly convinced I was going to be drawn and quartered. I can't even describe the SHAME I felt as I sat in her plush office, mumbling about how the error had occurred when I picked up an unfamiliar shift to cover short staffing. (Like that was an excuse) I didn't get any sort of reprimand except some education and a reminder not to rush. You went above and beyond. You sound like an excellent nurse. Be at peace!
  5. anashenwrath

    ER to Hospice

    Congrats OP! Based on your username, I'm going to assume you're in Oregon, which is a very good state for EOL care! Reading through your pros and cons, I noticed a lot of "logistical" factors, so I wanted to chime in as you get started as a hospice nurse. Yes, we get mileage, amazing bedside experiences, and awesome self-management. Yes, I have ended my day at 3 pm sitting on the beach in my scrubs, documenting on my tablet. BUT: that's not a reason to be a hospice nurse. I have sat at a patient's home for 6 hours (until 1030 pm), putting all my other visits on hold, while that patient breathed their last breath and their 12yo daughter screamed at me (most of my other families were ok with rescheduling, some made me feel like crap). I have had my phone ring at 8 pm with the on-call nurse trying to figure out how to get symptoms under control. I have had to drive an hour out of my way to change a dressing or have a family meeting because "dad seems depressed." I have had family members--HCPs--who were so in denial that they accused me of lacking compassion bcs I advised against CPR. I'm not trying to be dramatic or anything. I just really want to make it clear, hospice isn't all about the mellow hours and "kumbaya" philosophy. We work ourselves to the point of exhaustion caring for people and families at the darkest hour, and our reward is frequently tears, occasionally anger. Please prepare yourself for a type of burnout you may have never experienced before. Yes, there are hospice nurses who kind of "coast" through their caseload without ever really investing in the work. The other RNCMs are not fans of these individuals, and usually the families ask for another nurse after a while
  6. anashenwrath

    Triage and on call

    Ugh my heart breaks for our on-call nurses (especially bcs the RNCMs have been covering for one of them for the last three months!). On-call gets called for anything (ignoring actual out-of-control symptoms, admissions, and deaths). Boo boo? Fall with no injury? Anxiety? Out you go! Not only that, but triage is not the most dependable... patient called triage with c/o low bsfs in the morning...triage didn't let me know until almost 4pm! The plus side is, you can tell triage (at least in my company) to HOLD on putting a visit on your tablet until you speak with the patient. For example, I called the low-bs patient's nurse and she confirmed patient always runs low. Then I called patient and confirmed BP before lunch was 129. Called triage and said everything was cool, then wrote a note and left report covering everything. I always try to triage on my own: call the patient or family and talk it through. ALWAYS make it crystal clear you are more than happy to visit, but let them know you wanted to call first and talk out what was going on. When I was covering, I didn't have to go out too much. Maybe three nights a week? I honestly don't think on-call is a bad gig. But if people call and say "Gram gram is on hospice for COPD but she has a canker sore that's really bothering her! WE NEED A NURSE" Yeah, you'll be going out to look at it.
  7. anashenwrath

    Cape Cod Nursing

    Cape Cod RN here! The healthcare system on the Cape is kind of a horror show. Cape Cod Health basically runs the show, Outer Cape Health is "reorganizing," and we only have two major hospitals (both owned by CCH I believe). Emerald physicians is the biggest primary care group, and they recently became members of (surprise!) CCH. That being said, I love working here, because my specialty is hospice, and we have a pretty big senior population. (Like 85% of some of our towns are over 65 years old). There is, IMHO, an enormouuuusss need for better home and community care. There have been a lot of attempts to get "house call" programs off the ground, but they never make enough of a profit. NPs can do well here, I think (I'm actually looking into pursuing my own NP license), because there are so many SNFs and ALFs that rely on NPs. Oh, and obviously, summer the population booms and thus the need for nurses! Since my focus is visiting nurse/hospice, I can't speak too much about the hospital (even though I am in there a lot), but feel free to PM me if you have more specific questions. I'll do my best!
  8. anashenwrath

    License renewal Chapter 260 requirements??

    Hey ya'll! Just in case anyone was lurking to find out an answer.... I found out that the training is not yet available and we MA nurses will not be held responsible for it until it is posted on the Board's website. After it is posted, nurses who have not yet renewed their license will have 6 months to complete it and those of us who have already renewed will have until our next renewal date. Hope this helps someone besides me!
  9. Hey there, My colleagues and I are all SO confused bcs we keep getting emails saying we have to complete a mandatory Domestic and Sexual Violence Training when we renew our license. However, after navigating a million links on mass.gov, all we can find is a "Training will be available soon" page. (Training for Licensed Professionals to meet Chapter 26
  10. anashenwrath

    Aspiration drama!

    Great responses from you both. Thank you! I've incorporated this advice into my last few visits, and I think we'll get on the same page (hospice/patient, spouse, and facility). much love to my hospice homies!
  11. anashenwrath

    Scheduling Hospice Visits

    I see about 4 patients a day. Prefer 3 so everyone can get plenty of TLC, occasionally have 5 and then I'm antsy and grumpy. I know nurses who do up to 7 (but they're in there for about 15 minutes a pop). I assume an hour a patient and factor in drive time. I divide my patients by area and visit one town a day. If I have multiple patients in a SNF or ALF, I try to see them all the same day. (Not sure what your census is. I have 14-18 visits a week.) Home care patients get priority for picking their day/time. After a couple visits, I get a sense of whether this is a patient/family that needs lotsa love (so let's always assume they'll get an hour at least) or if they're kind of get in-get out (so I can probably get it done within 30 minutes). OH, and I always top-load my week. Best case scenario, I will have an easy Friday. Worst case scenario, I won't be drowning when the inevitable Friday afternoon admission comes in. XP
  12. anashenwrath

    Aspiration drama!

    Hello all! I am dealing with some drama with a patient on hospice for end-stage Alzheimer's at an ALF (darn ALFs!) and was wondering if the community could give me some feedback. Pt is total assist for all ADLs and has significant dysphagia, yet her husband comes in faithfully three times a day to feed her (and with that I'm sure a lot of you know exactly where this is going!) Diet is pureed. Recently, pt has had incr coughing, gurgling while feeding. She pockets and takes minutes to swallow. Otherwise afebrile, lungs sounds clear. Facility can NOT thicken, but I ordered thick-it and did nectar-thick teaching with spouse. Unfortunately, while he always smiles and nods and gives me return demonstration, every time I come to the facility, the staff complain that he is not thickening enough, feeds her way too fast and will sit with her for over an hour trying to get her to eat. I sit with him, reinforce teaching, and the cycle begins again. Earlier this week, pt began coughing and vomiting up liquid at breakfast. Facility freaked out and spouse became angry bcs they refused to feed patient until I assessed. I found her asymptomatic, but ordered a swallow eval to make everyone happy. Swallow eval concluded what we all know. Patient is at significant risk for aspiration. They recommended pleasure feeding w precautions. Now the facility is basically asking me to police this spouse and are saying that if they see him attempting to feed her too fast or not thicken appropriately, they are going to call Elder Services. It's important to note that ALFs in my state are SOCIAL MODEL, which means they are considered a "home" environment, NOT a medical environment. I'm thinking of maybe writing up some sort of "aspiration contract" that the spouse could sign indicating that he understands the risks of aspiration should he continue to be noncompliant. Anyone ever done something like that? Samples? But beyond that, I don't think there is much I can do... I don't feel comfortable "policing" this guy. If the facility wants to call ES or tell him he can't come in at meal times, I guess that is their prerogative. But I feel like the spouse has verbalized an understanding of the risks and there isn't a way to "force" him to comply, unless I recommend his wife be moved into a skilled setting (as she has no symptoms, it's not like I can GIP or inpatient her). If this was a home patient, I think I would do my best with teaching and reinforcement, but at the end of the day, I would drive home and leave it to the powers that be. If it was in a SNF, the staff would be able to thicken food appropriately and follow through on interventions in a way the ALF can't. Is there anything I can/should be doing here that I'm not???
  13. anashenwrath

    Hospice RN vs Case Manager

    Testify! I'm salaried now and making less as a Director than I did as a 7-3 SNF nurse! I put in 60 hours a week, never take a break or lunch, and that's fine! But I'm not paid for it, and after a while it starts to feel like I'm being taken advantage of. Given the choice, I definitely prefer to get paid by the time.
  14. anashenwrath

    Hospice RN vs Case Manager

    Guys thank you so much! Not only do I have a little more confidence about the role, but your info gave me some good things to ask about during my interviews! one more question if anyone is still scrolling this thread: can I expect the position to be salaried or hourly? thanks again all!
  15. anashenwrath

    Hospice RN vs Case Manager

    That's excellent to hear! So you feel like a nurse, not just an administrator?