momcats3

I have a student who has a G-tube. It is not used at school, they can eat and drink with no difficulties. Parents will not submit a Care Plan. I am curious as to why a G-tube is needed at all if the child is eating and drinking normally. They do not have a physical disability or chronic disease where I can see a G-tube would be necessary. Child has had for several years, so I'm thinking it's permanent. Am I missing something? Thanks

I worked in hospice for 7 years, at two different agencies in two different states. Both non-profit. I ended up doing visits/office stuff from about 8:30 to 4:00 - 5:00 and yes, I ended up doing my charting at home, on my time. There was just no other way to get the computer charting done. No matter what I did or how I planned, it always worked out that I had to do charting and/or paperwork (recerts, mostly) at home. I ended up working about 60 hrs/week, and getting paid for 40. It was one of the reasons I left - I just got too burned out. And my co-workers in both agencies had to do the same, so it wasn't just me. Everyone resented it, but did it because they loved the work. I loved the job, it was the time involved that got to me. And I don't have children.... Good luck, though, whatever you decide. mc3:nurse:

Dan-You're so right!! I've thought about that staff, all of them, as well as the other patients and families. God will bless them.. PD

We also use Hospice Pharmacia, and they've added a Cardiac Comfort kit..Unfortunately, I'm not sure what meds are in it (I left my MUGS book @ work..)

Hi :) I quit my first job, too, after about 10 weeks. I was in very similar circumstances, and they had me doing all sorts of things I really had minimal training on. I was told to "ask another nurse" if I needed help. Ha! Ha! that was a real joke! I came to the point where I did not feel safe working on that floor. Anyway, I gave my two weeks notice, and did not have another job lined up. It was the smartest thing I ever did! Good luck.

Hi, one of our textbooks was "Math for Meds". It broke things down very simply for me. However, I ended up doing my formulas like this: If 20 mgs is to 1 ml, what is 15 mgs to x ml? Written as: 20 mg:1ml =15 mg :x ml Remove the mg and mls Now you have 20:1 = 15:x Now, multiply 20 times x = 20x (multiply your two outer numbers) 1 times 15 = 15 (multiply your two inner numbers) remove the x from 20 Now, divide: 15 divided by 20 = 0.75 So, the formula is: 20:1=15:0.75 My instructor always laughed at me -said I was doing the formula backwards BUT as long as it worked it was OK! As I look at it now, it appears hard but it's really not! Take your time and break it down. I still use this today...Good luck! :)

If you're looking for info, try HPNA @ www.hnpa.org:)

AT what point are you talking about using Megace? From my humble POV, I wouldn't really use Megace at all. If the patient doesn't want to eat, they don't have to. At EOL, their body is shutting down, right? Why would you do that to them? As for the family, a little teaching about EOL s/sx is what I'd do. Isn't that what hospice is all about?

Good question:) We are also curious about how other hospices operate. We are all considered salaried, which is a joke. Pay rate is from about $18-27/hr LPN/RN. We are only paid for 8 hours, whether or not we work 8, 10 or 12 which is the rule and not the occasional exception. We're supposed to take the extra time in "comp time" within the same 2 week period. This, of course, never happens, or you would end up taking 1 day off a week of "comp time". This is a very sore subject for us!!! We've raised our concerns to the VP, told they'd get back to us (hah); it's not happened yet. 1 weekend/month commitment. Nsg team is RN/LPN, supposed to have a case load of 22 max but it's been 26-30 for the past month or so, and it's crazy. Not sure what the pay is for on-call rate, I think perhaps $65/hr if you go out. I'd like to see what other hospices are doing. As much as I love my job, I (and, collectively we) are feeling very taken advantage of. Our organization is growing leaps and bounds in "Chiefs" but the Indians are bearing the increased loads with no end in sight! Oh, yes, forgot to tell you, we do get paid $10. per person per wk for anybody over 22. Yipee :angryfire

Hi, we use Hospice Pharmacia. They also do things like MSIR in 1 mg gel paks, just open and apply. Also have Ativan gel, Haldol gel, etc. I think they may be out of Philadelphia. Also, I get a box of scopalamine patches, just to have. Don't keep them in the 'fridge, though. :)

We have MSIR and lorazepam liquid, Lorazepam tablets, Levsin tabs, ABHR suppositories, acetaminophen suppositories, and some separate Scop patches. PM me if you want the amts of ea.

Did you try VNA? There are also some private agencies that use LPN's in home care. Look in the phone book for starters.

Hugs and congratulations to you all :balloons: I'm thinking of trying either next spring, or next fall....

A big hug for you (((((((((((((((((((((((()))))))))))))))))))))))))))))))) I couldn't agree with you more....Let me add I have also had difficulty with the majority of geriatric NP's I've encountered. Aren't they capable of seeing what we see, or at least respecting our judgement, or are their egos that large??? I'm sorry for your loss. It's very discouraging to know you have the ability to help, but are unable to do so..

I would like to thank each and every one of you who sent words of kindness. I truly appreciate it... I'm still heartbroken, but life goes on, and you adjust. You never "get over" it.... I still wonder, though. How do you provide comfort, sympathy and support during those times when you are empty or grieving? I guess you just pull yourself up by your britches and do what needs to be done. It doesn't seem healthy, though it's not healthy to submerge yourself in grief, either. Anyway, thanks again to you all. Momcats3:sniff:

My heart is broken today. I had my beautiful 18 yr. old kitty put down today. He had CRF and was failing. I am filled with doubt. Did I do the right thing? What if he could have rallied one last time and I didn't let him? I even think, did I do it for my own convenience so I wouldn't have to deal with this later in the week/month(s) when I didn't have time? For cat lovers and non-cat givers alike, we all know we deal with this issue every day with our patient families. And our response is yes, family, you are doing the right thing by making your loved one comfortable until the end. In my case, I made the decision before he got any sicker. So why am I having such a hard time with this? And how can I comfort families when I feel so lost and empty inside?

Well, I was a new grad, too. I'd worked in a rehab hospital for 10 weeks (yup, 10 weeks) and decided that I hated it, too. I'm 46, and had gone back to nursing school at 44. I'd always wanted to do hospice nursing and was told I'd have to do the "year" also. It felt like a prison sentence before I smartened up a left. I was very fortunate to immediately get a new job for two hospice agencies, both per diem. My plan was to get in there and show them what I could do, not what I "couldn't do". I had two absolutely wonderful Directors that I interviewed with - both hired without any problem. One of the jobs led to full time, and here I am. I love it so much! I have discovered my purpose in life. So, I'd try out per diem first, to see if hospice is for you. In my case. I do think what helped alot was the fact that my family had used hospice for my Mom a few years back, and that became the turning point of my life. Let me know how you make out

Hi, I'm from up north, and we're considering a move to Florida (yes, I know, along with everyone else from up here!). Was wondering if you knew of/had an experience with LPN's working in hospice in the Orlando area. Or, do they just use RN's? I've found both situations here, although the majority seem to use only RN's. Our agency is one of the largest in our area and I love my job here. We work using a team concept, RN, LPN, Chaplain, SW, HHA. Nobody is "above" or "below" anyone else. Any help, advice, suggestions would be greatly appreciated. This will (of course) play a large part in our decision as to whether we move, or not. Thanks so much!:)

Why don't you ask the SW in your facility to contact whichever hospice they recommend and have them come in and do some pain management education with the staff? I've found these sessions presented by our Medical Director at our hospice go a long way towards educating some of the staff we deal with. It also takens the burden off you...

Not sure if I made it clear, I'm a Hospice nurse, work in LTC, and my original post was related to a Hospice patient. Pain management in Hospice is a unique specialty (yup, it really is). I've had many nurses who've stated to me "Well, they look comfortable, it's only when you move them that it hurts"..... I've seen patients who deny pain constantly. Then, when the family isn't there, they admit it to me. They don't want their families to be worried, or be perceived as a "baby". I had one patient who'd told me "No, I don't hurt" and "No, I'm not having any pain". I'd ask her in many different ways during my assessment, and she always denied it. Yet when I asked her how her knee is feeling today, she told me "Oh, it really aches today" and confirms she'd like some medicine. Staff are unable or unwilling to take the time to really ask the right questions, and listen, and use proper assessment skills. I've had patients actively dying, with HR 120, RR48 & labored, whose NP's refuse to schedule MSIR, instead leaving in PRN's because they're afraid of snowing the patient. Sorry, but using PRN's in LTC with Hospice patients is a joke. It just doesn't get utilized despite our best efforts at teaching. The staff, usually agency, don't want to deal with it. Call it simplistic, but what it comes down to me when I see my patients in such distress is "Would I want this for my mother? (or father, friend, etc").

I must disagree as well. My experience with our palliative care patients has shown me again and again that you can indeed live a full, productive life - working, driving, living(!!) with the addition of meds such methadone as well as oxycontin. I believe chronic pain is seriously underestimated in this country. As one nurse described it to me "I have my life back again". Not something to be taken lightly! :)

Well put everyone!!! I also think Hospice nurses are born and not made. You could not do this job just for the money....it's your heart's calling. 3 patients of mine passed away today. In each case I asked myself did I do everything I could, and in each case I knew I did (including fighting with, oops "educating", some docs). I know I do not have the power to change the outcome, but the ability to make someone as comfortable as humanly possible is a magnificent gift.

I love my job, I love my co-workers, I love my patients! Went back to school at 40 just to do this. I am so lucky:) , so blessed.

:balloons: Congratulations to you all!!! I just started looking into this.. Have several questions; How long did you wait to take it? I know they recommend 2 yrs in Hospice, did you all wait that long? Was is similar to the boards? Were there specific calculations involved? How many questions do you answer, or does it just shut off?? Do you use any books to study with? I saw someone used the study guide, but it looked like it's for RN's, not LPN's , which I am. (or, should I just study from the RN one?) Thanks for the info! Momcats3

Hi Lori, Please please please, by all means, see if you can get your Grandma on to hospice. I've now a hospice nurse, and have already seen patients who tortured themselves w/chemo, on the possiblity that they may have a few more months. It's cruel, and I was so surprised that some Onc. MD's I've met through out the years don't even mention hospice to their patients. Hospice's goal is to make those last months as comfortable and life-affirming as possible. Putting services into place for your Grandma early on allows her, and your whole family, to establish warm, caring and loving people to take care of you all, and to help her on her journey. Very personally, my Mom had lung ca. She had a horrible time w/chemo, and also made the decision to stop it after the first treatment. Still, the oncologist refused to even mention Hospice to her. I actually met with him, along with the Hospice folks for a consultation; he told me, and I quote "I don't like the idea of Hospice - you people use too many drugs. I'll put her (my Mom) on Hospice but I won't authorize any pain medication" :angryfire And this is from a person who calls himself a Dr? This whole, horrible experience is what made me change my life, go to nursing school, and become a nurse. Anyway, enough about me. I have worked w/many many patients that we've keep comfortable and pain free (yes, pain free, including no air hunger/gasping/SOB) to the end. We have many meds that can do this. As to administering meds sublinqual, is it better to try and shove a pill down their throat when they can't swallow, or give them a painful injection??? SL drops are put under the under the tongue. They can be given while the patient is awake or asleep - you don't have to disturb them. The kind of comments you've been hearing are outrageous, and totally false. These people need to be educated..... You sound like you love your grandma as I loved my mother. They truly deserve the best we can provide for them. I will keep you in my thoughts and prayers.