MissIt

Touting the need for a zero percent med error rate only makes people hide their errors, patients could be at risk and systemic problems don't get fixed. Hopefully the error rate won't be high, but their shouldn't be a punitive response if someone ma...

Different people have different things that bother them. I don't get upset every time someone dies; most of the time I feel like we did a really good job helping them and their families. IMO, there are few specialties in nursing as fulfilling as ho...

There are similarities to med-surg. Something that surprised me was how sick these patients are. We have the occasional patient on a vent, severe wounds, patients with intractable seizures. You use all your med-surg skills and learn a lot of new t...

We have a 15 bed unit. Our ideal staffing for day shift is 3 nurses (RNs and LPNs) and 3 CNAs. We also have at least one volunteer most of the time. Night shift is 2 nurses and 2 CNAs. Sometimes, of course, we aren't fully staffed. Other times a...

I took a refresher course this year and this is what they taught us: Rhonchi: snore like (airway secretions, may clear with cough) Wheeze: continuous (bronchitis, emphysema, asthma) Rales and Crackles are same thing: short, discrete sounds-- fine cra...

Do you work in a hospital? With two years, maybe try working prn. I honestly found that once I cut my hours a bit, I felt a lot better about nursing and didn't feel nearly as burned out.

I know we aren't supposed to use petroleum based products for a patient who is on oxygen. In the hospital, our respiratory therapists recommended surgi-lube. At our hospice, we use a lot of vitamin E. Is vitamin E okay to use with oxygen? Is there an...

I would find out what the usual patient load and staffing is at the inpatient facility you are considering. On days when I have 4 or 5 patients, I get to spend lots of time with patients and families. And that ratio happens a lot more often than it...

I agree, I think it's better because we have extra support staff there most of the time and volunteers during day shift. We usually have 5 patients, but it can go up to 7 on days. Admissions, discharges, and all of the resulting documentation are t...

Do you have a wound care nurse? If so, have him or her come out and take a look. Ours is wonderful and if there is ever a time when we don't know what to do, she's happy to consult.

Hello. I wonder if anyone knows of a train the trainer course to become a CNA instructor in Virginia? Thanks!

Thank you!

Where are you moving from; is it a compact state? I was able to work under my old license until the new one came, too (not at the VA hospital). I think it took about a month to get the VA license too.

Like most inpatient units, a 12 hour shift might be longer depending on what's going on (usually admissions and discharges), but never anything like 60 hours. It's similar to the floor-- we start the day with report, then do our morning assessments ...

I hope that one of these days it will be a regular thing for palliative care to be started earlier in the disease process for patients newly diagnosed with these types of diseases. Perhaps it would be "too early" for hospice if their symptoms were m...

I like this idea and am going to steal it. I steal a lot of ideas from this forum! :)

This is very true.

One thing they told us in our hospice orientation is that sometimes it's easier for people to hear "the last phase of life" than "end of life" or "terminal" diagnosis. Also, we have so many physicians that send patients to us from the hospital telli...

Is she impacted or having urinary retention? Fentanyl is hard because you don't really know for sure how much they're absorbing. Would you consider converting her to something else or adding something for breakthrough?

It depends a bit on whether you're doing home care, long term care, or inpatient hospice. I do inpatient hospice and it is acute care. We do all the skills you would use on a med/surg type floor-- IV starts, subQ site starts, trachs, foleys, gtubes...

Most people do 12 hours, but there is some variety with 8 hours or the occasional 4 if someone has some kind of special circumstances.

I always like the idea of including families. It bothers me when we have a patient in the inpatient unit and a family wants to help with their care and we take over. Thanks for the ideas! So, if a patient is on oxygen, surgilube/KY or the lotiony ...

My background is radiation oncology, so I had some symptom management experience. However, during our orientation, they did a nurses skills fair and went over all of the wound care products they use (plus how to assess and document a wound), central...

I work days. No rotating shifts-- Yay! Our orientation is amazing, nothing like what I've experienced anywhere else. I don't know if it's standard for hospice, though, because I never worked in hospice before. We had 2.5 weeks of classes that cov...

I think someone said something like 40% of our patients (home care, long term care, and inpatient combined) start out as full codes. Most of them become DNR at some point before they die. So, I guess it just really depends on the hospice.