tommytwice

-------Does any one have a contract to have suspected diverter sign with your agency? -------- Yes, sometimes we'll make them sign a contract if more meds are being used than what the order is written for. The problem is that the contracts are pretty much useless unless your hospice is willing to discharge the patient if the contract is broken. And when people have an addiction to narcotics and they have to choose between honoring a contract or taking a pill that is readily accesible, the pill is going to win out each time. It is very frustrating to be sure and it can make you feel like your hands are tied and you can't properly do your job....

As far as being in compliance physician visits are completely different from nursing visits. The main thing to remember is that you need to stay within your projected nursing visits(mine are usually 1-2x/week or 2-3x/week) which are actually MD orders and part of the plan of care. So if the MD visits it really doesn't matter because it's a totally different discipline, you still need to be within the range of your ordered projected nursing visits. Now, if the MD visits and you don't feel the need to visit you can always write an order to decrease the projected nursing visits for a specific weak so you are still in compliance. tommytwice RN

I never use an O2 sat to tell me if a patient is comfortable........like said above, sometimes you'll have a very comfortable patient with a horrible O2 sat....and sometimes a very short of breath patient with a great O2 sat. I find that all the O2 sat really does is make the family anxious..... Thas being said though, it does play an important role in recertifications. For pulmonary diseases Medicare guidlines require that O2 sat be less than or equal to 88%. So if we want our hospices to get paid in the future I think we will all be using O2 sats to help with pulmonary recerts..... tommytwice

Like Whispera said it can be pretty complicated at times. Sometimes families and patients want to continue their vitamins and other medications so they don't feel like they are "giving up." Sometimes for the mental well being of patient/family it makes sense to continue meds that really are no longer helping physically. All of us are going to die and all of us have our own ideas about death and approach it in a different manner. That's why it doesn't make sense to always discontinue all non-comfort meds.........we aren't just treating a physical body but a physical/spiritual/emotional person, and each of us are different and have unique needs. tommytwice

i thought that i understood crackles but now am confused. when i have a chf patient and i hear crackles, is this considered wet or dry crackles? am i correct in assuming that these are wet crackles since the fluid is backing up into the lungs and i am hearing the air moving through the fluid? when i have a pneumonia patient what kind of crackles am i hearing? is it dry due to the infection blocking off a good portion of the lower lungs, or wet due to the air traveling through the mucus of the infection. is it possible to distinguish wet from dry crackles primarily by auscultation, or do they both sound the same via stethascope? help! and thanks! tt

Hello everyone, I am also someone who is thinking of relocating to Nashville as a new grad RN. I was wondering if I could get some help from some of the locals. 1. Can anyone tell me which hospitals have 8 hour shifts???........I'm doing some research and it appears at first glance that most hospitals in the area are 12 hour shifts. 2. Can anyone tell me what I should expect to make as a new grad RN in the Nashville area hospitals.......I'm getting differing results from different sources and I would like to know from some of you who actually work in the area. Thank you for any help you can give me!!!! tommytwice

Hello everyone, I live in California and just graduated as an RN with my Associates a few months ago. My wife and I are thinking of possibly moving to Nashville in a few months....I lived there for a little less than a year a while back and really loved it. I was wondering if any of you RN's could tell me how much you make, in what nursing area, and how many years experience. I would especially appreciate any information you could give me regarding the market for new grad RN's. Out here in San Diego new grad RN's start right around $25/hr and the opportunities are boundless, especially for new grads and any retired nurses wanting to get back into nursing. There are soooo many training programs that cater to those just starting their careers out here. What's it like in Nashville? I've done the research regarding housing information so I know that the rent I'd pay would be much cheaper than out here, but I'm having a hard time finding out about salary info/new grad programs for RN's. Any information you could give me would be much appreciated. Thanks!!!! Tommy