CANRN

I am sorry to hear this. I took the exam and used Barkley review to study, I had his CDs and workbook, (please do not solicit to buy/sell items per TOS) and I took his review course. Barkley was SPOT ON with the topics we would see, Also, I used LEIK to study. Her book was a God send, If I can be of any help to you, please PM me. My fellow students and I studied together using Skype. Don't give up!

I thought the core services had to be available 24/7. Supposedly, our SWs are "available" but try getting one when you need one. Being at a difficult admission, death or just a panic call from a family and it gets hairy. It is hard to care for the patient, call the doctor, and take care of the family emotional needs at the same time. It does not happen often, but when it does and it is not handled properly, it can put a blemish on customer satisfaction; then cost the agency 10 new referrals. I have voiced this concern but, don't think I have been heard.

LCD= Local Coverage Determinations. These are the criteria guidelines for specific hospice admission criteria based on the patient's diagnosis. You can find these on the CMS website but, your company should have a worksheet also that has the criteria. Hope this helps. Here is the link: http://www.cms.gov/medicare-coverage-database/search/search-results.aspx?CoverageSelection=Local&ArticleType=All&PolicyType=Final&s=Ohio&KeyWord=hospice&KeyWordLookUp=Title&KeyWordSearchType=And&bc=gAAAAAAAAAAA&=&

I wondered about that when you posted that! I think adding insulin to her regime is needed. Good luck! About the shaking, my Mom was Diabetic and when she was being treated for cancer, her glucose levels were hard to manage, she always got shaky when her glucose was out of whack! Didn't matter if she was low or high. I think the first thing would have been to get her glucose under control then do a liver fxn test. Blood work certainly is not over the top here.

I am an on-call RN and have run into a situation I have never had before (been doing hospice 6 years) The company I work for is not providing an on call SW anymore, strictly to save money. There have been several times I have needed a SW for a family dealing with a crisis during a death visit and during emergency admissions and visits. It sure would have been nice to have a SW at the end of my phone to call and help out with the situations. It is my understanding, SW is a core service under the COPs and should be available 24/7. Is this appropriate???

I don't carry a purse with me, I keep my driver's license and debit card in my nursing bag. Honestly, I have felt safer in bad areas as crazy as that may sound. Anytime I have had to go into a bad area, they know I am coming. One of the family members or friends meets me at my car when I arrive and escorts me to the door. One other person remains outside, out of sight of others, and protects my car. I have NEVER had a problem in these areas and actually felt safer. Seems there is honor among even the socially-oppressed when we are caring for someone they love. Not to mention that some of my most memorable and rewarding moments has been while caring for a patient and family in the worst possible living situations.

Since your patient is not showing any signs of rapid decline, I would certainly notify her doctor and let him/her know that the patient's blood sugars are running high and tell him that her daughter is living with her and the patient is getting better meals and good care. She is showing symptoms related to the higher blood sugars. Adjusting her oral meds or adding a sliding scale would certainly be indicated here. You would be promoting her quality of life. :)

You have a PM

Good pros and cons! Your right, having a brick and mortor school is important especially if they have established nursing programs. Indiana Wesleyan Univesity has a wonderful campus in Marion INdiana and outreach locations as well and then the online versions. Some Master programs are not offered online but the Master in Education and Nursing Administration are online for obvious reasons. The University of Toledo in Ohio, is the closest local school in my area and the nursing portion of the BSN is all online. Electives, if needed, are taken at the school. I searched for a long time before I chose IWU. I am glad I did. The support is amazing.

I have not practiced in any of those areas. I have had my ADN for 15 years. I am currently taking classes for my BSN and I will be done in October. It is an online course. All the schools in this area do the BSN completion online. I attend Indiana Wesleyan University and love it. It is Christian based education and the instructors and staff are amazing.

Ya know, some nurses just don't get it! Instead of seeing how that fast intervention benefited the patient, she climbed on her high horse and destroyed someone's life. HER behavior (the DON's) was more inappropriate than the nurse that had the best interest of her patient and family in mind. Afterall, the family witnessed her behavior! Was it right what the hospice nurse did? That is another debate! Personally, I side with the hospice nurse. I sure hope she found another hospice position and is able to provide comfort and compassion to other families and patients!:bowingpur Cindy

That is the problem with so many hospice nurses, they do not care for themselves. When you think you are the only one that can take care of a death or the only one who can care for your patients, you are doomed to burnout. When you are off, shut off your phone! Period! Like you, I am not a spring chicken anymore and I just can't work the crazy long hours. Cindy

OMG!!! This sounds exactly like a facility I go to. State there regularly, they expect hospice to fix everything. We write orders and they don't follow them, when you do find the nurse to see how things are going you get, "I don't know, I just started. or I don't know, I was a for three days" It is soooooo frustrating. I would much rather have home patients, there is more teaching, more conversation and the caregiver always has answers to questions. If I had to continue seeing only LTC patients, I would quit!

I understand about some of the neighborhoods and at night. However, I personally, have never taken meds at night as the pharmacy is not available to outpatient services. If there is a concern about meds in a home, especially narcotics, we have lock boxes that we provide, and if that is not effective, we recommend inpatient placement into LTC facility. There is always a backup plan.

I live in Ohio and have delivered meds to patients. When doing an admission, we usually stop by the pharmacy and pick up the comfort meds, this includes narcoticcs, especially if the patient maybe having some discomfort. We also have a courier that delivers meds daily as well. If we get to a patient's home and need emergency delivery, we can call and they are great about going to pharmacy and picking up meds and getting them to us quickly!