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!

I am thinking the case load is 12-14 patients. that is where they try to keep us. It was posted a few years ago, Not sure if it is medicare reg or not. Just the standard. I wish you luck, I don't know how you do it! Cindy

7 DAYS, you must see them every 7 days. My once a weekers are seen on Wed. If I skip a Wed and make it Thurs, we are out of compliance. Sometimes, I have a patient I need to increase to once a week, so I will see that patient on Wed, and then again say, MOnday and make them a Monday and Friday visit. hope this helps, Cindy

I agree, your life experience is a big plus and will serve you well. I do think that having some critical care experience is also needed. I'll tell you why. When I graduated, I was offered a job at the hospcie that cared for my father. I had also done my community nursing practicum with hospice. All I wanted to do was be a hospice nurse. Because my Dad had recently died and my sister was diagnosed with cancer, I felt I was too fragile emotionally to do hospice. Like you, I was not a 19 year old, actually, I was 45. I am glad I spent some time in critical care (ER, ICU, SCCU, and MED SURG), I built confidence to handle being out there, all alone, when a patient is crashing, and the family is emotional. Working in hospice, I have learned more about how the body functions by watching the dying process than I ever did in school or the hospital, if that makes sense. You must decide for yourself. Hospice is the most rewarding nursing career there is, in my opinion, I can't image ever going back to the hospital ever again. I wish you luck. Whatever you decide, I believe you will be fine. Hospice nurses are very supportive of each other. You can learn much by listening and ASKING them for help and bounce ideas off of each other. I still ask questions and input from my co-workers and vice-versa. Take care, let us know what you decide. Cindy CONGRATS on graduating nursing school!!!

Milk of Mag soaked 4X4's! I will have to try that. Your right, the heels looked just like you described. I had never seen heels so ugly. They looked just like what comes on the coccyx. Thanks for the tip! I added it to my book of hospice tricks! Cindy

Thanks!! I had not heard of these.

I am aware of this site and have actually printed it out and used it for educating LTC personnell. I just have never seen them on a heel, but I swear, that is what it looked like. I have emailed Karen Kennedy and asked this same question. I'll post as soon as I hear back from her or whoever answers her email! We learned about KTU about two years ago. We had an amazing ET nurse who provided wound care to many of our hospice patients. She did an inservice on them. After learning about them, we realized we had been seeing them but did not know what they were. Cindy

NO! What you are experiencing is not normal. The one hospice I worked at expected their HHA's to be at IDT, they are part of the team. The one I work at now, does not. I would like to see that change. Personally, I would find another agency to work for if you can. That just sounds crazy! Good Luck.

Have any of you had much experience with this type of ulcer? The Kennedy Termial Ulcer? I had a patient I admitted a few weeks ago. He was in a LTC facility. This man develped the worst KTU's I have ever seen. My question is this, Have you ever seen them anywhere other than the coccyx? The reason I ask is, he had area on each heel, that came on within hours, they were purple and looked just like big blood blisters. His entire heels were covered! They looked exactly like the one on his coccyx. I swear they were KT ulcers. Could it be they were? Thanks, Cindy

No he did not aspirate, he did not qualify for Alz. He had "upper respiratory obstruction". The patient died last week. He had the worse Kennedy ulcers I have ever seen! They came out of no where!

Congrats on your summer with hospice. When I was in school, I did my clincal community rotation in hospcie care. As a hospice RN, visits are made to the patient in their respective place of residence. We do assessments not just physcial, but emotional as well as spiritual to see if there are any other services we can provide from the hospice team. ALso, the caregiver will be part of this, to make sure they are coping well. It maynot be obvious to you as you observe, but there will be a great deal of observation on the part of the nurse. I wish you luck! Hospice is the most rewarding part of nursing, if you as me! Cindy