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ErinS is a BSN, RN and specializes in Hospice.

ErinS's Latest Activity

  1. ErinS

    Kussmaul Respirations

    When we compare oxycodone and roxanol we generally see the same symptom relief from one to another. I do not think having morphine instead of oxycodone would have made her more comfortable, but she may have needed a different dose. The hospice nurse was not being negligent in not ordering morphine, she likely just knew that the oxycodone was doing the same thing for her that morphine would.
  2. ErinS

    Taking off your Nurse's Cap

    I think there is a big difference between being a daughter and being a nurse. I think that most of what you were doing is what we often see family members doing- helping to bathe their loved ones, providing support and encouragement, asking for things that may improve comfort. I think where the line may have been was doing a nursing assessment. And I agree with the social worker on this one to some point. There is a time to be a grieving family member, and a time to be the nurse in charge of a loved ones care. That being said, I always invite family to help with personal cares, including post mortem care. Often those physical acts are the last way to show loving care to someone who is comatose, or demented. I am sorry you have regrets, but you must remember (as we always tell our families) you did the best you could with what you had, and I suspect your excellent care kept your mother healthier and happier for longer than she would have been otherwise.
  3. ErinS

    Options for using my RN in Hospice

    Our company uses several nurses with minimal hospice/homecare experience to do our intake. These nurses get orders, build the charts in the computer and coordiante care with md offices and insurance companies. This may be an option for you.
  4. ErinS

    Any hospice RNs work for more than 1 company?

    We have a conflict of interest policy that does not allow employees to work in the same function for a different company.
  5. ErinS

    Is this really what it's all about?

    I believe your hospice experience can be variable depending on the acuity of clients a hospice takes, the diagnoses, and the nurse. Hospice is generally not a field heavy in 'nursing tasks' such as placing IVs, but very, very heavy in nursing process (also called care planning), assessment, and psychosocial support. That being said, I work in a hospice that has a very high acuity and lots of clients in the hospital. I do admissions, so I interact with nearly all our patients at their first visits. In a normal week, it is not uncommon for me to do the following: Start a subQ infusion Access a port Place a foley Drain an indwelling ascites drain Draw labs Give a bed bath Do wound care So I would say that I feel fairly competent in my ability to perform 'nursing tasks', but working with students I recognize it is often difficult for students to recognize everything I am really doing in a visit. For example, I go into a visit and sit down and chat with my client. During this time I am assessing for mood, affect, skin color, dyspnea, signs of pain, and signs of weight loss. I then do VS, listen to heart, lungs, and BS, and check feet and legs. While I do these things I continue to chat with client about bowel movements, appetite, fatigue, pain. One thing to remember about hospice is we are focused on symptom management. For example, I may hear crackles or wheezing in a client's lungs, but if they are not having symptoms (coughing, dyspnea, fevers, LE edema), I just keep watching. As a student, I encourage you to tell your preceptor you would like to do the assessment and care planning for a client by yourself and run by her the things you think should be priorities and why. You may also, unfortunately, just be with a nurse who does not much love her job anymore. It happens. Good luck!
  6. ErinS

    New Grad RN wanting to be a Hospice Nurse-Advice?

    Apply for all those jobs that say 1-2 years, and apply at assisted livings and nursing homes. You really need that solid 1-2 years of acute care or SNF experience when working hospice because of the autonomy. Some new nurses have been hired by hospices on this site, but I believe that has primarily been for inpatient hospice centers. Right now, focus on getting any job, any where, but preferably a med/surg/ICU in the hospital, or a SNF. My hospice really likes nurses from SNFs because they are great at working with SNF staff, but also because we know they are used to HARD work. You may want to put out feelers for areas needing more nurses. One place to start would even be a travel agency. They will not hire you without some experience, but you may find a recruiter willing to let you know where the highest nursing demands are in the country if they think you might be interested in traveling down the road. I believe where I live (northern Utah) there are a lot of SNF jobs even for new grads, but it is tough to get into hospitals.
  7. ErinS

    Hospital Won't Hire Obese Workers

    Well, my thought is that they are not hiring obese nurses and they are not hiring nurses who smoke. Where do we the draw the line on high risk behavior? Should we still hire nurses who drink alcohol, or drive motorcycles? And, a previous poster commented that a patient can not trust a nurse who is obese to give nutrition and diet information. As an obese person, I just LOVE it when someone who has never had to work at maintaining their weight tries to talk to me about weight loss and healthy eating. I KNOW what it is like to work out 5 hours a week and track everything I eat, and still struggle to see weight loss. I understand the struggle for these patients, both in the difficulty in losing weight and the difficulty in being heavy. The number of times I hear a nurse say 'Well maybe if they would just lost weight...'. If it was that easy, we would all be thin. Anyways, all of that being said, I understand the reasoning behind this rule. This is one of my big motivators for working my ass off (literally!). Although I understand the reasoning, I think they will come to regret this rule. It is difficult to find quality nurses. Give me 1 fat nurse with a great work ethic over 5 skinny lazy nurses any day!
  8. ErinS

    How are hospice nurses paid? By visit/hourly??

    i am paid per visit, about $43 per visit credit (this is expected to cover about 75 minutes of time). I make very good money compared to the nurses that work in local hospitals, where the hourly rate is $25/hr.
  9. I am not sure what kind of wound you are looking at, but I do hospice and we have a wound care nurse we consult with and then we do the dressings, even though I don't have detailed wound care training. If someone has a wound vac KCI will provide this service. My honest thought is that if your pt needs home health and wound care, then he needs an agency that can provide that. I am not sure how you would get Medicare to pay for a visiting nurse to wound care, unless your agency contracted with that nurse and did the payment. Also, in my area there is non-emergent medical transport that is very inexpensive. It is provided by our ambulance agency, you just have to ask for a van transport. Also, I am not sure about home health, but with hospice the agency is required to contract with a dietitian or have one on staff. It sounds like your administration needs to find the staff to contract for dietary and wound care.
  10. ErinS

    Hospice and Assisted Suicide

    I know you didn't want personal opinions, but I am going to give mine. First, people rarely commit suicide because of physical pain. Suicide is usually because of emotional pain. I don't know what the hospice role should be in assisted suicide, but I know one of my patient's killed himself and there are others I have suspected. The one who killed himself was well managed symptom wise. He killed himself after I described the dying process where he would slip into a coma. I can't be sure, but I think the thought of losing his independence and that his family would have to go through watching him die. He shot himself. You are going to have a real hard time convincing me that assisted suicide would not have been less traumatic than his wife finding him in their living room, and giving him the option of assisted suicide would not have provided him some dignity. My last thought on assisted suicide: I get to meet incredible people through my work. Individuals with a quiet strength, calm dignity, and an amazing hope for their life that is left. I am not sure, knowing what I know, that I could be diagnosed with end stage CHF, for example, and know about the swelling, the leg sores, the dyspnea, the anxiety, the slow crippling debility that will leave me dependent on my kids or husband to help me to the toilet, and just keep going on. I fear I am not that strong, not that brave, not that hopeful. I suspect if I received a terminal diagnosis, I would spend all my money on a lavish vacation, say good bye to my family, and then choose my own death before it got me. I work for a hospice that does not and I believe will never provide assisted suicide support. I am blessed in my work, and I do not share these opinions with my patients. I screen for suicide risk and manage symptoms the best I can, working with the IDT. But the longer I work in hospice the more sure I am that assisted suicide should be an option, if only to allow some dignity and relief from truly intractable suffering.
  11. ErinS

    Lasix use in CHF?

    Remember that no medication or even treatment is against the rules in hospice. Different agencies will approach things very differently, but some agencies will do more aggressive interventions than others. In my agency I see TPN, tube feedings, palliative radiation, and certainly lasix (as well as far more aggressive medications) fairly often. Each pt is assessed individually, and if it is the right thing to do for the pt for their comfort and to meet their goals, then we do it. I would always be cautious if a pt has come onto hospice and had all their meds stopped. Our goal is not to stop maintenance therapy or hurry people along to their death. Our goal is comfort, and while pts do sometimes decide they want to stop all their meds, this is a decision that should not be made for a pt, but with them. That is not to say that the nursing home pt on 30 meds should not have some meds d/c'd if they are no longer appropriate for the pts condition. There are some hospices that do things that are ethically questionable, if not plain illegal to make or save money. Often the money is the factor of why there is such a broad range of attitudes in hospices, although management and medical directors can also really affect that.
  12. ErinS

    Hospice with Physical Therapy together??

    We often will order a PT eval, and our aides are cross trained to restorative therapy and will continue whatever the PT suggests.
  13. ErinS

    Best one sentence handoff report

    I work hospice and the best one sentence report I have ever received: Increased dilaudid to 250mg per hour, versed to 20 mg per hour, and she is still alert. Also: pt is seeing her cat that died 15 years ago, so reviewed dying process with family.
  14. ErinS

    What was wrong with my patient??

    Someone who has a fixed delusion can be like this. Totally alert and oriented, except for the delusion. I took care of a psych pt who had a delusion that Jesus was her boyfriend. It was so bizarre, you could talk to her about anything and it would be totally normal, until you started talking about where she lived and her family. I work in hospice, and the first thing that popped into my mind from my background is terminal restlessness. It sounds like that is probably not it for this pt, but if she was on hospice that is what I would suspect.
  15. ErinS

    Family Nurse

    I have considered starting this kind of business. Kind of a healthcare consulting business. There is a huge need for this- I know because I work in hospice and realize how little people understand of what is told to them. I am not sure what kind of liability would be involved, or even if this is in scope of practice.
  16. ErinS

    Odd requests

    I had a patient yesterday ask if I could take her glasses to the eye shop, get them repaired, bring them back, and then just bill her the cost. I am sorry miss, but I am a nurse, not an errand runner. I had another patient ask if I would mind bathing and trimming her dog. Normally I might have considered, but this was the same dog she had to lock up because it bit the first nurse that came to the house. And of course, my all time favorite, asked repeatedly throughout my career: "Nurse, I coughed some stuff up (insert time frame ranging from 1 week to 1 day ago here), and I saved it so you can look at it". I usually just tell people that mucous is the only thing that makes me queasy, and why don't they just use their words to describe it to me so I don't throw up.