teach_hospiceRN

>>>wow, fond memories. I interviewed at Oschner when I was in nursing school in 1990. I waited forever for an offer from them and finally I got it! I started there in June of 1990 in their SICU, a 21 bed trauma surgical unit. I had a great nurse internship program but I had a HORRIBLE preceptor. He made me feel so uptight and nervous. I had to work night shifts so I only had once choice I was told for the preceptor. After 3 months I was told I could not come off orientation that I had to move to day shift and continue for a while longer. During those three months with my preceptor I just could not seem to get it. Whenever I was with someone else for other reasons I did just fine. The unit manager knew this and so did the clinical educators, but they could not give me anyone else they said. I elected to leave since I could not afford to move to day shift and went to Touro after that. Oschner itself was a fabulous place and Im sure with the right preceptor I would have been just fine. Good luck to you!!

wow, i have to say it took me a while to get through all of the posts, and from what i see most veered off the question that was presented. perhaps a separate thread to discuss the use of prn and pain meds would have been more appropriate. i see many strong feelings posted here and i believe that what we as nurses in hospice need to remember is what the patient wants. the discussion needs to be had with them in the care planning stage what he/she needs/wants. an honest discussion with the patient and the family need to be had regarding the use of narcotics and at what stages they are extended release with breakthrough meds ordered, sl meds such as roxanol, iv or sq morphine or dilaudid. it should always be about the patient, not what i as a nurse believe, as long as i am following the nurse practice act for my state and the guidelines of my poc.my spiritual beliefs should never interfere with my treatment of the patient. but back to the original question. as a student nurse 22 years ago, i also did a research paper on euthenasia. it is amazing the responses you get when discussing this topic with people. should this ever have a place in hospice? why not? what is hospice about anyway, if not the comfort of the patient. why shouldnt the patient have the right to say when enough is enough for them and be allowed a comfortable death on their own terms? we can take our dogs and cats to the vet and have them put to sleep just because they are getting old or we dont want them anymore... but a human? omg..... i hope one day the majority of americans will come to understand how euthanasia is a right all people should be entitled to. a part of hospice? sure, at some point it will be allowed and embraced. currently a couple of states are allowing doctor assisted deaths and i say more power to them. am i a nurse kovorkian? am i out here killing my patients so they dont suffer? no. im a diligent hospice nurse assessing the pain level of my patients and discussing with my patient and family the treatment options and obtaining orders and educating the pt/family on their uses. but i believe in everyone's right to determine how their end will be. i hope that gives you a reasonable answer studious. good luck on your paper. i too am back in school and researching a paper as well.

wow, it sounds like you have many changes approaching in your life. change is the only constant in life however, and how you handl those changes is what counts. hospice is for those of us who have that calling to it, a desire to help patients and families during the hardest part of their life cycle. yhey need special people who are dedicated to this and if this is what you want, go for it. the other changes have not occurred yet but you can begin preparing for them and it helps to have something dear to you as your income to back you up for those changes. as to the pet part of your question, absolutely! pets are used in therapy for all sorts of reasons now. hospices have pets of all kinds utilized, dogs, cats, rabbits, birds. most anything. if you have a pet, or get a pet, you can train them for this type of work as well. good luck to you with all the changes.

What part of nc are you in? I am in the raleigh/durham/chapelhill area. The triangle has a higher pay scale than some areas. If it is a salaried position like many are, please expect that you will work a minimum of 40 hours and there is a lot of paper work that must be completed and preparing for idgs, on call etc. This may make you per hour rate go down as you put in more than 40 hrs. The pay also depends on the company you work for. Home health home infusion home hospice typically make less than a hospital setting anywhere you go. Good luck to you.

you will get all sorts of advice from everyone. here is my 2 cents: i graduated from ns and went straight into trauma surgical icu. i had a 3month internship and had a mentor who drove me nutty and so scared i couldnt do one thing right with him. i changed hospitals and learned more in 1 month there. i then started doing agency work wich was unheard of for a relatively new grad. but i wanted to be an icu nurse! so, i learned everything i could. when i became a homehealth/hospice nurse after icu i was very graterful for the expereice i had in icu learning what i feel i needed to know because out in the field it is you and your gut, oh yeah, and the telephone to the doctor to tell him what is going on. if you learn your a&p and feel comfortable with your assessments, go for it! does your school have any hospice or home health clinicals set up? when you interview with the hospice agency, ask what kind of orientation you will have. just remember, they will tell you most anything. ask what their turn over rate is and why. ask why do they need a new nurse? has their census grown or are they losing nurses because of interoffice yuck as i call it. i love hospice too and wish you well. sue

sara, as a home hospice nurse i find many nurses in the ltc's are not comfortable with the use of roxanol, even when the patient is exhibiting pain or other sxs. i try to explain to them and to the families that as a patient is dying they may need something to help them relax or not struggle. roxanol is a great med for this but requires alot of education all around. i understand your delimma as the patient was not exhibiting signs when you arrived, however would it have been fair to the patient to withold the med and have her become symptomatic? no. so continuing the medicine was in her and her families best interest. it did not cause her death and even when her respirations slowed to 2 that was ok, because she was dying and you were allowing her to die without pain and suffering. kudos to you for giving her the med and hopefully this will help in the future when there is a patient in need.

i am interested in knowing if the schools today are including any instruction on hospice, home health or pain management? i have been out of nursing school for 20 years and am now returning for an rn to msn bridge. i am doing a research paper and want to write about this. please reply and let me know if your school has such a program, how long it is and if there is any clinical to it. thanks!

i have been a trauma/sicu nurse and i always spoke to my dead patients while performing post mortem care. i believe the soul can hear us after it departs the body and it should be recognized and assured the mortal body is being cared for. i encouraged families to speak to them as well. if a patient had been pronounced brain dead i would ask the family what their belief system was and honor that. i encouraged them to talk to the body as it was being prepared for removal of life support if they wished. i have more recently been a hospice nurse and all my nurses spoke to the bodies while perfomring care. again, i feel the soul is around and takes comfort in these "rituals" we do. i had a family that did not want the body removed from the house for a while so they could all talk to her and sing for a while. death is another part of the life cycle and needs as much care as any other part. i will tell you it is also one of the hardest things to do, that is die. so please, keep on talking to those bodies and especially the ones actively dying. sue

I have used this phrase many times before myself, but I see it in another realm as well. what happens when the nurse coming on the next shift discovers you have made an error, or even you tell her/him of your error? what happens to the nurses who make mistakes, albeitly innocently? instead of an educational opportunity for enlightening the nurse usually it is a bash session and the nurse is "written up"!! oh my:rolleyes:. so many times a new nurse, whether it is in experience or just new to the job, does not get a proper orientation and they have to learn by fire. then later on the learning experience or orientation time is gone and the nurse is still behind trying to catch up to where she needs to be. so many times I see this happen and have even been the recipient. education is the empowerment for these nurses and we as experienced and supervisory nurses need to remember this and help them learn. we are not sharks for crying out loud and these nurses need all the help they can get in the world we practice in now. thanks for your insights in this matter and hopefully this is more food for thought for the rest of us. sue