aphillipi

Yes exactly and yes I'm a hospice rn. Our CAHP survey scores show there is an issue with families receiving conflicting information from hospice and facility. So we are trying to brainstorm on how to fix that... We are offering an educational presentation that explains what hospice is and isn't and have a list of contacts which is left in the facility chart.

Hello! I was wondering if anyone would be willing to share any practices or forms their agency uses to facilitate good communication with SNF or ALFs... it's consistently an issue for us. Thank you!!!

Is it possible to get my MSN in leadership and management (online) and then get a doctorate of np or do you have to first get a msn in nurse practitioner? I'm interested in leadership/management and I have an opportunity to do that at work in the next few years but my dream has always been to be a NP. I can do the online msn in a year but a np program would take much longer with my work schedule. Thanks for any advice!!

Congrats! I'm in hospice too and sometimes think about doing what you're doing. This book and website is amazing as far as I can tell and has helped me w general nursing practice: index best of luck!

New nurse here w question: Earlier today i could NOT get ahold of a doc on the phone for my new ltc pt. so i sent him a fax w standard admission orders, asking him to add anything else he wanted or cross out anything he didnt want. i called the office and gave them heads up and asked if they could have doc look at it between pts. few hours later i get signed orders faxed back - i thik okay great we are all set. My boss just told me I really messed up by not signing ad writing date and time I sent the fax on the order. She says they aren't official orders and apparently I ruined everything. I tried to explain they weren't verbal orders- why would I sign the spot for verbal orders? But she was adamant that I had initiated the ordrs and that's the date and time that the order should say. ( I had documented the attempts to contact and the fax under communication notes. ) my point is that it could be proven that I had Not talked to the doctor and they were Not official orders until he approved them. Anyways I feel lousy because I was chastised like a child and I'm pretty sure I was in the right. Any opinions? (Sorry for typos, I'm on my phone) thanks!

Yeah I'm really starting to have my doubts about this nurse's credibility... It's hard when you're new and can't trust your "very experienced" coworkers advice. I have to look EVERYTHING up - but I guess that's a good way to learn the most up to date EBP. Thank goodness for Allnurses!!!!

In your experience when a patient has entered end of life phase and family decides to dc continous tube feedings,is it completely dc'd at once or gradually the rate is lowered? I would think that discontinuing at once would be the kinder thing to do rather than drawing out the process but I've heard otherwise from another hospice rn recently... I just don't understand her rationale that the body needs to "get use to the lack of food" and think she might be referring back to when patients are started back on PO feedings, not dying.. I'm still new to hospice and could be wrong so thought I'd seek more experienced advice. This is all hypothetical at moment so dont want to bother md for his opinion right now. Thanks!

Thank you so much for posting that link! I had found it a long time ago and loved the Fast Facts but lost the address in my bookmarks. I need to print that whole website out. Thanks again!

Thanks Tewdles I have quite a few of them and can't wait for my core curriculum from hpna to arrive any day! :)

Thanks for the insight! The other nurses I've talked to have said the same. I guess I need to go with the flow of hospice instead of focusing on my textbooks and the internet. Unfortunately I'm always going to be a book nerd! (Also just so it's clear: I'd never make up orders, we have PRN orders on a sliding scale for dyspnea and/or pain from 5mg to 20mg.)

I went through the same exact thing as a new grad. After I had one terrible, horrendous night I called the don and said I was never coming back. She was actually really nice and wrote me a letter of recommendation! I guess she knew the situation was as bad as it was and couldnt blame me for wanting to get out. Now I'm in hospice and love it! I strongly suggest you get out of there and find somewhere that appreciates their nurses more.

I should also note that the pt I have in mind has no history of pain other than some arthritis and was receiving it for pulmonary edema and dyspnea. I'd be much more aggressive w morphine in a cancer pt, etc.

I'm reading a lot about neurotoxicity seizures and hyperalgesia occurring due to morphine being administered around the clock even after a patients kidneys have stopped putting out urine and pt has been npo. So I've been telling PTs caregivers to lessen frequency (q 4 instead of 2) and watch for any signs of pain when pt gets to that point. If that occurred I'd imediaty say raise the frequency back and watch for myoclonus and if that occurs I'd call doc to switch to oxycodone, etc. however my administrator says to push morphine and don't even think about lowering it. If pt has any symptoms do Ativan and even more morphine. All the textbooks say this is exactly what not to do.. I'm new to hospice and just want to make sure I'm doing right by my patients. Has anyone seen morphine seizures? I saw myoclonus in a pt but it went away w Ativan and he passed shortly after.

I'm a new grad who just started working in hospice as a case manager three months ago. (I worked in a SNF for 3 months before I took my license and RAN to hospice.) I see that a lot of people on allnurses are saying that all new grads are pretty much doomed to fail in hospice because they don't have the golden two years of med surg experience (impossible in my part of the country for a new grad with only a ASN - I was Very lucky to get this position). But so far (knock on wood), I really like hospice and I'm told I'm doing a good job. I was a CNA for almost ten years and did get some hospice type nursing experience (Roxanol, ativan, methadone, etc.) as a RN in the nursing home. And I love reading and have read every textbook on Palliative and Hospice nursing I can find. I also think I have a good head on my shoulders (got good grades, instructors liked me). Plus I have my boss on speed dial when I have a question. But after reading the posts on this forum, I can't help but think that I don't know what I need to know. My (maybe impossible to answer) question is, what exactly do you learn in med surg that is so invaluable in hospice? Can anyone give me some examples and how it helped you in hospice? And are there any other new grads in hospice who have succeeded long term? Thanks!

I emailed my board of nursing and got a reply yesterday pretty much saying follow your company's policy... Not really the answer I was looking for. Their policy is no CPR but it really feels wrong to me. if the patient hasn't signed a dnr, and they've been given the opportunity, that means they want to be rescusitated. I just can't wrap my mind around how it's ok to not do CPR. Any other ideas of who I could contact about this other than my BON?