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?

If a patient is admitted to hospice but does not have a dnr and they are actively dying in front of you what do you do? I answered I'd call 911 and start CPR because by not signing a dnr patient is saying they want to be resuscitated. I was told that was wrong answer and we stay with the pt and make them comfortable until they die. I understand that's the meaning of hospice but what about our licenses? Doesn't not performing CPR on a patient without a dnr in place have legal reprocussions?

yeah i thought so bummer i could have used the extra shifts. oh well.

I'm a new grad who has a per diem position at one hospice and just called in to an interview at another hospice. I'm wondering if it is a conflict of interest to work for two hospice companies? I know they are very competitive. Obviously I would never share pt info or do anything inappropriate I'm just wondering how an employer would see it. Does anyone else work for two hospice companies? Thanks!

Hi! I'm a semi new grad ASN RN with 1 month SNF experience who just got an offer in the Sacramento area doctor office for $23/hr with the possibility of topping out at 26/hr after a year or so. Am I wrong or is that really low? Thanks!

Why did you choose Hurst over Kaplan? I didn't think I meshed well with the instructor teaching Kaplan at my school. I'd also heard great things about Hurst and really enjoyed a Hurst demo I saw at nursing student conference I attended. Why did you choose the online versus the live NCLEX review? Online was cheaper and easier. I wish I had attended the live review though. How is the review so far? I really enjoy most of the lectures. They are interesting and most of the speakers are funny and entertaining. I wish they had lectures on meds instead of just handouts. I also wish they used more mnemonics and testing strategies like Kaplan does. However, I think that learning the core knowledge will help me with my career as well as with NCLEX. The lecture videos do a great job explaining the material.

Congratulations!!!! (Wow 23 SATA, that's painful!)

Hello! I'm doing the online Hurst review and just did my first QTest. I scored 101 points (or 80.8%). All of my classmates are doing Kaplan, so I have nothing to compare my score too. Any input from anyone who has done Hurst and then passed NCLEX? Thanks in advance!!

Thank you very much Davey Do!!

Hello! I'm taking psychology this summer and one of my assignments this summer is to interview a mental health worker. One problem: I don't know any mental health workers and all of the ones I've tried to call from the phone book have completely blown me off! So I was wondering if anyone could answer these questions for me. I'm really interested in learning about the mental health field and I would really appreciate any answers you can give me! Thanks! How did you get into this field? Were there any personal factors? What did you need to do for education and field experience in order to work in your present position? What do you like best about your job? What do you like least about your job? How would you define Abnormal Behavior? Please describe the most difficult or challenging case or situation that you have encountered. What theory or theories do you use most often in your work? Working in this field can be very stressful. What do you do to manage your stress? What advice do you have for a psychology student who may enter the mental health field?

Hello! I am working on my first care plan right now and for part of it we are to prioritize all of the nursing diagnoses we came up with from our assessment. Well I found a ton of abnormalities with my patient so I have a ton of dx's and I'm getting all mixed up with my priorities. I tried to do ABCs and then Maslows needs and put the actual dx's before risks (we were told to stay away from risk dxs but i think the 2 i have are biggies so im still going to throw them in there). anyways i would love to hear any suggestions about the order of the dx's or any of the dx's themselves. My patient was a 70 yo female recovering from total hip replacement and small bowel obstruction due to postop mild ileus. Vitals were all within normal ranges. Thanks!! Constipation R/T medication use and immobility AEB patient report of no BM in 5 days. Acute pain R/T postoperative pain AEB patient reports of pain. Impaired Tissue Integrity R/T surgical disruption of tissues AEB surgical incision on right hip. Activity intolerance R/T reduced oxygen carrying capacity of the blood AEB hematocrit level of 32.9 and patient reports of fatigue. Impaired physical mobility R/T pain and imposed restrictions of movement AEB limited range of motion. Impaired skin integrity R/T shearing force of surgical tape AEB area of excoriation on right upper buttocks. Urinary retention R/T high urethral pressure caused by disease AEB patient report of "dribbling". Self care deficit, dressing R/T musculoskeletal impairment AEB patient request for dressing assistance. Disturbed sleep pattern R/T gender related hormonal shifts AEB patient report of difficulty falling asleep and staying asleep. Imbalanced nutrition: More than body requirements R/T sedentary activity level AEB weight 20% over ideal for height and frame. Bowel incontinence R/T immobility and medications (laxatives) AEB patient report of involuntary passage of stool. Impaired urinary elimination, urge incontinence, R/T uninhibited bladder contraction AEB patient report "Sometimes I feel the urge and then I go before I even get a chance to get up." Disturbed sensory perception: kinesthetic r/t altered sensory integration and medications AEB patient report of vertigo once a month. Risk for infection R/T surgical incision on right hip. Risk for Acute Confusion R/T electrolyte imbalance AEB hyponatremia and hypochloremia. Fatigue R/T poor physical condition AEB patient report "my energy level is in the cellar." Anxiety R/T threat to health status AEB patient statement "I'm nervous about getting another bowel obstruction." Ineffective coping R/T situational crisis AEB verbalization of absence of coping methods. Impaired knowledge R/T complexity of therapeutic regimen AEB patient statement ""I do take vitamins and herbs. I can't remember all of them." Impaired memory R/T neurological disturbances AEB patient reports of difficulty with "retrieval". Ineffective sexuality patterns R/T absence of partner AEB reported changes in previously established sexual patterns. Readiness for enhanced self health management R/T altered health status AEB patient expresses desire to seek higher level of wellness. Disturbed body image R/T change in appearance due to multiple pregnancies AEB patient verbalization of such changes in a negative way.