RNSUEIA

You do not need to be religious to be a hospice nurse. You have to be a caring person. Religion is not always important to our patients.

Maybe we should remember to look for the good in our coworkers. Some people spend too much time worrying about looks and clothes. Nursing spawns a lot of petty criticisms of one another. I am just not down with that. Lets be nice. : )

I have a patient with pancreatic cancer that I have managed for approx 2 weeks now. It seems like nothing I say gets through to the wife in regard to pain management. I believe this is due to her own fears of pain. She told me one day that she doesnt think her husbands pain is "that bad". She did then say "but its not my pain". She definitly wont give morphine. "makes him too sleepy and glassy eyed, like he's over medicated" The vicodin she gives maybe twice a day and then only one pill. I have encouraged her to give the vicodin at scheduled intervals and have discussed with her about preventing pain. OMG...........any pointers????????

No she is'nt allergic to Morphine, but she really resists my doing alot of changing of her meds so I am trying to ease her along. I did start her on Trilasate 750 mg BID today, trust me she wasnt that pleased. I hope it makes some inprovement i told her to start tonite and take another dose in the morning then I plane to see her tomorrow afternoon. My next plan is to get rid of the hydrocodone and replace with the oxycodone. I will see what tomorrow brings. thanks for all your advice SUE

I have a new patient that I am seeing who is having a hard time adjusting to any new pain meds being added to her current dosages. I have her on oxycontin 120 mg bid and hydrocodone 7.5\325 2 every 4 hours and oxycodone 5 mg 2 every 2 hours for breakthrough (tho its difficult to get her to take it). She continues to have breakthrough hip pain due to bone mets. Seems like every time I do|try to change something it really gets her anxious. I tried a medi planner she did not like that at all. now I have made a written list of everything she is to take and at what time. My main trouble is getting this bone pain managed. Any suggestions? By the way if you couldnt tell. I have case managed exactly 1 week and I really want to do my very best for this patient. Welcome all suggestions. Thank you

I have never had to start an IV in the home, we do however use piccs and ports. Mostly for pain control or nausea. We dont do a lot of blood draws either. I think that if you feel like hospice might be your calling, you should go for it. It is a GREAT job!!

At my hospice, the nurse does all of the paperwork, signs consents, fill out emergency contacts sheet with md, pharmacy numbers, calls for equipment etc. The social worker only gave out some printed info.{on this particular visit} I do see the importance of our s.w. you bet, I personally dont care to have them accomp. me on admissions. Plus it throws off my whole routine. I dont think our chaplains have ever gone on admissions. Thank you all for your imput.

I have been doing hospice for a couple of years and mostly on the weekends. Two days ago the social worker asked if she could go along on my admission as we were going to admit this pt in Jan. but she was scared and refused the admission then. The sw reasoning was....she thought she might not get to make contact if she didnt go to the initial meeting. The pt has two young children in the home and the sw wanted to get some info to her. Heres the question........imo this was far to much for the pt too soon. Do your sw go on admissions with you?? I am not sure if i can refuse to take them with me or not, that is something i will have to check out if the occasion arrives. I know the sw is a very important part of our team, but I really feel badly about subjecting the pt to such an overwhelming visit. I dont always bring up death and funerals on an initial visit, I like to kinda feel out the situation first, and I dont case manage so I may or may not see this person again. Sometimes I think it is helpful to build a relationship with someone before getting right down to it (if there is a probability of the pt lasting at least a month) Please give me some feedback on this and how you might handle it. Thanks much!!

I know of a very good brain injury rehab facility and they do work with title 19 as well as having done some hardship cases. Its called On With Life in ankeny iowa. They do miracles there. Another suggestion, how about a Vail Bed. This is a bed that is fully enclosed by netting the pt can see out, the nurse can see in. Pt is safe. These beds can be rented by the hospital... Hope this helps:nurse:

I made the switch to hospice 2 years ago and I love it. I work part time for them and part time on a med surg floor so I have lots of variety. I find that in hospice I have much more respect from the MDs. When my pt has a need I call the Doc and tell them what I want to have ordered and 99% of the time they tell me to get my pt what ever they need. My greatest job satisfaction comes from taking a pt who is in pain and stressed and the family is stressed to the max and making a huge difference. Try that on a med surg floor.............

TIGRESS; I lost my 12 year old daughter 3 months ago and I can tell you with great conviction that the family has suffered a terrible tragedy and can use all of the kind words and deeds you can give them. Having people whisper and speculate is not what is needed here. Also their need for kindness will be there long after the funerals are over.

After reading the product information, long ago. I always give Lovenox in the love handles. I have found that typically pt have less discomfort with this area as well.

How about teaching the wife to do the dressing change? Giving her some hands on training during your visit would be comforting for her. That would at least eliminate this daily dressing change. If you've been doing it for a while, she probably already knows how to do it. Now, take a deep breath. Your going through a tough spell in your job. Utilize your on call nurses to do routine visits. Then see the patients who are declining the most. Things will get better! Good luck to you

we typically use atropine gtts orally to dry secretions. 2-3 gtts per hour usually works well, and is less invasive than suctioning.

Pt was just diagnosied 2 weeks ago. Thought he had a sinus infection and turned out to have a tumor behind the eye with mets everywhere. I suppose there could be sometime of involvement close to a nerve that is causing the hiccups. I just dont know and I just dislike not knowing how to explain to the pt and loved ones what is causing this. Thank you for your reply.

Can anyone tell me why our patients get the hiccups? I have been working hospice about 15 months and I was assessing a pt who is complaining of hiccups that he describes as coming from deep with in him. It sounds very uncomfortable, I did get him an order for some thorazine. Any way when I was asked why this happens I was at a loss to explain. Can someone help me with this? Thank you in advance

You know if this pt is homebound he probably qualifies for a home health nurse to make at least a weekly visit. That nurse could place and monitor the foley catheter. I have never had a good experience (for any length of time) with a texas cath. Usually there is just not enough of the pt to get a good hold of to effectively get the darn thing up, around and fastened. Good luck to you!

I remember years ago when I worked as a cna, the only baths that we gave on a night shift were to bed bound patients. No showers were given unless we had a code brown or some one enjoyed getting up extra early and wanted a shower. Other wise we were all pretty busy getting people up and toileted and ready for the day. Our staffing did not allow for anything beyond that. The only regular showers we gave were to wheel chairs.

Couldnt you get a foley catheter for him? I am aware of infection issues with this but it seems to me that he could be kept cleaner if he is not wet which will lead to fewer skin breakdowns. You would be more easily able to keep his skin clean. Male pts are usually very easy to catheterize. And you can turn him much more easily this way. just a thought. Good luck and I do agree that we need more caretakers just like you!

The reasons I love my job are 1. Really good pt to nurse ratio 2. We have enough cna's to make our job easier 3. We have hard working cna's 4. I make some darn good money!!:roll

Hello Shay! I work as a home hospice nurse part time. I also work med\surg prn. I feel as though I have the best of both worlds. I love my hospice position, and as a part timer I do not case manage. I see pts who are usually more stable in order for the cm to spend more time with those pts or families who need the cm more. I find my position is very rewarding. I actually get to make a difference, also the MD's work so much better with us than with floor nurses who have to beg for every little thing. I think most hospices will be happy for any extra help they can get for home visits. Or even in a hospice facility, you could be an extra set of hands. You will never know how great a job it can be if you dont check it out.

I also worked in a nursing home in Alvin TX for a short time when I was a cna. There were two of them there and they were the absolute worse I have ever seen. I worked my tail off and could barely walk to my car at the end of the shift for trying to do and be all for those pitiful residents. Your right the pay and work conditions are horrible. My advise to you would be go back to school and become a nurse it sounds like you are just what we need.

that's a great idea. My handwriting is awful when I have plenty of time to write. I cant imagine that anyone could read it when i am in a hurry. and no stopping what your doing if your using a recorder. Thank you for that tip!

I dont plan to work there full time. I work prn for this hospital and requested to cross train. I do plan to tell my supervisor that I dont feel as though I have had enough orientation to try to do any shifts on my own at this time. I worked WAY to hard for my lisence to risk losing it just to pick up an extra shift. I did enjoy learning how to set up an art line and watching proceedures. I just feel as though I need more hands on so that I dont get so flustered when things really get going. I just really felt over whelmed and incompetent that day and needed some feedback from other nurses who might understand. Thank you all

Having just completed my 5th day in the icu i must admit that i am mentally and physically exhausted from taking care of one pt. I have been a RN for 2 years and have had med\surg experience all during that time. I have never felt more incompetent until now. My pt today was a total train wreck. halfway through report the surgeons decide to entubate. then we sink a ewald tube. this guy fills up approx 6 suction canisters one after another. a central line goes into the femoral then a art line into the wrist. meds flying the whole time. my preceptor teaches me to write everything down by not telling me to keep track of everything while it is happening. I cant get out of the room because I am completely wrapped up. I should have just stopped and gotten something to write on i was just so overwhelmed i didnt think of it. than 5 hours later im trying to catch up. of course this is after 2 units of bloot 4 units of ffp and 6pk of platelets. crap!!!!!!Any suggestions on how to keep up? my old med surg floor is lookin better all the time. and I am the float nurse. my five days of orientation are done. Help i am scared to go back. and no, the unit is not offering further orientation. I feel that it is all do able but i guess i dont like the feeling of not knowing exactly what to do at all times and when to do it. Thank you all for letting me rant. I do feel better now. WHEW