MJ Marx

I have only been in Hospice a few months. In a crisis, until getting something subcutaneously, we will utilize the rectal route. This has been determined by the Medical Director of my agency and he tells us which medications we can do this with, as well as we have a pharmacist that collaborates with us and assists the doctors in which medications can be safely given rectally. Check with your policy and procedure manual, and the physician. If the physician has ordered something rectally, it's good to know which medications can be given that route. We will utilize that route for Morphine tablets, i.e. MS Contin, MS IR, etc. Some anti-anxiety medications, we will also use that route until we get something better. I do know that pharmacists recommend not giving any NSAID by rectal route.

Deb, In regards to appreciation. Observe them and give thank you cards, notes, giving them specifically what you are thanking them for. Does your agency have the capabilities of doing small dollar amount gift cards to a local coffee shop or eatery to go with that thank you note? Little things go a long way with a team who feels underappreciated. Hope there is something you can use.

Deb, It takes time. I know that is probably what you don't want to hear, but it is true. I do have some ideas that I myself have been using the past few months in my new position with Home Health/Hospice. Listen. Listen for tidbits about each ones personal life that you can either ask a question about later or give a positive remark too. Listen for their ideas and give encouragement where you can. Try a new idea one of them brings up to encourage them to bring ideas to you. Look for processes where you can bring them together and lead them into teamwork without them knowing they are doing it. For example, we have a brief meeting every morning where assignments are given out, I ask for a mini report during that time, or share a mini-report that I ascertained the day before when everyone was taking off for the day. Now that works only if everyone comes in to the office before making their visits for the day. If your staff don't all come to the office but maybe work from home, a conference call at a specific time every day may be helpful. For our Hospice IDT meetings we invite all staff to attend if they are able, to promote the team. I hope some of this is useful.:)

I have worked in SNF's with Hospice nurses coming in, and now I'm a Hospice nurse who visits the SNF. Check with your supervisor and find out what the "arrangement" is. We had to write out the expectations of each role. And as the Hospice nurse I will make recommendations regarding the Hospice standing orders, then the SNF nurse will ask the primary doc for the order for the recommendation I gave, write and implement said order. Also will then copy that order for the Hospice chart.

I am so sorry this is happening. But I'm an optimist, and will believe that because you are already employed, this situation is out of your control, the hospital will work with you to stay on board. Good luck.

Kate,RN, I apologize that my newness is showing. I was unaware that the nurse themselves got paid per visit. I have only worked in rural america and a nurse being paid by the visit is unheard of out here. And I actually appreciate you explaining the PPS system, no one has been able to explain that to me here. Thank you so much for being able to share your knowledge with me.

As a new person to Home Care, if the efficiency rate I've been faced with would be closer to 3.5 instead of almost 8 per visit I might be willing to agree. However, I feel very passionately there is a happy medium, but then I do live in a "rose colored" world, as my staff tell me frequently.

For the person who assumed that nurses are paid per visit, that is incorrect. Home Care is paid in a bundle based upon diagnosis. This creates real havoc for nurses who have been used to being paid by the visit. Medicare cuts are creating stress on all Home Care agencies. But I digress. As a new supervisor to the Home Care world, with about 12 years of Long Term Care experience. I'm struggling with what is appropriate timing for visits. I have a nurse who has been in Home Care for an extended period of time who feels that 2 hours is a normal time for a routine skilled nurse visit and wants 4 hours to do a start of Care. Unfortunately, this creates an overstaffing issue.