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Hospice + Palliative
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4boysmama has 4 years experience and specializes in Hospice + Palliative.

4boysmama's Latest Activity

  1. 4boysmama

    Fall with injury in ltc

    I very much doubt that you will lose our license over this, but you might lose that job. While it is appropriate to delegate personal care to the aides when available, it is also well within our scope of practice to provide that personal care and you should have done so instead of leaving the patient alone while you went to search for another aide.
  2. 4boysmama

    Multiple prn pain meds requested all at the same time

    I would need more info on this before offering an opinion. There are folks tat I would have no problems doing the meds you listed all together, and there are ones I wouldn't - it all depends on their opiate exposure/tolerance, disease process, etc. One thing, however, that stands out is if she is needing oxycodone 15mg every 4 hours scheduled on top of the fentanyl - why hasn't the PCP d/c'd the oxy and gone to a higher dose on the patch? the 75 is clearly not effective. Even with my hospice folks, I don't like to have that many different opiates in the rotation. I would want to d/c oxy, go higher ont he fentanyl, and use the roxinol for breakthrough (with or without the fioricet, though I'm not really a fan of fioricet in general.)
  3. 4boysmama

    RNs: How much vacation time do you get?

    Im a community-based palliative/hospice full time RN. we get 5 weeks PTO, which includes vacation and sick days. Holidays do not come out of this bank - if we work the holiday we get 8 hours holiday time banked (that we can either cash out or use as vacation time). we do not ever getting called off for low census/etc, so I'm not sure what would happen in that scenario (it just never happens in our particular speciality, because we have patients scheduled every day for visits). We work one winter holiday, one summer - and get paid time and half for the holiday we work. there's 6 paid holidays, so for the ones that you dont' work we get paid regular 8 hour day. Weekends every 6 weeks, and we get off a comp day week before and week after when we work that weekend. time off requests during holidays (thanksgiving to new years) need to be in by October 1. Time off for june-august needs to be in by april 1. Last year it became apparent that there was no system for granting summer vacation requests (no advantage for seniority or for early request - I put in my requests jan 1, and still didn't get several of the days I requested). manager heard and earful from many of us on that, so now they are planning to do a first-come-first serve)
  4. 4boysmama

    How important is pay vs work environment for y'all?

    in my current situation, work enironment wins hand down over more money. If my financial circumstances were to change, then I would consider rappy environment for (much) more money, but it would still be a tough choice
  5. 4boysmama

    OCN 2017, insight

    congratulations!! where did you take the chemo/bio 2 day class?
  6. hello, hope ya'll don't mind a palliative nurse peeking in to your forum :) I'm looking for guidance for resources for inservicing/continuing ed for our group of community-based palliative nurses. A rapidly growing proportion of our patients are undergoing treatment with the newer onco meds like opdivo, keytruda, tarceva, etc and I would like to do some in-depth education on these treatments. Can anyone point me towards some resources? Thanks!
  7. 4boysmama

    Full Code required for surgery?

    how is that even legal? DOes your state have a DNR registry?
  8. 4boysmama

    New Grad Qualification Question

    it means that you can start applying when you're 90 days out from graduation, and then must take and pass nclex within 90 days from graduation. eligible for licensure means that you have satisfied state requirements for education and are qualified to take the nclex. since you have already graduated and are awaiting your att, you are eligible to apply right now. However, be aware that most hospitals will not go through the hassle of the hiring process until you've already passed and have your license
  9. 4boysmama

    Should I quit my patient?

    have you exhausted all options to get assistive devices for repositioning/transferring? I would start there before quitting...
  10. 4boysmama

    Is this a normal patient load for one nurse?

    as someone who worked sub-acute/rehab, my very first question is WHY in the world are you doing dressings and treatments on nights? That stuff should all be done 7-3 or 3-11. It's absurd to be disrupting their sleep to do treatments.
  11. 4boysmama


    yes, programs will require proof of health insurance (as well as current immunizations)
  12. 4boysmama

    Using hospice protocol

    our hospice medical directors are my go-to for the c2 scripts. they are always available by cell phone and willing to fax scripts to our hospice pharmacy (enclara) with a very quick (usually less than a hour) turnaround. in the absence of cooperative hospice MDs, I would do as the previous poster uggeted, and ask for copious scripts with partial dispenses with start of care orders.
  13. 4boysmama

    Why is Neudexta not covered?

    yep, it's not covered by most hospices because it's ridiculously expensive. I had one patient who we just did dextromthorphan 10mg/5ml (give 20mg/10ml) with the quinidine 10mg/1ml liquid (give 10mg/1ml) once daily for the first week and then twice daily ongoing - WAAAAAAY cheaper than the neudexta and it's the identical meds/dosing.
  14. 4boysmama

    Care plan help

    agree with the others that cardio is not our most imminent assessment with persistent headache and BP that high. what could be the culprit there?
  15. 4boysmama

    Call 24/7/365, no back up - is this reasonable?

    nope nope, nope, NOPE. they're paying her 70k a year to OWN HER. 24/7/365 is not a sustainable employment plan.
  16. 4boysmama

    on call requirement

    i responded to your other post and now seeing this. honey, as gently as I can say this...you need to cut and run from that agency. they do not care about their nurses, nor the patients. it is not possible for you to give good end of life care to patients with a caseload of 30. it's just not. you are not a whiner, you are not weak. they are setting you up to FAIL, period. I worked for an agency like this, and I lasted 9 months. it was the WORST 9 months of my life. soul-sucking, and i swear by the end I thught *I* was the crazy one. I wasn;t - the situations they put me in, repeatedly, were crazy. you need to get out, and find somewhere that will appreciate you and your hard work.