4boysmama

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.

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.)

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)

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

congratulations!! where did you take the chemo/bio 2 day class?

how is that even legal? DOes your state have a DNR registry?

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

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

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.

yes, programs will require proof of health insurance (as well as current immunizations)

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.

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.

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?

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

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.

is this for a dedicated hospice pharmacy, or a local cvs/walgreens type scenario? For our dedicated hospice pharm, once we call the scripts in and give info on the prescribing doc, they will send a request to the doc (email, fax, or escript if the doc is set up with that program). most of the time, I have already called the doc and have asked them to fax a script, but sometimes i'll be calling the pharm for an unrelated med and in the review they will note that a c2 script has expired or something and then they will initiate the request with the doc. so don't assume that there isn't follow through.

This is unsustainable it's not safe for you or for the families you care for (or for the people who share the roads with you if you've been called out multiple nights in a row and are still working your regular days) praying that this is just a temporary situation and hat your agency is able to staff appropriately very soon. Stay safe out there, and Yes, Lord please help this nurse!!!

in facilities i've worked in they have always been sutured in, but I still make it part of my practice to anchor the catheter under the skin with my thumb just above the edge of the tegaderm so that as I am removing the dressing I am holding the line in place.

ep, as others said. we tuck folks in, make sue they know hot to use backup o2, have enough meds, etc. but only critical visits happen - if they have pleurex or other drains than need doing, wound care with no caregiver, or actively dying with symptom mgmt issues.

agency goal is 12-14. usually it's 14-16, sometimes up to 18 when we get slammed with census out of nowhere.

I pretty much ALWAYS do at least my narrative note, if not all the documentation, outside the house in my car after a visit.

I am not a hospice np, but do work with several in my organization. Ours do f2f, and also complex symptom mgmt visits.

have never seen one before - interesting concept. not sure I'd find them useful in my practice, and I imagine it's not very comfortable. Plus, I wonder what the risk of rectal abrasions (and subsequent infection) would be with repeated insertion and removal of the device?

I respectfully disagree that there will be no need for MSW in 5 years because rn's can do the job. it's just not true; rn's are already overworkd and with technology advances that isn't going to change anytimes soon. I can tell you a a hospice rn, I depend heavily on our msw's to deal ith psychosocial issues that I don't have the time or expertise to handle. I would strongly suggest against going back to school for your np at this point. you will end up with double (triple? the debt in 2 years, and honestly...you will not be an attractive candidate for hire with no real world nursing experience. the degree without experiene is not worth the paper it's printed on, and if you do get a job you will not be getting the 100K salary you quote.

rr of 40 is an absolute indicator for use of roxanol (whether or not the person is on hospice) that level of respiratory distres is very unpleasant. I'm sorry your patient passed in less than ideal circumstances. I do want to follow up on one point - you mentioned that they weren't ready for comfort measures because they wanted to pursue.... they are not mutually exclusive. I've had plenty of hospice folks doing abx, while still utilizing morphine/ativan for dyspnea. sometimes the abx are treating the family who aren't ready to "give up" or don't want to feel like they didn't "do everything" later on, but it's ur job to educate that while the abx might/might not work, we NEED to treat the current symptoms to give the patient comfort right now, while we're giving the abx the chance to work.