nosonew

Luckily, No. We do document where, how long, miles, etc, but have never been questioned. I totally depends on the traffic, weather, etc.

Okay... new hospice nurse (RN since 93 however) and having difficulty transitioning from curative to palliative care. (imagine that!) Pain control: What do you most commonly use? Do you ever fear using too much Roxanol? How do you explain the difference between Roxanol and Morphine Sulfate? Our Medical Director tells me they are TOTALLY different drugs. Yet they are both MS, so I do not understand this. Yes, I know Roxanol is stronger... but that isn't what he meant. Bowel regime: What do you do when you get a patient (new admit) and apparently he/she hasn't had a bm in 7-10 days? (eek!) Is unable to tell you.. and facility he has been at "hasn't paid attention?" (eek!) What would you have done? Ordered? Skin Care: What products do you use most frequently for skincare and decubs? Last but not least... (boohoo) HOW do I get supplies that I would LIKE to use, but aren't on in stock (perhaps expensive)??? And I work for a non-profit... (eek!) Help!

Actually, I was a bit more concerned about what she might do to the oncologist than to herself. However, UPDATE... spoke with her at length today. She sounds better and she and I do get along very well. She told me our bereavement counselor "sucked" and if he would "quit beating around the bush and just state it like it is they MAY have gotten somewhere". She is open to suggestions and she and I are going to get together next week for lunch to talk about her feelings. We need to talk about her mother (on hospice also) as she has some medical issues and daughter is POA. So... I think we are on the right track right now.. and I am going to keep in close contact as I can. I am NOT going to contact the sons at this time. At least not without her permission, which I plan to ask her next week for. She did actually tell me on the phone today that she is still "angry as hell" but doesn't feel like killing anyone anymore as that won't bring her husband back. (whew). I think her anger stage is moving forward...and onward we go. Thanks for the advice ladies!

Her husband died after a very short battle with cancer. The oncologist told them due to his liver function that chemo would kill him, but he did do radiation. However, the cancer spread and within 3 months he died. They were just about to retire and travel. Now, the wife is very angry, making threats against the oncologist, stating he didn't give them the option to do chemo and it was their right to choose. She has called the oncologist and written him letters. She talked to our bereavement counselor once, then told him he should look at a different line of work. She refuses to see a therapist. Is it appropriate to call her grown sons and voice my concerns without giving out all of the info? I am really concerned about her and also just found out her youngest son was just diagnosed with cancer. And her mother is dying. I don't think she can take anymore. What to do???? I am taking care of her mother and I also took care of her husband during his last weeks, so I have met the sons.

We pay for all meds associated with their hospice dx. Including any comfort care items (ie: bowel, bladder, depression, pain, etc. of course) The thrift shop is in a rented building on our main street. They take donations, have volunteers that come in M-W to go thru the items, price, etc. It is open Thu-Fri-Sat. It is all based on donated items and volunteers. All monies go to help with hospice expenses. I think they opened it because so many families lived out of town and didn't know what to do with the clothing, nik-naks, recipe books, crafts, Xmas items, etc... Occas. they get furniture. Lots of kitchen things. Luckily, we nurses can use it for our patients needs as well. If a client with no money has a broken crock pot or coffee pot... we can go in there and get one for free. There is also a volunteer who checks everything electrical for frayed cords, if it works, etc.

We currently have 58 patients. We live in a rural community and cover many counties. Luckily, we do have many donations and many/most of our clients do memorials to our hospice which helps make payroll (that is paid after paying medical bills of course!) and we also opened a hospice thrift shop with all donated items and that money is also used to pay for things patients need but are not covered. I love love love my job... I wish I could win the lottery and donate half of it and work for free. Honestly. Until last year, I have been told this hospice paid for all medications for all clients. They are still sad they can't keep doing that, but medications are just too expensive.

So more or less it depends on the Hospice Organization itself? The hospice I work for is non profit and allows this... yet I have a friend across the US that can not find a hospice to help with her 80 yoa MIL who has terminal ca but needs palliative radiation. I have encouraged her to speak to other hospice organizations in her area. Thanks!

And still be considered a hospice patient? I am wondering because those can both be done for comfort care, to keep the size of the tumor from growing, thus allowing increased comfort. I am new to hospice nursing and confused! Help!

Honestly, my biggest stressor in 7 years with dialysis are the critical issues you deal with. No, they do NOT happen often, however, they do happen. Strokes, seizures, anaphylaxis, etc. I have been extremely lucky in that I have never actually had a full code in my 7 years, and generally I was the only nurse working (small unit). However, when you have the periods of time with a patient who is ill, and you know "something could happen at any time" it is stressful during their entire run. I personally loved MedSurg too... the busy aspect and seeing all of the different medical issues. But, I think dialysis is my one true love. I just don't do it anymore.

My first 3 months were a nightmare. Large unit, hateful staff, none of whom had ever heard of teamwork. When I went to a smaller unit, it was soo much better. Honestly, if I had stayed at the larger unit, I would have ended up quitting. I worked in dialysis 7 years and loved it. It was unprofessional of those nurses to speak to you in front of the patient, AND I know the Althin machines take a long time to learn (which is what I have always used). Best wishes...

I was pregnant twice in my 7 years. I didn't have any issues with pregnancy and working, although I ended up on bedrest (I was 35 and 37 during each pg). So, I was off work a bit longer than normal, but other gals I worked with had no issues. Personally, do NOT tell them you are pregnant. If you are beginning to show, just wear maternity clothes. They should be able to figure that part out. Also, beware, this is not a sit down job of any kind. You work your butt off! Good luck!

After 12 years clinical experience, I decided to do what I love best... teach. I love teaching patients, families and staff. So, I took a position with our local college and now have the full time job of developing an ON LINE Out of Practice RN Review Class. It is an 8 credit hour course with 180 hours of clinicals (preceptored). I need to have my syllabus and outline developed by February 1. I would like to have the texts picked out and in my hands prior to Christmas. Any suggestions on texts that cover literally everything? Any other suggestions? THANKS!!!

I recently quit Davita after 7 years but they pay both PTO and EIL (Extended Illness Leave). Don't know who you work for... but I personally wouldn't be happy... sounds like someone is giving you false info.

Deigo... I just emailed my local college DON about open positions... she put me to work right away! Most of these jobs are word of mouth, rarely advertised! Of course, I knew her... perhaps you could go in person... Babs... I would have LOVED working with you.I worked for Davita... great company as a whole, sucky admin in my facility. I am loving my new job... patients still call me at home to chat... (small town :) ) however, I am trying to gently cut ties for THEIR well-being... and mine I suppose. Hugs to all of you working your tails off! I do still wake up at 4am as I did every mon-wed-fri for 7 years.. hoping that quits soon! Noso...

At our unit we had a 2K or 1K bath.. nothing else. If below a 5.0 K we did a 2 bath...if over 5K we did a 1 bath. All we could do. Also, I titrated versus patient telling me what he or she was eating.. summers, lots of 1.0, winters, 2.0 due to veggie consumption.

Honestly, from what I have found out... the penalty is the RN losing his or her license IF ANYTHING goes wrong. That is why I refused to work with inadequate staffing... that is also one of the reasons after SEVEN years with Davita I am no longer with them! It is NOT the company...but the administration of my unit. Don't think Davita isn't a great company to work for.. but when you get stuck with a sucky admin... you are screwed.

I have a question... how can WE, RN's, SAFELY care for patients with short staffing? Check out this scenario: 1 RN, 1 Tech. 9 patients (4 wheelchair, 1 cath). From 5:45a-8:30 a only 2 employees in the unit. And if there was a fire? Tornado? Other emergency? See where I am going with this? No reuse tech, no water person, no secretary, NO one but those 2 employees. I recently had this happen to me. I told my Director I refused to initiate treatment to the patients without at least a 3rd person (tech or RN). Amazingly she found another to work. I call my state board of nursing and dept of health and environment. They both backed up my decision. So did 3 nephrologists. As the only RN there, it is my responsibility to put patient safety first. Not the budget.

Fresenius just bought RCG Davita just bought Gambro I say it's a toss up. :shrug: In 2 weeks I am OUT of dialysis... Best wishes!

Thanks Jnette... And I plan to go by weekly to check in on them... The last straw was the 2 people (literally no one else in the building) and 10 patients.. not only is against policy and procedure, but my state board of nursing and the dept of health and environment backed me up on it. Didn't matter... she still gave me a warning "for not being a team player". Well, if that's what she calls a team player.. I don't wanna play. Safety is my primary concern.. obviously not hers. I start my new job later this month and I can NOT wait! Developing and teaching classes... doing clinical instruction... HOW different! But I plan to enjoy every second...

Yep... 7 years in December... but my administrator is pushing for unsafe practices and I refuse to be any part of it. I am going to go into nursing education... teaching classes and on-line classes, clinicals, etc. I will miss my patients sooo much!

If it isn't her phosphorus level, it may be a reaction to her dialyzer. If you use renalin or another cleaning product for your dialyzers.. that could be it. Try no-reuse for a week or so and see how she does. If it improves and her phos level isn't very high... speak with your medical director. Dialyzer reactions aren't pretty and get worse each time.

Honestly? QUALITY OF LIVE VS. QUANTITY OF LIFE in question here. If the prognosis WITH dialysis treatment is POSITIVE.. YEA! If not... BOO! And honestly, you have to respect the rights and decisions of the family, however, find out if there was ever a living will, and perhaps even discuss with the family about DNR issues. Actually, besides staffing issues, I see a bigger issue with what the other patients see. How depressing for them. How does it effect the REST of your patients? Is there an isolation room this patient can go to for 1-1 care? Is there a rehab facility that offers dialysis for post-cva patients? How old is the patient? What is the family like? Are they doing this per patient wishes or their own? YOu need to really get to know this family... I mean GET TO KNOW them... Good luck.. by getting in THEIR heads, perhaps you can figure out the interpersonal issues occurring. Also, discuss during your next staff meeting WHY the patient was accepted. If you are at a for profit agency... why? If non-for-profit, WHY? Either/Or... why? Most of the nephrologists I know would DISCOURAGE dialysis for a patient like this.

Well... let me say ONE THING! It is YOUR license on the line! This happened to me today! I was told that Monday 10/3 that I would open with 11 patients with 2 staff members. We have NO reuse tech, no water person, no secretary, just 2 people. Me (RN Charge) and a tech. Period. I said NO WAY! If there are not at LEAST 3 people to OPEN (5a-8:30a) I refuse to put the patients on. Period. Amazingly they found help. Our 4th persons will arrive by 8:30am Monday. I am speaking to our Medical Director about it this weekend. I am sick of it.. my patients whom I have know some for almost 7 years, and the newer ones DO NOT DESERVE to be put in this position. Myself and the tech do not deserve to be put in this position. MY COMPANY doesn't deserve to be put in a position like this (law suits galore if there was an emergency!). I stick to my guns and speak my mind... appropriately however. I REFUSE and will continue to REFUSE to give care under-staffed to the point I FEEL my patients could be in jeapardy. It is YOUR responsibility as a nurse to be the patient advocate! YOUR license is on the line. Document everything and I suggest you keep it all in writing if possible (email), if you discuss this issue in person, as soon as you leave, document it... in a Word doc. with date, time, etc. Keep a running log of issues. Be prepared to act on that, and inform the higher ups as needed. IT IS YOUR JOB AS AN RN TO DO THIS!

Our max is 2L/hr as well. Your patient needs some literature on how difficult his fluid gains are on his health. Go research nursing sites, dialysis sites and nursing research literature. CINAHL and other nursing research data bases have info you can print out. Go to your local college, ask for help to find this if you can't on your own. Or their nursing department. That patient needs education, education, education. I am currently doing a nursing research paper on compliance regarding Phosphorus and have found TONS of info on weight gains/non-compliance issues (this was on 9/29/05 I searched on-line) so I know the info is there! Encourage.. in positive manner... negativity doesn't work! Education doesn't always work.. but from what I have read, consistent education by TRUSTED NURSE OR PCT is imperative to compliance. Good luck... PM me if you need me to email you some sites.. :big:

I agree with all posters. Zebra... most of my patients are very wiped out post dialysis when they begin. Some are over it in months.. others years. I am almost into my 7th year as a charge nurse. Look at URR/Kt/v, pre and post labs, what is their albumin? phosphorus? potassium? calcium? ca/phos product? What other meds are they on? (Many are on bp meds that NEED REDUCED... ) I say, EDUCATE, EDUCATE, EDUCATE patient, patient, patient, family, family, family! They need to know the questions to ask.. good luck!