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AtlantaRN

AtlantaRN RN

Med Surg, Hospice, Home Health
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AtlantaRN has 13 years experience as a RN and specializes in Med Surg, Hospice, Home Health.

RN X13 years

AtlantaRN's Latest Activity

  1. We had an end stage copd pt who was on service greater than 2 years. Pt had 2 caregivers who are nurses. Pt with several revokes for aggressive tx with intubation as 1 caregivers goal was sustaining life. Recently a hired caregiver called on call to report pt vomited x1. On call Rn instructed stop tf and give phenergan via peg n maintain high fowlers. On call called back On call called back 30 min later, pt was asleep, no further vomiting n no distress. 6 hrs later, hired caregiver called family member to report pt not breathing. Pt ended up at a local hospital & was pronounced deceased. Fast forward 4 weeks, family member whose goal was to preserve life came to office to lodge a formal complaint stating life would have been sustained if on call nurse had visited. I understand if is the holidays n a few complaints have come to the office concerning other patients, one pt passed 5 months ago, with families stating "I don't like the way the nurse treated me/family member. Even nurses not affiliated with the patients are feeling hurt by the complaints . We give and give and give and it just isn't enough . Any words of wisdom I can offer my co-nurses ? Thank you
  2. AtlantaRN

    Worried about tomorrow

    It all worked out. Facility said i TOLD them to call x-company. My bosses knew better, they just had to hear my side of the situation. Thank God.
  3. AtlantaRN

    Worried about tomorrow

    Asked to come in n meet w branch director n mgr clinical practice. Word is a facility complained about me this weekend. Said that i said "we dont do continuous care," and they said when i returned their call i asked "is she dead yet.". I would NEVER say anything crazy like that to a customer!! I asked nurse to describe her symptoms and i was on route to evaluate. When i arrived, pt transitioning and mouthbreathing vitals stable, sat 99 on 2l, no secretions, pt did not meet criteria for continuous care. ((to make matters bad- in the same room was a competitor hospice w a hospice aide doing a 12 hr cc shift on a pt that wasnt having symptoms.)). I explained to facility lpn n charge rn criteria for cc, she verbalized an understanding, said they were short staffed, why cant we do like x-company does. I cant break regulations. I went back the following day, pt the same, sat 98, encouraged nurse to use roxanol more than once a shift for any pain or dyspnea. Different nurse verbalized an understanding, 2 days later x- company gets family to sign pt onto hospice after she has been with us 15months?! Its CRAZY. I didnt do anything wring, but if facility upset, someone has to pay. Please keep me in your prayers. This really hurts my feelings.
  4. AtlantaRN

    How many patients do you see each day?

    no, 16hrs a day is not normal. Our case managers work 8-10 hrs a day, but if they get near overtime, they can usually take part of a day off (corporate does not like ot). cms see 4-6 pts a day, more if they are in a facility and driving is not an issue.
  5. Choline Magnesium Trisilicilate 1200mg, i can't recall 2-3 times a day can help with bone pain (its an old drug, and its cheap, but it works), also steroids are helpful. dexamethasone can be titrated up to 96mg/day but insomnia is a major side effect.
  6. AtlantaRN

    Careplanning for Comorbidities?????HELP?????

    I guess my issue is, this is hospice and there is NO real recovery....just symptom management. Narcotics cause gi sluggishness, so of course i'm gonna open a gi care plan and add senna to the patients routine scheduled medications. Hypotension treatment outside of hospice is ivf and stopping meds that would cause hypotension. usually hospice doesn't do ivf because its considered aggressive treatment and hospice is all about nature taking its course. AFTT is adult failure to thrive, which is a blanket diagnosis that no one likes because essentially you say they are dying, but you don't know exactly what is killing them. I would feel better if careplanning for comorbidities was brought to the attention of all nurses at this location, and not just one particular case manager. I don't know, maybe there will be a note in my box when i go to work friday. Im just confused. Thank you all for your comments. Brainstorming helps.
  7. I understand careplanning....but we got a note from our QI person that we should be careplanning for comorbidities.... Qi lady says if pt has hx hypertension we need to be careplanning for hypertension, even if now he is aftt and now he has hypotension??? I am so confused. We don't careplan it unless we have a problem? isn't that correct....
  8. AtlantaRN

    IV certification / wound vacs / PCAs common?

    It depends on the company. Some hospices sell hospice as an "extention of home health," which is wrong because hospice is end of life care. NO pcas, no wound vacs. mostly oral meds and wound care would consist of duoderms or wet to dry dressings. Maybe they are encouraged by your med surg experience because with that training, you can think on your feet. Frankly, i wouldn't even think of accepting an on call position without working as a case manager in the field first. Or at least having a 2-3 month orientation to on call. You get all sorts of calls and you have to know what to do. Ive done on call for the last 3 yrs and i've been an rn since 1996, and STILL some things will stump me. We do have some ivf, and accessing ports just to flush and heparinize q30 days.
  9. AtlantaRN

    Taking the time to educate the families

    "Gone from my sight" is standard issue in our admission packet. Our case managers take the time to go through this book on admission, admissions usually take 4 hours; but when the symptoms start happening, the families are at a loss. I too am a on call nurse and am amazed at how each family deals with the changes. Pretty much if I'm calm, they are calm. I tell families i've been a nurse for 16 yrs, I don't endorse ivf at end of life, and patients with peg tubes, well, its hard for famlies because they have been used to giving nutrition because that will make them better? I liken the stomach to a big balloon.....we can pump the nutrition in, but if their body isn't using it, patient will start coughing and that balloon will lose its contents up the airway..... I was a case manager before i was an on call nurse---the case managers are sooooooo freaking busy, i HAD to go to on call for my sanity. The Idt meetings every 2 weeks, the incessant calls from the office, i just couldn't take it anymore. A bad weekend on call is light years better than a good week as a case manager. Im sorry you had to spend so much time at one location and the family didn't seem to have a clue what was going on-at a good death, most folks just slow down and fall asleep, but how often does that really happen-maybe 10% of the time? usually there are secretions, and families don't know what to do, I show them its ok to log roll them to one side with a chuk under their cheek to catch secretions (i don't like to use suction because it causes more secretions). I show them its ok to touch the patient, it won't hurt them, and to talk to them even when they are not responding, they still can hear. Kudos for a job well done from another on call nurse....
  10. AtlantaRN

    Taking the time to educate the families

    "Gone from my sight" is standard issue in our admission packet. Our case managers take the time to go through this book on admission, admissions usually take 4 hours; but when the symptoms start happening, the families are at a loss. I too am a on call nurse and am amazed at how each family deals with the changes. Pretty much if I'm calm, they are calm. I tell families i've been a nurse for 16 yrs, I don't endorse ivf at end of life, and patients with peg tubes, well, its hard for famlies because they have been used to giving nutrition because that will make them better? I liken the stomach to a big balloon.....we can pump the nutrition in, but if their body isn't using it, patient will start coughing and that balloon will lose its contents up the airway..... I was a case manager before i was an on call nurse---the case managers are sooooooo freaking busy, i HAD to go to on call for my sanity. The Idt meetings every 2 weeks, the incessant calls from the office, i just couldn't take it anymore. A bad weekend on call is light years better than a good week as a case manager. Im sorry you had to spend so much time at one location and the family didn't seem to have a clue what was going on-at a good death, most folks just slow down and fall asleep, but how often does that really happen-maybe 10% of the time? usually there are secretions, and families don't know what to do, I show them its ok to log roll them to one side with a chuk under their cheek to catch secretions (i don't like to use suction because it causes more secretions). I show them its ok to touch the patient, it won't hurt them, and to talk to them even when they are not responding, they still can hear. Kudos for a job well done from another on call nurse....
  11. AtlantaRN

    Nurse burnout/Moral distress/Compassion fatigue

    original poster------you hit the nail on the HEAD! Thank you for starting this thread. i have shared it with my whole office---we are all experiencing levels of your symptoms. Some days are bettter than others. I don't want to go back on antidepressants. Hospice is a roller coaster, and just when you think you have a handle on things, everything changes. I do my best to fill my emotional tank with church, friends, healthy relationships---things that will fill my tank. On bad days, it seems everyone takes a "piece" of me.
  12. AtlantaRN

    Compassion Fatigue

    This is a good thing! I have shared the link with my office.
  13. AtlantaRN

    oxygen orders vs nursing perceptions

    i had a patient with pulmonary fibrosis that was on 15liters.....he did fine for about 2 weeks, then he passed. he also had been a smoker yrs prior and had copd.
  14. AtlantaRN

    Pain med PRN ATC

    Thats why it's prn instead of scheduled....you did the right thing. Did day nurse come into a patient in pain? No? you did the right thing. some folks just want to tell everyone how to manage the patient.....
  15. AtlantaRN

    Any hospice RNs work for more than 1 company?

    nope. im on the south side of atlanta and they are all competitive and won't allow you to work for another hospice company. Now, if you work for a large company, you could work for another location, prn. does your company have an ipu unit where you could work prn? I've done that in the past.
  16. AtlantaRN

    Discharge from Hospice

    i don't really know, i just know adele music is dramatic, so i would believe that is why it's on the site