zelda2012

Hello all. I've been an LPN for almost three years, and I've only really ever worked in assisted living. I recently got hired PRN with a local hospice company, I still work my ALF job part-time. So far, I've shadowed 2 crisis care shifts and 1 at one of their inpatient hospice houses, as they can call me to fill in for crisis care or the hospice houses. I don't get any more shadowing for crisis care, I only get 2. I think I can handle the crisis care shifts on my own, except I'm terribly rusty with basic care, bathing/cleaning pts.. my ALF residents are not (usually) bedbound. I've been watching videos on YouTube to help refresh me on personal care and also inserting foleys, etc. Also, I'm a small-ish female and I worry about how I would turn/change a large pt if, say, family was unwilling to help. The pts in the hospice house seemed very acute.. I was told it's a mix of actively dying pts and pts in crisis, recently d/c'd from hospital, very sick, can have trachs, still be on tube feedings, massive wounds, IVs, etc. Nurses can have up to 5-6 pts each. I'm not used to such sick pts, coming from a standard license ALF. I was already offered to pick up shifts on my own next week in the hospice house but I declined, told the scheduler I'd rather do 1-on-1 crisis care shifts right now, that unless I had more orientation at the HH I wouldn't be comfortable. The staff there was very nice, offered constructive criticism but I just felt nervous/awkward being there! In a way, I feel like I've hindered myself by working in ALF the past few years. I am planning on starting my RN bridge this summer. Should I ask for more orientation? I don't feel like I need to shadow a CC nurse for a full 12 hours, I'm comfortable with giving meds PO/PR/IM/SQ but I'd like to go over things that I haven't seen before I come across them by myself in the field, such as the pain pumps. I want to be a good hospice nurse, I just feel like there's so much I don't know that I feel like I should being 3 years out of nsg school. Any advice is appreciated, thanks.

Thank you. However, I'm not so sure this lady's husband would be very receptive to the suggestion of hospice care. He is elderly too, and she has no advance directives so since he is her spouse, he is in control. Their children live out-of-state. He was threatening to call 911 while we were waiting for the MD to get back with us today (just called up to work to check and see how she's doing.. MD NEVER responded). I told him no, please don't do that. I showed him her V/S were WNL and she's not in any apparent distress, so he settled down. I told him if he really wanted to, he's well within his rights to take her to the hospital (just PLEASE don't dial 911, yikes). But he said "She's been to the hospital 6 times this year." I feel for him.. I really blame her doctors for not being more straightforward with him about her disease progression and her decline, and that she's NOT going to get any better. He doesn't know any better and of course wants to just hold on to his wife. My coworker said she refused food/meds/fluids all 3-11 shift, wouldn't even open her lips.

Hi there, I work at an ALF and I have a resident who has pretty severe Parkinson's. 87 years old, has had pneumonia twice in the past 3 months, 95 lbs soaking wet, can't do any of her ADL's besides feed herself and even then we usually have to step in and feed her. She can still get up and walk (or shuffle, rather) on her own, when the mood strikes her. Sleeps all the time. She's actually not appropriate for our ALF as we only have a standard license, but that's another story.. She was hospitalized a few weeks ago with pneumonia, but has been doing better since returning to our facility. Today, she was very lethargic, difficult to rouse, resting tremors seemed worse. Rubs in bilat lungs, sometimes sounding like she had phlegm caught in her throat. Percussed her back, tried to get her to cough up secretions but she couldn't. V/S and SpO2 WNL. Mainly, she was just zonked out all day. No apparent respiratory distress. Her husband is freaking out.. I don't think her neurologist or primary MD has been completely honest as to what to expect with Parkinson's Disease and the progression, or the complications (recurrent pneumonia being one). As of the time I left work today we were still waiting to hear back from her primary and hopefully get an order for at least a CXR. She is a full code, which freaks me out. I can't imagine doing CPR on this tiny lady.. her ribs would crack in half. Her primary MD ordered physical therapy for her last week.. I guess to palliate her husband. Surely her doc knows no amount of PT will help her get better. She also saw her neurologist last week, who merely bumped up her Aricept dosage. You'd think as a physician that deals with this disease all the time, they would notice her decline and speak to her husband about it.. I know only MD's can order a hospice consult, but would I be out of line to suggest this to her doctor? Honestly, to me she looks like she is dying already, albeit slowly. I feel, at least if hospice is a no-go, she should be made a DNR.