KMRN81

Hi there! Hospice RN for 5 years. It depends on the setting and acuity level of the hospice. In the home hospice setting, you will probably be doing lab draws, dressing changes, managing Pleurx and/or Aspira drains, inserting foleys, that kind of thing. My inpatient hospice is high acuity and we care for patients who are trached/vented, LVADs, access chest ports, start PIVs, various drain systems, chest tubes, wounds, etc. So, lots of skills are required but training is provided on all of them. If she's hesitant, she can reach out to your local hospice and ask to do share time as she's interested in applying. It's not the right fit for every nurse, but when it is - it really is!

I think clarification is needed on the type of suctioning you are talking about in order to gauge a more accurate response to your survey. For example, deep suctioning = mostly a no-no due to increased production of mucus from agitating the mucosa. Oral suctioning is much better tolerated.

I'm seeing this post so late in the game!! I work at an inpatient hospice unit and we use it for select patients. I LOVE this thing. First of all, as mentioned by some other posters, it's not for every patient (agitation/restlessness, frequent ambulation, etc.). However, I've used it with great success on the ladies with tumor burden r/t ovarian ca, on lasix and too dyspneic to get OOB and unable to tolerate in general r/t pressure, burning, spasms, etc. I've strongly advocated for this product on my unit and have networked with nurses in the hospital setting who are also using it to share ideas. I will also say this. PureWick the company was bought out by Bard, in part because the small smart-up couldn't handle the volume of orders. Guys. This is *likely* the future of female incontinence, and better models are likely to come about as a result of hospital requirements to reduce CAUTI. TIPS FOR USE: -Set suction to 40-60mmHg CONTINUOUS - not intermittent. It won't suction pee that is already soaked into the bed pad or diaper so you need a continuous suction. This should go without saying, but it's happened. Also, higher than that setting may result in the patient feeling the sensation of air "down there"...which...they might not complain about...LOL -Replace it every 8-12 hours (once on your shift) OR if soiled with FECES or BLOOD - not urine. It's expected to have some urine on the wick itself, which will dry d/t continuous suction. -Reposition PureWick every time you reposition the patient -Make sure you have the bottom of the PureWick at the perineum to best catch all the urine (watch the videos on their site) PROS: -Suctions most urine away from the skin -No odor in the suction canister - similar to anything else you would suction to a canister -Easy to position -Prevents excoriation from frequent urination - preserves skin integrity much better than plain old incontinence ? CONS: -It doesn't catch every last drop of urine, especially if not properly placed or if the patient self-positions in bed and the PureWick isn't adjusted accordingly -Harder to keep in place for thinner people without some MacGyvering (mesh underwear or taping the PureWick to the patient) -It can be a hard sell to patients/families/other nurses who are skeptical about its use -Currently, there is only one size/model available -It's expensive

I've heard great things about Kaiser. I hope you love it and best of luck! :)

I prefer 12 hr shifts, hands down. The 8 hour shift nurses often leave around 5 pm, only to get stuck in rush hour traffic! No thanks! I love commuting during off-peak hours, and having 3 days off in a row helps me recharge and relax in between my 12-hr shifts. Our 8-hour nurses like their shifts because they rely on the hours (40 compared to 36) each week.

Just a lil funny for ya :) Most of us drove in on Friday afternoon and were able to get out Sunday night or Monday morning. The night shifters and some of the aides & kitchen staff dug everyone's cars out. We gotta take care of each other! Hope everyone is all dug out by now!

I live 25 miles from work. This weekend is my weekend to work (of course, lol). I'll be heading in Friday and will plan to stay all weekend. The stress of driving in the snow is worse than just sucking it up and getting to the unit before the storm. Granted, with no small kids at home, my hubby can handle the shoveling. We will probably all be in cots in the conference room...yay....at least my employer will feed us if we stay over! :)

The same thing happened to me. Despite my workout routine & healthy eating, I gained weight. You may not have much luck dropping the pounds until you switch to days. Just an unfortunate byproduct of being awake at night and how it messes with your body. Good luck!

Oh, I see what you mean! Different than what I expected! Hopefully it's nothing but a scratch from something else. Easier said than done, but try and relax a little. Whether you were scratched by a needle or something else, it can't be changed. I'm sure you washed your hand as well as you could too! Best of luck to you! :)

You may have scratched your knuckle on the sharps box itself when prying off the lid. I probably wouldn't ever attempt to open one though, they aren't really meant to be r/t that exact possibility!

After your first semester of nursing school, many states will allow you to become licensed as a CNA. For every one of my classmates who worked as a CNA in nursing school, we all transitioned into the RN role after we graduated. For those without CNA experience, it took up to a year to find work. Experience is always a good thing. Even if it doesn't turn into an RN job offer, it still provides you with hands-on patient experience that you will use everywhere you go. For likely very little extra effort on your part, you could be licensed as a CNA. In my eyes, it was the best decision I made in nursing school.

OP, that sounds like a tough situation, and I'm sorry you feel bullied into the nursing profession. I encourage you to to seek a career you would really love. Nursing is not the type of profession to get into if your heart isn't in it. I could give you many reasons why, if it would help your parents understand (unless they're nurses, in which case...)... There also isn't any guarantee of job security. Even many top students are having difficulty locating a job right out of nursing school. With all due respect to your parents, it might be a good idea to sit down with them and discuss your plans seriously. Maybe you could go to them with a plan of action in how you intend to succeed in your major of choice. Nursing pay & job availability vary greatly on location, level of experience, etc. and as I mentioned, really not meant to excel in if your heart isn't really in it. Life isn't all about job security, anyway! :) Best of luck to you, and please feel free to reach out if you want to talk more about it.

I'm curious - does your hospital have a hospice unit where nurses manage only one patient? I've never heard of that. I'm an inpatient hospice nurse and our ratio is 5:1.

I'm curious - does your hospital have a hospice unit where nurses manage only one patient? I've never heard of that. I'm an inpatient hospice nurse and our ratio is 5:1.

Inpatient hospice is much different than home hospice. A vented patient will be transferred to us from ICU for withdrawal from the vent to allow natural death (with the appropriate comfort medications). We don't make adjustments to the vent settings or wean patients. The pressors are allowed (without titration). The patient may die on the pressors anyway, or the patient/legal healthcare decision maker may request they be stopped. The wound care comes into play when we receive a patient with multiple staged decubitus, dehisced abdominals and/or multiple fistulas. We've done wound vacs when appropriate. Hospice has changed a lot over the years due to many reasons, one of which is Medicare. The goal is still the same, but some of the therapies the patients are provided would be too traumatic to d/c right away. They are also much sicker than in years past.

I went to nursing school to be a hospice RN. I really enjoyed all my clinicals though! I do inpatient hospice care and will probably stay in this specialty my whole career. I absolutely love it. I get a great mix of technical skills (vents, trachs, PEGs, NG tubes, chest drains, complex wound care, foleys, accessing chest ports, PCA pumps, pressor drips etc.), nursing education, and being privileged to care for EOL patients! I don't think I'll ever work in a hospital unless it's on a palliative care team or as a hospice liaison. I love reading about everyone's nursing passion and am so glad we all have different gifts! :)

I feel like I'm a detriment to my patients on the days I'm running charge with a full assignment. I'm just not available as much as I should be. And I'm really not able to be a staff resource except putting out fires instead of preventing them from starting, so to speak.

How often are you "in the numbers" when running charge? I work at a very busy, high acuity inpatient hospice center (very symptomatic patients, some trached/vented, PLEUR-X drains, tons of PRNs, multiple drips; very complex issues requiring lots of nursing education etc.) and we feel like we're drowning trying to run charge with a full assignment (5-6 pts) plus assigning multiple admissions, handling miscellaneous staff and patient issues, and doing the assignment for the nursing staff/aides for both evening and night shift. What's your floor's protocol when running charge? Do you have a policy that dictates how many patients the charge RN cares for based on your floor's census and/or what your staffing looks like that day? I'd like to bring this up at our next staff meeting to advocate for change, and I'd love your input and suggestions.

*sigh*. I have another to add. Was running charge today AND in the numbers with 5 pts, frazzled and calling for report on a new admit w/diagnosis of metastatic uterine cancer. The patient had kind of an androgynous name, and without thinking, I asked the nurse "is this patient male or female?" ....The patient with a uterus.

Hahaha! These are so great. The dumbest thing I EVER said was back in nursing school. Although I've said some pretty dumb things since. Anyway, it was my mother/baby rotation and my clinical instructor all but *shoved* my whole group into a new mom's room. She had her baby with her, and the baby's grandmother was also in the room. There was this long awkward silence as we all stood there looking at each other; finally, I couldn't stand the silence anymore. Looking at the patient's mother, who was holding the newborn, I exclaimed "Your grandbaby is so cute! Is she the newest member of your family?" She looked at me in total confusion as I stammered awkwardly, trying to backtrack. I literally had no idea what was coming out of my mouth. As soon as we all walked out of the patient's room, we collapsed into gales of laughter. The newest member of their family? Really? The baby that literally was just born.

I usually answer with "it's a calling". (And it is!) They usually respond with "it takes a special person"...and I respond that we are all special people with unique gifts. I could never do some types of nursing (burn unit *shudder*), nor could I imagine working in construction - in the middle of a dangerous highway, with difficult physical demands (way more than it takes to turn & repo a BB patient!)

That sounds rough!! :-( Is there any chance you could transfer to inpatient hospice? We work 3 12s and overtime only if we want to. Some of our nurses work 8 hr shifts days, evenings, or nights.

I agree with everything BerryHappyRN said. I'm an inpatient hospice nurse - kind of the ICU of hospice care. We see so many types of breathing changes at end of life. It's possible that the hospice nurse was giving everything possible but the respiratory changes were caused by pressure to the brain stem (that same kind of breathing pattern we see in terminal stroke patients), or that she was in acidosis with Kussmaul breathing. No matter the cause, it is difficult for loved ones to see this happening. I pray that she had the best care possible and the family has support following their daughter's death.

Hello fellow hospice nurses, I'd like your opinion on the upcoming changes being implemented by CMS. Particularly, the "Medicare Care Choices Model", which will allow certain Medicare beneficiaries to pursue both hospice and curative care. Here is the link to the CMS description (it's the 4th bullet point down): http://www.cms.gov/Center/Provider-Type/Hospice-Center.html Here is some additional information about the potentially blurred line between curative care and hospice care: http://www.medicareadvocacy.org/medicare-care-choices-model-is-it-better-for-hospice/ What are your thoughts on this change? How do you feel it will affect hospice care, and the kind of care we provide our patients? Can you see the potential benefits, or pitfalls, of this new model of care? Can you think of other options (i.e. better implementation of palliative care by hospitalists)? I have my concerns (outlined in the Medicare Advocacy link that I linked to above; scroll to section 2A and 2B), but would love to hear others' ideas and opinions about it.

Hello all, I know this thread goes back a few years, but I wanted to share my experience with hospice for those who might be interested in going into hospice at some point! I'm graduating from nursing school this fall and my plan is to become a nurse at my local inpatient hospice center. I, too, feel called into hospice care, and this is a recurring theme I've both read here and heard in the field. Since I was interested in hospice care before I started nursing school, I decided to first volunteer with the local hospice to see if I was really cut out for this type of nursing. I did this for three years while in school, and then applied for a CNA position at the inpatient unit. I was hired and have gotten tremendous experience doing this. I work part time around my school schedule, and plan to apply for an RN position there following graduation. While many hospices won't hire new grads, it certainly helps to have experience as either a volunteer or CNA, as well as a passion for hospice care. There is no guarantee that I will be hired as a new grad, but the odds are in my favor due to the different roles I have played there and my passion for end-of-life care. I think it is difficult to begin doing any kind of home care right after graduation due to the level of autonomy that home care nurses demonstrate, as well as the expansive knowledge required to educate patients in the home setting. However, one of the great things about inpatient hospice care or facility-based hospice care (for example, in a long term care facility) is that a new grad may be precepted in these environments much more effectively. Once the new grad has attained enough experience to move into the home care setting, the transition can be more seamless. I think there is a steep learning curve for a new grad going directly into hospice care, but it's not impossible: I know of new grads who have succeeded and those who haven't. Some "old-school" nurses have told me that oncology and/or med-surg experience is necessary to be a hospice nurse, and other "new-school" nurses who have told me to pursue my passion and the rest will fall into place. Both philosophies carry wisdom - it is up to the new grad to decide what is best for him/her. Fireball, I hope you continue to pursue hospice! Perhaps the hospital where you work has a palliative care team that you could join, or you could volunteer at your local hospice. If you want to message me, perhaps we could collaborate and I could help you find an inpatient facility near you or know someone who could help. Best of luck to all (including myself - haha!) :-)