pmabraham BSN, RN

Hospice, Palliative Care

Follower of Jesus • BSN, RN serving others as a Hospice RN Case Manager • Lifelong Learner • https://compassioncrossing.info/

Member

All Content by pmabraham

  1. pmabraham

    Question on End Stage Parkinsons

    Question on End Stage Parkinsons Problem Statement: Over the past 4.5 years between two separate hospice agencies there has been a pattern of admitting patients for Parkinsons Disease where the result is frequent discharges for failure to decli...
  2. pmabraham

    Changing Careers At 42

    Then there's home health and home hospice where you are not working 12-hour days 😉
  3. pmabraham

    Changing Careers At 42

    I went back to school at the age of 50 to become a nurse, got my associate in nursing science, passed my NCLEX-RN boards, then went for my BSN. You can do it if this is your dream.
  4. pmabraham

    Lowest Dose of Morphine To Cause Death

    0.25 ml = 5 mg of morphine. The max daily dose of morphine is 1,600 mg. As a hospice nurse, I've had pancreatic cancer patients on 960 mg morphine daily and still talking. Morphine is not a euthanizing agent.
  5. pmabraham

    Morphine for Hospice Patients: What Nurses Need to Know

    The 4 drops of clonazepam DID NOT speed up the dying process
  6. pmabraham

    Hospice agency shutting down - help!

    As a visiting hospice RN case manager, I don't know how much I would trust cameras in order to be able to properly see the condition of the patient. While vital signs, in my experience, are often not the main factor for me to determine estimated end...
  7. pmabraham

    Morphine for Hospice Patients: What Nurses Need to Know

    It comes from experience and I'm not trying to be snarky. I've articles on medium dot com that go over how to recognize terminal restlessness, when someone is within two weeks or less (does not include sudden death syndrome), etc. but the last time ...
  8. pmabraham

    Morphine for Hospice Patients: What Nurses Need to Know

    Cheyene stokes and Kussmaul are among the common end of life breathing patterns, but nothing you wrote came across as excessive. We are called to use critical judgement and you used yours. Morphine and Ativan are not euthanizing agents; you did the...
  9. pmabraham

    Morphine for Hospice Patients: What Nurses Need to Know

    Let's start off with just a little background of how hospice is supposed to work with families. What I'm sharing is per Medicare guidelines and that means every hospice nurse and provider should be following what I'm about to share but I'll put it ou...
  10. pmabraham

    Morphine for Hospice Patients: What Nurses Need to Know

    It’s frustrating do you have anyone who is a healthcare professional think that hospice uses morphine for euthanasia. Prior to becoming a hospice nurse I worked on the cardiac floor where are they increasingly gave me more and more hospice patients. ...
  11. pmabraham

    In Hospice are RNCM's Ever Paid Hourly Instead of Salary?

    Check https://careers-brightspring.icims.com/jobs/intro?hashed=-626002160 as they own Grane for whom I work as an hourly RN Case Manager.
  12. pmabraham

    In Hospice are RNCM's Ever Paid Hourly Instead of Salary?

    Grane Hospice pays hourly. They are owned by BrightSpring so it is possible other BrightSpring branches for hospice also pay hourly.
  13. Dear friends, please allow me to share with you the various lessons I've learned as a visiting hospice registered nurse. One of the primary lessons I've learned as a hospice nurse is that being mortal teaches one about the value of human life as well...
  14. pmabraham

    On-call hospice nurse

    "Tuck-ins" are calls or visits to see if the patient is OK, needs supplies, etc. More often they are phone calls but can be a visit if a change in physical location such as nursing home discharged to home or home going to a nursing home (respite or ...
  15. pmabraham

    On-call hospice nurse

    Hi: Tuck-in calls and visits should be doable by LPN/LVN/RN et al as it is just a routine visit or call to check in on the patient. Pre-admission evals typically require a good understanding of LCD's and what makes a patient terminal from a nursin...
  16. pmabraham

    On-call hospice nurse

    "I have been told that I do not have a set number of patients to see, nor will I have a list of "regulars" or appointments. I was hired to be a go-between for families and patients who already have scheduled visits during the day, but feel/know that...
  17. pmabraham

    On-call hospice nurse

    Salary has pros and cons. When I worked for-profit their for-profit took advantage and I worked more hours without the benefit of overtime. On-call can be just phone, phone + PRN visits or phone + PRN visits + scheduled visits. The latter can be h...
  18. pmabraham

    On-call hospice nurse

    As a day RN CM, the company policy is that we do supervisor visits every visit when there are CNA's assigned to the case.
  19. Home Hospice (which from a point of view is very close to home health). You drive solo with the only time management is around is for an annual survey of your skills/practice. When you get good at SBAR's, almost all providers accept your recomm...
  20. pmabraham

    Getting Flack For Not Getting Covid Vaccine

    Margaret Sanger founded Planned Parenthood and has a long history and connection with the KKK, called black people, "weeds," and wanted all blacks wiped off the face of the planet. Bill Gates and his wife support Planned Parenthood and are on record ...
  21. pmabraham

    Getting Flack For Not Getting Covid Vaccine

    Minimizing? Misinformation? Oh my, what a malarky. I've taken care as many of 40 sickly, geriatric, COVID-19 positive patients per shift when I worked in long-term care from April 2020 to November 2020 and 98% to 99% recovered. The liberal fake ne...
  22. pmabraham

    Getting Flack For Not Getting Covid Vaccine

    Aysympomatic spread has not been proven.
  23. pmabraham

    Getting Flack For Not Getting Covid Vaccine

    I am educated, thank you. And I'm one of the RN's (along with doctors I know and other nurses I know) refusing these experimental vaccines. We don't know the long-term impact, and will not for some time. My point of view is not based on a lack of ...
  24. pmabraham

    Getting Flack For Not Getting Covid Vaccine

    A lie is a lie is a lie. Trying to justify the lie just makes the liar a worse person.
  25. pmabraham

    Getting Flack For Not Getting Covid Vaccine

    A liar who uses "the ends justifies the means" logic has no integrity.