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pmabraham BSN, RN

Hospice RN Case Manager

Follower of Jesus • BSN, RN serving others as a Hospice RN Case Manager • Lifelong Learner


Content by pmabraham

  1. pmabraham

    Hospice Pay?

    Similar to the post above, I'm making far more than I did in telemetry/medsurg as a home hospice registered nurse.
  2. pmabraham

    Nurses' Attitudes Towards End of Life Care Research

    It's BSN, RN vs. RN, BSN
  3. pmabraham

    Hospice case management but less income

    Hello: 1) Absolutely 2) Hmmm, I moved up from the hospital to Hospice (not backward) 3) Work-life balance comes and goes based on the census and staffing; still, see #1
  4. pmabraham

    MSN after Hospice Nursing

    I am currently working in hospice as a registered nurse case manager. I have my BSN and have considered the master's route. The question to ask yourself is what value will you get out of the degree and associated cost?
  5. pmabraham

    Should New Grad Start in Hospice?

    I do not agree with Nurse Beth. There are many hospice agencies that work with HOME patients who live and die at home. Hospital skills add only minimal value when you completely on your own working in a palliative care setting where the goal is COMFORT not cure, symptom management, not lab tests and working towards a cure. Hospital nurses often have to unlearn a number of areas to work in hospice where the focus is 100% different than the hospital setting.
  6. pmabraham

    Credentials question

    Good day: It is my understanding that credentials should be displayed as the highest degree, RN, followed by certifications in alphabetical order. Is that understanding correct? If yes, what is supposed to happen if the highest degree is non-nursing and the next degree lower is nursing? I.e., I'm considering going for an MS in Palliative Care, and I currently have BSN. If I went in that direction, would it be MS, RN or MS, BSN, RN since that the master's degree is not in nursing? Thank you.
  7. pmabraham

    Credentials question

    Your answer makes sense if the highest degree is nursing. If the highest degree is non-nursing the party seeing the degress may miss that the person has a higher degree than ADN. I.e. MS, BSN, RN vs. MS, RN where the latter has the reader wondering if the highest ** nursing **degree is only AD or diploma.
  8. pmabraham

    As a RN, which would you choose?

    I am a relatively healthy (no routine medications) 55-year old male with a stated (to family, friends, co-workers, my employer) desire to be DNR/DNI comfort measures only, abx for comfort and no artificial hydration or nutrition. When I worked on a cardiac telemetry floor, I was able to witness the reality which is backed by evidenced-based research on the apparent futility of CPR as well as the research for CPR outside the hospital environment.
  9. pmabraham

    Swastikas & Nursing | Refusing care based upon moral objection?

    Based on my understanding, there are only a few areas for which the law supports nurses refusing care. Two areas that I know involve the purposeful taking of life. Nurses and doctors have the right, supported by law, to say they will not participate in the outright murder of an innocent unborn baby. Nurses and doctors have the right to refuse to participate in assisted suicide in even states for which it is legal. My employer already knows, pre-hire, where I stand on these issues. I've already had to tell hospice patients who have asked if our agency helps with assisted suicide that will illegal in the state of Pennsylvania, should it ever become legal and they were to request it, I would have to recuse myself from being a part of their care team. I have the full support of my employer in this matter especially since these issues were discussed pre-hire.
  10. pmabraham

    A few questions for the group

    Good day: 1. RN's as case managers. Medical director is an MD and CRNP/NP's help the medical director, but don't "case manage." 2. Our agency allowed for up to 8 weeks; I was in the field in about 4; it's up to the individual CM as to how long do they need to orient. 3. Combination of curriculum adding up to over 25 CEU's. 4. Our agency handles caseload differently than other agencies. Typically you will here x-y # of patients per CM. While we have that for IDG purposes - right now as we have an RN on LOA, we are about 25:1 which is high (normal is 10 to 15:1), our patient care coordinator schedules the RN CM's who see anywhere from 4 to 6 patients on light days and 7 to 8 patients on heavy days. When fully staffed, it's 4 to 6. 5. We use an encrypted text system to communicate through the day as well as phone calls. We have IDG every other week (14 days vs. Medicare guidelines of 15 days). We have mandatory staff meetings monthly. Every business day, we have stand up and stand down. Whoever is on call gives an on-call report the morning of the business day (secure text and during stand up). 6. If a patient dies during day shift, the RN CM goes even if not previously scheduled (unless they are overloaded with patients), otherwise the on-call RN CM goes. The exception is if the patient dies at a SNF; in that case, the RN CM (or on-call RN CM) handles the death visit remotely unless the SNIF asks the RN CM t come in. 7. Home Base Point Care. Thank you.
  11. pmabraham

    New RN going right to a Hospice admission nurse?

    Good day: Hospice is one of those specialties that can often start fresh though x period of hospital experience offer some help (how much is very personal, and depends on the agency for whom you work). For admissions, learn the Medicare guidelines as well as LCD's for terminal illnesses. Learn what are appropriate diagnosis and conditions for hospice, and what's not. You can do it.
  12. pmabraham

    New grad, start in hospice?

    As someone with just 1.5 years hospital experience, I would recommend it would be ok to start off as a new grad in hospice with the right company/agency. I have friends that started right out of nursing school in hospice and they are fine. Hospital nurses focus on curring, lack the autonomy of most hospice nurses, and working in the hospital doesn't guarantee any experience that will apply to hospice. In relation to "you are expected to know," families often don't have a healthcare background, and they just want their loved one comfortable. Therefore, you don't have to be able to know in advance what might happen -- because it may NEVER happen, you just deal with symptoms that are presenting in an effort to ensure comfort. It's a completely different ball game (so to speak) than hospital nursing. Thank you.
  13. pmabraham

    Having a hard time with hospice

    Hugs. I'm sorry for your experiences. Please speak with the unit's social worker, unit manager/RN supervisor as well as the charge nurse. You have the right to lodge a complaint. When you lodge a complaint, stick to facts. Some key facts to point out: Morphine and Ativan timings, letting the morphine available for the patient get so low the next nurse might not have enough for the patient, the nurse goodbye statements to the patient. I would also add in the lack of giving the patient morphine prior to attempting to change the dry patient who didn't need changing. I'm glad you had good nurses, and not just a bad one as all hospices are different. Hugs.
  14. pmabraham

    Capella RN-BSN Flexpath-My experience

    I graduated in 6 months and a few days. It was worth it.
  15. pmabraham

    Tips for Hospice RN interview.

    Hi: Be sure to tell them why you want to be a hospice RN. Let them see your passion for hospice. Do ask questions such as hourly vs. salary, how on-call works, and position requirements and expectations saving the salary vs. hourly until the end as well as asking about mileage reimbursement. If you have any experiences diffusing difficult situations, share them. Hospice Nursing Support Group Public Group | Facebook is a good resource. Thank you.
  16. pmabraham

    Hospice nurse role in death at home.

    The caveat doing that in our case is we have 4 to 6 (sometimes more) visits per day and if the death occurs during the work day, we have other visits to do. And if at night, most of us put in 8 to 10 hours during the day and will need to put in 8 to 10 hours the next day (unless the next day is a Saturday). So while we are paid hourly, not being robots would cause burn out.. again we do ask the families and the only times they say stay is for local pickup that typically occurs within 30 to no more than 60 minutes of our call.
  17. pmabraham

    Hospice nurse role in death at home.

    Hello. Hello: This is an excellent question just raised in Hospice Nursing Support Group Public Group | Facebook Here's what I do: 1) Once on site, document mileage 2) Enter the home and see how the family is doing, then assess for death and note time of death 3) With family permission, immediately all the funeral home 4) Then I call the primary care provider 5) Then check if on family desires for when to have any equipment picked up, then work that out After that I fill out the death certificate portion that can be filled out along with a cheat sheet for the funeral home that includes the primary care provider contact information Only after that do I educate on med disposal for the family; most of the time they dispose of the medication on their time. If the funeral home is local, by now (30 to 60 minutes after my arrival), the funeral home personnel comes in, and I'm present through that portion. If they are not, I ask the family if they want me to stay with the exception of far-a-way funeral homes where I'm given an estimate of 3 to 6 hours for arrival of the funeral home staff; then I let the family know and typically they don't want me there for that long and they need private time. Thank you.
  18. pmabraham

    Miles on my car

    Hi Anne: Sometimes I consider getting a more economical car (EV, PHEV, or hybrid), but I don't fret the miles. Stressing about what we cannot control doesn't help. BTW, somedays I only drive 40 miles, and other days well over 300. A coworker had a 350 mile day a short while back. Thank you.
  19. pmabraham

    Capella RN-BSN-MSN flexpath experience?

    My BSN with Capella via their FlexPath program took a few days over 6 months, and yes, I was (and still am) working full time.
  20. Good day: Consider joining the Hospice Nurse Support Group at Hospice Nursing Support Group Public Group | Facebook Home has a lot of information available. For one book, I recommend "Gone from my sight" by Barbara Karnes, RN
  21. pmabraham

    Case Load Home Care

    10 to 15 patients with time periods where it may go up just prior to a new nurse being hired.
  22. pmabraham

    Repositioning end stage of life hospice pts

    If their pain is being properly managed, just reposition as you would a non-hospice-patient.
  23. pmabraham

    hospice rn admission per diem pay

    It's going to vary based on the agency. At our agency, we are paid at our hourly rate with overtime over 40 hours per week.
  24. pmabraham

    Capstone Project ideas

    An educational project to educate families that demand a full code concerning the actual torture it puts terminally ill patients through. An educational project as to the benefits of hospice and palliative care especially answering such questions as to why hospice, why now? An in-service educational project to educate the providers, social workers, case managers, etc. on the various floors of the hospital where you work as to the benefits of palliative service and hospice, and why providers, social workers, and case managers should be advocating for hospice sooner than later.
  25. pmabraham

    New Nurse on a Tele/Oncology/Hospice Floor

    Good day: Barbara Karnes, RN has a number of pamphlets that are very informative; my favorite is "Gone from my Sight: The Dying Experience." Keys to hospice: patience with the patient, family, and friends; symptom management with the goal to provide comfort. Thank you.