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happyRN29's Latest Activity

  1. happyRN29

    Which job is better?

    Take the caseload of 10 and less call. "On call" can cause major burnout in hospice. The less of it you have to do, the better. A caseload of 10 for a full time monday through friday nurse is very reasonable and doable. The hospice I worked with before told full time nurses that 12 was what the full time caseload would be but most of the time they had anywhere from 14 to 18 which is way too much especially with one day a week call and every 4th weekend call. I often had 10 to 13 pts as a part time 3 day a week case manager in addition to one day a week call and every 4th weekend. I loved hospice but the 'on call' burned me out completely after 2 1/2 years. That and excessive charting. Hospice can be great if you have bosses and a company that really cares about the welfare of their nurses. Good luck to you in your hospice career.
  2. happyRN29

    Interested in Hospice Nursing

    I love being a Hospice visiting nurse but as with any job there are certain difficulties to work around. I would change the atrocious amount of charting required, condense it, refine it, make it more realistic and pertinent to the type of visit or type of problem. I would require that the office be more proactive about supporting the field staff. Supplies: yes I have not had needed medical supplies for a visit before. You have to learn to improvise, call coworkers for ideas if needed. Our agency has terrible organization/management of supplies so my experience may be worse than others. Our office does not allow supplies to be sent to the patient, it has to be sent to the office, then the field staff distribute the supplies to the pts at visits. It would actually be a lot quicker and better if we could just send the supplies directly to the pts home. The last agency I worked for did allow supplies to go to ot homes and it was much better. Supplies could make it there in 1 to 2 days. I've been a nurse 8 years. I've worked in LTC, home care (one on one), med surgery, and now hospice. Hospice is the most rewarding field I've been in and I genuinely love it. It is however very demanding because of all the 'on call' required. Every agency is different so make sure to ask for a realistic depiction of what 'on call' looks like. It can be very difficult to have good work-life balance working in hospice.
  3. I have had the plantar fasciitis in my right heel on and off since I became a nurse in 2011. The last time I had it was in 2017, I was working medsurg day shift and had just had a baby. It started in the few months before I had my baby but became much worse after I had her and returned to work. It was complete misery with no end in sight. I tried so many things: heel inserts, special shoes, compression socks, heel cups, night splints, foot soaks, hot wax peels, frozen water bottles, physical therapy for 6 weeks, cortisone shot x 1. The cortisone shot was the only thing that worked and it lasted a few months but then the pain came back over the course of a few days. After battling it for more than a year and a half I knew the only way it would get better would be to find a job not being on my feet all the time. I left medsurg (had been there 3 years) and went to hospice. The heel pain gradually got better and was completely gone after about 6 months. I've been in hospice a little over 2 years and still no heel pain thank goodness. I am obese and have been almost all my adult life. I am sure that is the main reason I have the trouble with it. I also think it runs in my family as my Mom, Dad, and sis have all suffered with it at one point or another. Plantar fasciitis stinks!
  4. happyRN29

    Quotas for visits, mandatory overtime?

    I've been a hospice RN case manager for little over 2 years. About a year and a half with my current agency. I love hospice so much and really feel like it's where I'm supposed to be. That being said the current company I work for definitely takes advantage of all the nursing staff. We ALL work more hours than we signed on for. My days always run long because of some long visits and the ridiculously redundant charting. We take one back up call shift a week and backup call one whole weekend (friday through sunday) a month. The biggest issue we have is backup call gets greatly abused because of admissions being the company's #1 priority. It doesn't matter if the nurse taking back up call has already worked all day. If they have an admission they want you to do starting st 5, 6, 7, or even 8pm, they do not care. You are expected to suck it up and deal with it. It also foes not matter to them that it takes a good 5 to 7 hours to complete every piece of an admission (not including if you have to run all over God's creation to obtain scripts, meds, or needed supplies.) Its terrible. I had 5 weeks in a row where I worked 15-16 hour days at least once a week on my weeknight backup call because of these admissions. What's even worse is they see no issue with tying up both the primary call nurse and the backup call nurse at the same time with admissions. Not to easy to provide timely pt care when both nurses are tied up in admissions for 2 to 3 hours. Our team of nurses has voiced our complaints and concerns about this multiple times over the last year but it always goes in one ear and out the other. We are still waiting to see a real positive change. We have lost good nurses because of the worker abuse. I frequently think of leaving because every time I pull a 16 hour shift against my will it makes me get even more angry with the company for caring so dang little about the field nurses who hold it all together and whom they are really so dependent on. It's maddening for sure.
  5. happyRN29

    5 things you wish you knew before starting a hospice career

    1. Expect most of your pts to have some degree of constipation, many to a severe degree. Be very knowledgeable on what medications to recommend to the doc. Expect to administer lots of enemas and occasional digital stool removal assist (with Dr. order of course). 2. In hospice you wont have a respiratory therapist to be on top of everything respiratory. You will need to be your own expert on everything respiratory so study up on those o2 delivery systems (nc, High flow, low flow, oximizer, venti mask, nonrebreather, cpap, bipap etc) and respiratory drugs. 3. Have a thorough knowledge on the dying process and expect to educate on this.......a lot. People will always want to know WHEN is he/she going to die. Don't beat yourself up if/when you get it wrong. Patients have a way of making us look silly sometimes, even in death. 4. Educate yourself on the election of hospice benefits and have a good understanding of what all pts should be able to expect from their hospice provider. This will help you advocate for your pt. Expect to reinforce education to pts and caregivers on this topic frequently. 5. Expect to find a tremendous amount of appreciation from pts and caregivers in this nursing environment centered around the final phase of life. Beware that being around so much death and dying can take a huge toll on your emotional wellbeing. Find healthy ways to cope. My background is LTC, homecare, and medsurg. I have been in hospice nearly 2 years and truly love it! I knew almost nothing about hospice prior to leaving medsurg to try something different (hospice) I have learned a lot along the way. I hope this helps a fellow nurse

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