Race Mom

Hi Joyful! Did you accept the IV Hydration position? I have been away from nursing for almost 5 years and ready to hop back in. I have considered this position too and was hoping you could give us an update!

I just submitted everything yesterday and hope to start July 1st. I still am debating RN-BSN vs. RN-MSN. I have a few friends that have done the BSN-MSN through WGU and now they are both going through an FNP program, online, through another school.

In the hours, after she passed, the OC RN came to the death call. The first thing she did was start to destroy meds. She was ready to destroy meds that never were filled by their hospice (she had the bottle before electing hospice) and I said "those are not your medications, those were purchased by her. You don't need to destroy them". To that she said, "well, will have to document that you are requesting these meds not be destroyed." Whatever.....they were filled well before hospice came on board and hospice had nothing to do with those meds, nor did they pay for them. But, they destroyed plenty of meds. And then...she left. She did ask if we wanted her to stay until the funeral home arrived. There was no reason to have her there, so she left. It was 3 days before the medical supply company arrived to take the bed, etc. That was unacceptable. Three days of a hospital bed, commode, walker, etc sitting around. The hospice I worked for would have had it out of there in hours, to ease the pain of the family. 3 days!

Thank you everyone for your loving words. It was hard enough to be losing my sweet, young sister, but couple that with advocating. You will never question yourself more in your life. Her death will pain me forever.

I would have revoked if I had a choice. (I was her MPOA) Unfortunately, they were the only hospice in the county. The ONLY one. So, the night she had a seizure, besides no answer at the hospice number, and no way to leave a message, by the time we got ahold of someone (continued to try to call them), the nurse was in a town that is over an hour away and was with another pt. This is a non-profit hospice. I do plan on filing a complaint. I just need to get through some grief first so that my letter is professional instead of fueled by emotions. I am guessing the spouse will get the survey, so this may not help. He is aware of the issues, but as a non-medical person, he wasn't aware of what was going on because he didn't know any better. If I lived in Florida, I would really be thinking about opening a hospice in this community.

No, no puppies :) This was for my sister who went on hospice. She had some incontinence at one point, when they had her overmedicated. I asked for some chux and was denied. They told me they didn't provide them, but were very happy to tell me where I could buy them. Funny twist from what you said about the puppy. They had some of those pads at home and we decided we would just use those if we needed to. Pretty sad.

Two days before she passed, she had a seizure (only time she ever did). At that point, she transitioned to active dying. When we got her into bed, after calling hospice (which took multiple tries...getting voicemail but it didn't allow you to leave a message) I made the quick decision to open the kit. Her seizure was at 3am and it was about 6 am before the OC nurse arrived. He said "who opened this kit?" I told him I did (although I didn't use anything, just got it ready and looked to see was in there). He said "well, I don't know if there could be any legal ramifications for you since there isn't an order for those meds." I told him I didn't care. I couldn't get ahold of them and she was non-responsive. He was a really nice RN, but that just hit me weird. Then next night, when she was in a large pain crisis, I called the oncall (this is after her CM wouldn't come and open her kit). I asked her, when she called before making the visit), if I had permission to open the kit. I was told no. It took over 3 hours for them to arrive. So, while waiting the 3 hours, I opened the kit. If they weren't going to take care of their hospice patient, I certainly was. I pulled out enough morphine for 3 doses, giving her one, and fridging the other syringes. Taped the box back up, and put it in the fridge. I made this decision after I was told the OC nurse was in a town 1.5 hours away and wasn't done with that visit yet. So unacceptable. I really did see my sister's death as being something more peaceful and spiritual, but it was the opposite. I will struggle with this for a long time, I'm sure. This went against everything hospice was supposed to be.

Sorry for the confusing way I typed this. As you can tell I was a little angry. I have been a hospice RNCM and have worked for two really good hospices. Unfortunately, my young sister went on hospice (in another state) and this is the story of her death. No one would open the dang kit! I was so mad! It would take 3-5 hours to get the oncall RN there for a crisis at nighttime. Her CM refused to come over and open the crisis kit when I called and asked her to please come and do this. Her response was to crush what can be crushed and give her MsContin rectally (they don't supply gloves or lube, even though they supplied suppositories PRN). So, in a nutshell, my intent was to ask if any of these situations were ok and I was just being out of line by requesting them. The whole hospice experience for my sister's death was a horror story. (They wrote on FMLA paperwork that her hospice dx was brain cancer, and CM verified it with me when I questioned it, only to tell me a week later she didn't have it but offered not one glimpse of an apology for what that did to our family. She discussed her "next pt visit" with the SW while sitting at our table during the visit, mentioning how difficult the pt was.) There is SO much more that is even worse than these examples, but I'm not going to mention all of it, cause it would just be a rant. Thanks for your reply. It is greatly appreciated :)

When I was an L&D nurse, I would always advocate for my pt. Docs would come in and want to AROM the pt and up the Pitocin. The pt would just nod in agreement. When the doc would leave, I would tell my pt "you don't have to have your water broken. You can let this go more natural. All you have to do is tell the doc that you want to wait for interventions." The pts always expressed gratitude but allowed the doc to AROM them. Nurses need to really be strong and not worry about what the doc thinks. I always advocated for my pts. After that, it was their decision. Of course, this means that I have gone head to head with a few docs. I don't care if they don't like me. I have seen too many poor outcomes from wanting to deliver in the 9-5 world.

So, if you have a pt that is within 1-2 days of end of life, has thrush causing difficulty swallowing, when do you change meds to liquid vs crushed? What would keep you from opening the comfort kit at EOL? Is it ok to give pt the [COLOR=#444444]Hyoscyamine[/COLOR] from the comfort kit, even though it "causes urinary retention"? If a family member calls you on a Friday at 1630 with c/o pt having pain crisis and family requests visit to utilize EOL kit, is it ever ok to say no and direct family to continue to crush all meds or give them rectally vs visit to open comfort kit for liquid meds and not visit? Yes, your guess is correct, this happened. It makes you want to open your own hospice in that town.

I used to be a hospice CM. I asked our hospice RN CM (for our family member on hospice) for a pack of chux pads and she told me they don't supply them but I could go to the store and buy some, same with briefs. I was always under the impression that hospice covered these supplies so I became pretty confused by her answer.

Pt has private insurance. Is hospice required to provide incontinence supplies for a pt on hospice with need for incontinence supplies (chux, etc). No other dx other than what pt is on hospice for. Young pt with no previous need for incontinence supplies. Thanks!

I am having trouble finding any hospice care (home visits) in Englewood, FL. Tidewell seems to be the only one. Anyone in this sunny state know of anyone else? Thanks!!

My mother-in-law died from a brainstem glioblasoma multiforme. She was on hospice for almost 3 days. She taught me how to be a hospice nurse. I was an L&D nurse at the time, but quickly educated myself on hospice (it was a weekend admission and not very much support for us, unfortunately). She never lost her wit, or her mental ability. She just faded quickly that last week. Her last day was spent with her eyes closed (she said the day before that the earth was spinning and it made her nauseous so she kept her eyes closed). I had a true heart-to-heart with her, about 2 hours of me talking and crying and laughing and forgiving and telling her we would all be ok. At that moment, she transitioned. She began Cheyne-stokes breathing. She was also having the "death rattle". It was so unforgiving and difficult to listen to. She blessed me with teaching me "textbook dying". I was grateful to have researched what to expect. It really taught me how to educate my families. Perhaps this family was witnessing "death rattle" and Cheyne-stokes breathing. It is a normal process that is believed to cause no distress to the patient. God bless

Visiting the newborn in L&D, as the nursery nurse, I was happy to comply with the family's request of waiting 2 hours from birth for bonding. I arrived a few minutes prior to 2 hours (parents were accepting of vitK but not erythromycin) to give the VitK in our standard 2 hour time frame, as well as newborn assessment/Ballard/etc. I had prepped the VitK, ready to give, and the doula walked in between me and the infant (on the warmer) and coo'd over the infant for at least 2 mintues while I stood there with an exposed needle. The warmer is in a confined area in the room, so I could only feel that it was intentional. The rest of the family did the same thing repeatedly during my assessment. I was hoping to get it all done quickly so they could continue with the bonding, but my assessment ended up taking about 45 minutes with all the "stand in front of the RN while she is working". It was frustrating. In the end, the family thanked me for not taking the baby off the breast and allowing for bonding. No harm, no foul, but my interest is that the baby is transitioning well and I need to assess that. That is what we do in a hospital environment. The baby is just as important as the mother.

NICU position offered before graduation. Only stayed there 5 months (orientation completion). It was NOT a good fit at the time. Hit the streets and visited local hospitals. One LDRP was not locked down and I was nervous to enter the unit so I was turning around to go home and submit my app when one unit nurse asked if I needed help finding someone. I told her I was an RN looking into hospitals for a position in L&D. She gladly toured me around the unit and gave my name to the Director. The Director called me, interviewed me, and secretly told me that she was going to pass me onto HR for a formal offer. I worked there for 4 years, as well as returning to the NICU during that time (working both hospitals at the same time). I then wanted a change from hospital life and night shift and went into hospice nursing. I am now exhausted in hospice nursing and began to appreciate the 12 hour shifts and my continued love for mother/baby (reason for having my interest in Nursing). I start back at the hospital in a few weeks and I am excited! It has been a long time since I could say that.

Congratulations on staying in hospice for so long! I just left my most recent hospice RN Case Management position for the same reason you are looking to leave. I am tired of death. I loved caring for my patients and their family but in hospice, you are never quite "off" shift. Your life becomes about death. Your perspective on life changes and you can forget to live in the "here and now". I didn't work in hospice nearly as long as you have. I have experience in NICU, L&D, and postpartum so my abilities to get a position at the local hospital were somewhat easier than you might have. I did highlight my hospice nursing skills and discuss how they are a wonderful asset for a unit that, on occasion, needs that excellent nursing skill. Before hospice, I had one newborn death at delivery and I didn't quite know how to handle it. I now would be honored to have that mom on my assignment. You need to look at all the positives of your hospice career and how they can benefit you in this area. (time management, stressful situations, difficult family members and your ability to bring them together, etc) Look into all the improvements in processes that you have contributed to and put them on your resume for each company you are listing. Good luck to you in your search and keep trying!

Hi Hopeful, From what I hear, the main hospitals are mainly looking for BSN. I know St. Luke's is Magnet and a few years ago stopped hiring ADNs. I'm not sure about St. Als. I will tell you I had an interview with them about 2 months ago for L&D. They were going to require me to go back for my BSN within one year. I ended up withdrawing my app since I found another position. I didn't transition from NICU to hospice. I transitioned from NICU to L&D to Hospice. Every new specialty is going to be tough to transition to, but the nursing foundation is the same. You just have to learn about that specialty and it's related meds and tests. I make $5/hr less in my clinical office setting than hospice. You can expect pay in the low to mid $20's. Hospice is usually mid to upper $20's but you really feel like you are constantly at work, even on the weekends. Plus, you have oncall. Not worth it for me. Put your apps in wherever you can! You never know!!

Sounds like he is looking for an RN to be his PA for the pay of an LPN!

I read it to say that your license trumps the need for a cosmetology license, but what you do must be allowed by your license as that is who dictates what you can do. Exemptions.—(1) This chapter does not apply to the following persons when practicing pursuant to their professional or occupational responsibilities and duties: So, when you do it, you are practicing to your profession of nursing and are providing nursing services. Good luck!! Sounds like fun!

My MIL did the same grimace with her last breath. It still bothers me that it may have been pain. My intuition tells me it was when her heart stopped beating. She passed quickly after that as it was during her last breath. She is now free from the bully of a brain tumor that had taken over.

This issue is one of my biggest gripes with this profession. The problem is that the majority of nurses will just be "ok" with not getting breaks or a lunch and chalk it up to the profession. That is BS! We have labor laws/rights in this country and every time one single nurse is ok with not getting lunch or a break weakens the fight to make it happen. The hospital is more than happy when nurses have the mindset of "well...that's nursing". Since when???? Are we superhumans? NO! We are regular folk and we deserve to receive our breaks and lunches like all the other workers in the United States of America! Nothing irked me more than a nurse telling me they were just going to write down that they took a lunch (even though they didn't d/t short staffing) so they wouldn't get IN TROUBLE! What??? The hospitals are more than happy to have you poo poo away your legal rights to rest periods as you are only helping them make more money to line the CEO's pocket and mansion. You (generally speaking, not directed at OP) are effectively skipping breaks and lunch and the executives are buying mansions and luxury cars d/t not having to pay you for lunch. Enjoy working for free for an hour a day. Off my soap box. (ps...this is a generalized rant not directed at anyone who has posted...unless you have mentioned that you are ok with working for free and taking no lunch or break cause that's nursing)

I can't imagine if someone performed CPR on a person with a DNR and (although rare) the pt survived, brain dead and in a vegetative state for the next 5 years. THAT would cause a pretty good lawsuit. Your coworker needs to be "armed" with the information that pt was a DNR and even though 911 directed her to perform CPR, it was against the pt's wishes and was honored. Facility protocol to perform CPR until EMS arrives does not trump a patient's wishes for no CPR. The PATIENT decided that and your coworker honored it. God bless her!

In 2007, I applied from out of state. I didn't receive a call back until about a month before I graduated. I was a little afraid I was moving without a job. I had a phone interview (team interview) and was offered a job not too long after. I would just call the nurse recruiter and ask about the status of the residency application process. The nurse recruiter WANTS to recruit! Do not be afraid to call her/him!!

My family moved here 2 days after I graduated! Couldn't wait!! haha I haven't worked in a bedside position for about 3 years but you can expect pay to be in the low $20 range. Other (non-bedside) fields may pay better. I work hospice and make WAY more than I ever did in the hospitals! I live in Meridian.