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ShesanRN's Latest Activity

  1. ShesanRN

    Approaching tough subjects with the boss

    I think your boss' responses to you so far have told you where she stands on the issue. I agree with the above poster, and the fact everyone else is looking for an out is a big red flag. The month I left my last nursing job, they lost 1/4 of their nursing staff; it was a mass exodus.
  2. ShesanRN

    General rant

    I'm curious, too, as to the details of the situation. Was the patient at home, with family monitoring symptoms? Or was it in a clinical setting? It seems there would be, as others mentioned, more safeguards in place to prevent this scenario, i.e. more frequent monitoring. If not, putting them in place for the future may give you peace of mind. I've had patients, too, whose symptoms were just plain hard to control, with endless hours and multiple med changes needed. In most cases, the family appreciated the fact we stayed in the ring fighting for their family member's comfort, even when it was elusive. Afterward, I analyze the case with my colleagues and do my own research to see what, if anything, I may have done differently to relieve symptoms more quickly. I try to redeem the experience by incorporating the lessons into my practice, so my future patients can benefit.
  3. ShesanRN

    How to transfer into hospice

    Your med-surg experience will serve you well, as all the basics like I&Os, ADLs, med management, catheters, wound care, drains and trachs, are all relevant depending on the needs of your individual hospice patients. I agree with the above posters who advised to "try before you buy," on a PRN basis. You may find the biggest adjustment has to be in your mindset, because in hospice we are always looking for and documenting toward decline, not improvement, with a focus on palliation and comfort vs. cure. Good luck and welcome!
  4. ShesanRN

    I want to be a Hospice Nurse

    Like vampiregirl, I was introduced to hospice nursing working in LTC. I loved what I was doing there, and began to especially love the extra time, care and attention I was able to give patients and families as the patient's time of passing drew closer. What can you expect? For me, hospice nursing has made life bigger and grander in many ways. Being with patients and families who are facing end of life amplifies my senses and sharpens my priorities. Things that were once a big deal no longer even fall onto the radar, and it's a beautiful thing. Helping get a patient home from the hospital because they just want to leave this world in the most comfortable setting they know, is the most rewarding thing... Like most nursing, it can be physically and mentally exhausting. Interventions that don't work like we'd hoped, grieving and possibly non-compliant families, and lack of easy answers in general take their toll, but it only takes one day off for me to begin missing those I care for in this most worthy specialty!
  5. ShesanRN

    LPN Hospice Nurse

    At our hospice (not inpatient), the LPNs conduct patient visits under the supervision of the RN/case manager (they see the RNs patients and report in to them any condition changes/new orders). When they are on call, there is always an RN on call during the shift as well, and they report to him or her when doing triage visits and taking orders. They aren't allowed to pronounce patients who pass away, nor are they able to work with "invasive" interventions such as the CADD pump. The scope of practice for LPNs in Indiana is pretty vague; our company has its own standards for what LPNs can/can not do. I would advise asking your question of whomever interviews you to gain a better sense of what your responsibilities will be. Good luck!
  6. ShesanRN


    This sounds like a bad deal all around. Our PRN nurses do not have to participate in the on-call rotation. When a nurse is on call, they make $2/hour beeper time, then hourly rate + mileage "door to door," from when they leave home to answer a call, to when they return.
  7. ShesanRN

    hospice on call

    For on-call work specifically, there are good map/travel apps others may mention - I have a Garmin, with which I have a love/hate relationship :) I have found gas station price-finder apps handy for getting cheap petrol...Keep your vehicle in excellent shape and topped off w/gas of course! One of the best things that's happened to me since I began working on-call is aquiring the ability to fall asleep within 15 minutes of returning home I used to lie awake and stare at the phone, wondering when it was going to ring again. Now I'm back asleep before my head hits the pillow.
  8. ShesanRN

    Good apps for hospice?

    I had a lab values app that I didn't use a ton doing hospice, since we focus more on palliation than treatment...I do, however use my BMI calculator app quite frequently, since we use BMI as evidence of decline both during the admission process and later on for recertification...
  9. ShesanRN

    Care for surviving family

    You may also consider contacting the American Cancer Society to see if they have recommendations for your situation/area. Somtimes even being willing to use the word "cancer," is a needed step in caring for a family in this situation. It feels like dropping a bomb into the room, but if your tone and mannerisms are gentle and respectful, the injection of reality can be therapeutic in its own right. I have also cared for families, though, where we don't even refer to ourselves as "hospice," because the patient just can not deal; use your best critical judgment
  10. I agree with those that encouraged you not to feel put-upon or taken advantage of. The patient benefited most by you giving the suppository then and there, and their needs should come first. If it bothers you to think of it as doing it for other nurses, just stay patient-focused and it'll be no big deal. The fact that it was a suppository doesn't make it any different than any other procedure, imho. We nurses are all about the poop - I tell my two boys, who are currently obsessed with bodily functions, they should become nurses!
  11. ShesanRN

    calling all on-call nurses

    I don't have a way to advise you to explain it, except as you have just done to us. You don't really have the option to seek additional employment lest it interfere with your ability to take calls. Your employer knows this. You can try negotiating for a better salary, or consider looking for a different position. In my position as weekend on-call, I am paid a full-time salary for being on call 64 straight hours (Fri 430p-Mon 8a), so it's apples and oranges by way of comparison. I average 35-40 hours worked during that time. Our weeknight on-call (Mon-Thurs 430p-8a) is paid similarly to you, though I'm not privy to the details. At one point I had a manager try to tell me driving time "didn't really count" for me when it came to consecutive hours in the field (I've been out as long as 20 on a handful of occasions). I reminded her that if travel time counts toward a weekday nurse's hours (it does) it should count toward mine. Even good managers can have blind spots, so it doesn't hurt explaining your case in a respectful manner.
  12. ShesanRN

    Dating a former patient

    I can't see myself ever crossing this boundary; my career means too much to me. There are many more ways to find potential dates that won't put your career at risk.
  13. ShesanRN

    Hospice Nursing Question

    Sometimes that help means discontinuing medication, other times continuing medication for all the reasons you've mentioned in your posts. The patient's desires and quality of life drives everything we do. At our hospice, it's a very individual process for each patient. There is no "cookie-cutter" plan, nor would we want there to be.
  14. ShesanRN

    Hospice on call setupd

    Our census is hovering around 150 currently. We have two dedicated on-call nurses, one for weekdays 430pm-8am and one for weekends (me!) from Friday 430pm-Monday 8am. Our RNCMs serve as backup to the dedicated on-calls, one during the week and two over the weekend. We have one phone triage nurse covering during the off hours. Admissions vary; sometimes an admission nurse will do an evening or weekend admission, other times we do them. One thing to keep in mind when staffing for on-call is the size of the territory and desired response time. Our patients live as far as 60 miles apart, and our desired response time is
  15. May I ask the circumstances of your case? I'm sure any employer that may give you a chance in the future would want to know...
  16. ShesanRN

    Seeking Opinions on End of Life Care

    Everything everyone above said :) plus, if I understand your question correctly, one of the most important steps to promoting ethical clinical practice is communicate, communicate, communicate with the patient and family members. Listening to your patients and their families is bedrock to ethical care! Listen and find out what they want and document it. Talk about it in interdisciplinary group. An open, honest, documented dialogue on advanced directives, symptom management, patient dignity and nurse-patient relationships is key...

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