ShesanRN

Can you tell us more about what the sore looks like? I've not yet seen that caused by Roxanol, either.

My initial reaction is I'd still prefer to use my own gloved fingers/hand. In some procedures, there is no substitute for the sensory feedback, because of the high perforation risk, as newhospicern indicated. "Current treatment of FI often means inc...

We can take move our GIP patients to a snf we are contracted with for that purpose, but most of ours are cared for in the hospital. We either get the referral from the hospital for one of their patients who needs palliation, or one of our current pat...

I agree - I'm not sure how you could've known not to call 911 not having worked in hospice. That's intuitive for most people. In my agency, we knock, sometimes at an alternative entrance, attempt to call the home/cell of patient/caregiver, then leav...

Our patients are in multiple settings, and the ones who pass at the hospital (that is our inpatient setting) do get taken to the morgue, although by hospital staff, not me. I wouldn't mind it, though. I've bathed and dressed patients post mortem, of ...

$28/hour x 40 hours salary for weekend on-call RN in the Chicago-Detroit cradle, logging an average of 35 hours/weekend including travel time, all hours of the day and night. There are times when I think "I can't believe I get paid to do this!" and o...

Our standard comfort med orders are for sublingual Roxanol, Ativan and atropine drops every 2 hours as needed and Tylenol and phenergan suppositories prn. We adjust and substitute from there with Oxy IR, Xanax, haldol, scopolamine patches, Robinul, c...

I haven't used nebulized Dilaudid, but we routinely get orders for Oxycodone IR 20mg/mL (OxyFast) as a substitute for morphine when there's an allergy/intolerance.

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 nu...

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. mor...

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...

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 close...

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 duri...

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, ...

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...

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 nurs...

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 fo...

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.

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 proces...

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 ov...

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...

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 p...

We've used both Haldol and ABR (ativan-benadryl-reglan) gel as well as AHBR (ativan-haldol-benadryl-reglan) gel topically with patients like these. It is very, very challenging for everyone when the larger patients give their family members a run fo...

Based on what we know, I'm not seeing the nata for the prn dose overnight. The patient sleeps soundly without s/sx dyspnea; the med is given routinely during the day but not at night, and the pt had stated they would ask for the med at night if it we...

Sounds like a marketer! Fortunately, I haven't seen ours try to weasel in unqualified patients - they seem to know better, and the nurses always seem to have the last say. The most ours do is try to get a qualified patient admitted ASAP - before midn...