vampiregirl

In hospice, this medication combination very appropriate for management of EOL symptoms. I work in the inpatient hospice setting and out in the field. From what I'm hearing (from friends who work in acute care settings and from family members of hospice patients), it sounds like this is not medication combination that is common in more acute care setting due to safety concerns (fall risk, respiratory depression etc.).

I have 2 friends who are both nurses and have a pastoral degree; both work in hospice and I believe both also have done parish nursing. They are both very highly respected by their colleagues and patients. Both are very professional but bring a sense of calm with them. While you may not have a nursing background, everyone starts as a new nurse. Nursing skill sets related to a specific area of practice can be taught. Strong interpersonal skills and critical thinking are things that can't be taught but instead are developed over time. I would encourage you to list your previous education/ experience in some fashion as it would support strong interpersonal skills which are an important part of nursing. If critical thinking skills were relevant to any of your previous positions, then this would also be something to highlight. Think of other relevant skills that your applied in previous positions and figure out a way to include this as well (assessment, problem solving, high stress situations) - these can all be relevant to nursing practice,

Honestly, the title of this video probably wouldn't have prompted me to view this video. But wow - so much good perspective in that video! I'm not in the ICU environment but this content is so applicable to any area of nursing.

Are you under the care of a rheumatologist or podiatrist? If not, especially with your young age, this might be something to consider. Establishing a good plan of care now could be important to your future comfort and mobility. One of the amazing benefits of nursing is that there are so many options for work environments once you get your licensure, especially after you get some experience. Best of luck!

My thought process has always been that if the patient is on a unit which I am working on and my assistance/ care with a patient for whom I am not specifically assigned is needed, then it is appropriate to look in the chart to obtain or verify the necessary information. For just the reasons you mentioned - safety, appropriateness of interventions. We are expected to provide safe, appropriate care and need information to do so. On example of this would be a patient found pulseless/ apneic and the assigned nurse not immediately available. I would need to know code status to determine how to proceed. We get education regarding patient privacy and this is crucial for many reasons. We don't always get the education explaining when it is appropriate (and necessary) to look in patient charts for patients who are not exclusively assigned to us.

I don't have an MSN, I have a Master's in Palliative Care. I assist the education department at my agency as needed but work in another position full time. Not sure if my responses fit exactly what you are looking for... 1. I use a variety of teaching styles depending on the topic and audience. I try to include interactive components for any education I am providing. And hands on if possible. 2. It depends on the topic and audience. Competency based, role play, simulations and sometimes games all can be effective strategies. Even if it is a "simple" skills, having the opportunity to ask questions and get clarifications makes a huge difference! Blended learning strategies can also be effective with a reading/ online portion and then a more hands on activity to reinforce and clarify material can also be a good strategy. In hospice, we focus on teaching caregivers to perform many of the skills. Being able to perform a skill yourself and teaching someone else are two different things. Plus we tend to retain material better when we teach someone. But it takes some practice to become proficient in teaching caregivers and practice opportunities give people the chance to figure it out. 3. I find that most of my colleagues don't benefit from just reading a procedure/policy and then being expected to put it into clinical practice without some type of hands on learning activity first that uses the skill they read about. 4. Assessing current knowledge level and going from there whenever possible. Taking opportunities to encourage growth and development of critical thinking. Identifying available resources to help/ support nurses. Recognizing the importance of a calm, compassionate demeanor and interpersonal skills; also the importance of listening to our patients. Reinforcing that there may be multiple correct ways to perform a skill, promoting learning perform skills consistent with an agency's policies and procedure. Encouraging self-care and boundaries. Promoting professionalism. Establishing culture of intolerance for inappropriate behavior from patients/ caregivers and how this should be addressed.

I would agree this is unstageable:) The slough completely obscures the wound bed. Pressure injuries are either over a bony prominence or caused by pressure from a medical device/ something else. It takes time to consistently accurately stage pressure injuries and sometimes it isn't easy. Treatment plans depend on agency policies - I encourage you to be familiar with yours as well as your scope of practice. For example - I can not apply anything beyond a dry dressing for protection without orders for HH patients where I work. For hospice patients, our medical director has some basic standing orders for wound care while we await further orders. Effective wound care treatment plans address moisture management in a wound bed to promote healing/ repair. Too dry or too moist won't heal well. Calcium alginate absorbs drainage so it is typically used with wounds with higher exudate. Different agencies may also have formularies. If yours does, take time to learn about the products available so you are using them to their best potential. Most of us have our favorite products. Any effective wound care treatment plans also include non-pharmacological interventions. Education to promote skin integrity - avoiding pressure, shearing etc. Offloading pressure. Nutritional status. Patient/ caregiver education on how other co-morbidities affect the wound. It also depends on patient goals and patient/ caregiver abilities.

You've gotten some great suggestions and perspectives from other posters... Additional information that might help your decision: How long a typical SOC takes at each agency (different charting programs and different processes at different agencies can both influence the time involved). How many patients are typically scheduled to a nurse each day. Regarding call - geographical area covered, agency census, typical number of calls/ visits per call shift. Another poster recommended asking for a specific number of case management hours a week. An alternative questions might be inquiring about the wage for case management. Some cases have a lot of follow-up/ coordination of care or education/ support via phone is necessary outside of visits. When I worked HH, I found this to be vary variable. Unless the agency is set up with a phone nurse who handles all of this and an established process to ensure communication is in place to facilitate this. Home health can be a great place to use your experience and knowledge from the ICU/ER. It's a challenging area of nursing at time with some of the same frustrations I'm sure you're accustomed such a non-compliance and frequent flyers. It also can be so rewarding to see patients gain health literacy that allows them to better manage their conditions or improve through hard work.

Another thought... if the patient was having an inferior wall MI an EKG could have made a huge difference due to the risk of hypotension with nitro.

Kudos for investigating something further that you're not familiar with! Have you looked into the policy or procedure for administering Kyprolis at your workplace? If I can't find a specific policy or procedure regarding something, typically my next "go to" is manufacturer's materials. Good luck!

I'm another nurse who got a good skills foundation in SNF. I encourage you to take every opportunity to learn. Look things up, take every training opportunity available. Don't discount all the informal non-technical skills you've gained as a charge, including leadership and delegation. Hospice is another option if that area of nursing interests you. In patient hospice centers would probably be the most appropriate option for someone who uses public transportation.

Agree with above poster. Also recommend (if you haven't done so already) to get your scheduled hours and compensation in writing. Not sure what your caseload/ visit load is or your geographic area is. I work a 48 hour weekend position (Saturday 0800-Monday 0800). Flat rate paid for these hours regardless of visits. Includes admissions. 1.0 FTE/ Full time position. As it is an "on call" position, I get paid mileage for all miles driven related to work. If I pick-up extra call or visits outside of my scheduled weekend shift, that is additional compensation. Visits during the week are no mileage paid to the first visit unless over a certain number of miles and no mileage home from the last visit unless over a certain number of miles. On call during the week is the all mileage covered. Most of the time, I enjoy my position as an on call hospice nurse. I did case management for several years and honestly this is a great fit for my skill set (EMS background). I also love having most of the week off. I never schedule anything on Monday before the evening. Lately, I've picked up one day a week to help with admissions, but this is something I chose to do.

Parkinson's patient's can be tricky to accurately assess if they meet the life expectancy criteria of 6 months or less if the disease process takes it's normal course! Some of the considerations our team presents to our providers in order for them to make eligibility determination: Significant co-morbidities Significant/ progressive decline in past several months Any recent infections in past 6-12 months Weight loss in past several months, BMI, current intake, dysphagia? PPS ADL status FAST Score if appropriate

It takes time to get faster. Learning to keep yourself organized and getting a process in place can help. Little things like figuring out a system for yourself to order refills. Making sure the med cart had all the required supplies including fresh water prior to each med pass. Also knowing how to prepare each patient's meds (whole, whole except for the potassium which needs to be split in half, floated in applesauce, floated in pudding, floated in yogurt, who only drinks their miralax in cranberry juice etc) - I made myself a cheat sheet that I just updated and gathered all my supplies prior to med pass. Adding 9 patients is a big deal, especially when it's all new patients. Please also remember though that correctly doing all the required steps of a med pass isn't typically a "quick" process. Better to do all the appropriate steps and perform a safe med pass. It's also helpful when a supervisor or regulatory agency is doing observations because you can just do your "normal" routine instead of trying to remember how to do it correctly. When I worked LTC, I was NEVER the "fast med passer" because I did all the appropriate steps including any assessments required for meds. But my med error rate was nearly non-existent. Med passes can be critical - so many patients take a number of meds that if not administered appropriately can have serious consequences. If your preceptor is giving you positive feedback, please accept it. And give yourself grace as you are learning.

@hppygr8ful - Nope, I don't think you are old and out of the loop. Especially in the psych setting, professional boundaries are crucial as is following policies. Consistency amount staff is also crucial to maintain a therapeutic milieu in that environment. While we aren't currently in the throws of a pandemic, there is a rise in RSV and influenza in some areas; infection control is also a consideration. I'm not in any way diminishing the importance of physical touch. And I'm also not ignoring the current social norms of touch (and social distance). I completely support your education approach - that's my preferred approach as well in comparative instances. Staff may not be aware of the implications of touch, specifically in this professional setting and how touch could potentially be misconstrued (intentional or not). Modeling and recommending appropriately/ alternative ways to convey reassurance, support, presence and other emotions that the staff are attempting to communicate via hugging etc. Treating others respectfully, active listening/ undivided attention, validating emotions, eye contact (as appropriate), and recognizing/ supporting appropriate coping strategies are just a few of the ways provide therapeutic support in this setting.