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vampiregirl BSN, RN

Hospice

Content by vampiregirl

  1. vampiregirl

    RN-BSN (Affordable!)

    I was actually surprised to discover that the most affordable RN to BSN program was a local private. It was one night a week, very well organized, great professors and accredited. So, you may want to consider just checking with local private colleges/ universities. Another consideration would be to check with your employer - some employers have special arrangements with specific colleges/ universities. Tuition assistance may also be available.
  2. vampiregirl

    Stylish Shoes for Male Student

    Agreed. Although I think keeping shoes clean and in good repair is important. However comfort (and good support for your foot type) is really the bottom line. Cute doesn't count if your feet hurt so bad you're wobbling around.
  3. vampiregirl

    I Desperately Want Out

    Great suggestion - good managers care about their employees and often have suggestions or can present options that the employee may not be aware of. Just getting some support can make a huge difference!
  4. vampiregirl

    I Desperately Want Out

    Great thread!!! OP- you mentioned you are feeling burned out. In addition to the other awesome suggestions in this thread I want to throw out there to suggest you look at whether you are practicing good self care. Are you taking your breaks? Spending time with friends and interests outside of work? Eating well, getting some physical activity, getting enough sleep? All of these things can make a huge difference. Also, does your workplace have an EAP service? Using EAP doesn't mean something is "wrong" with a person, EAP also can offer tools/ resources for self-improvement. Compassion fatigue (which can be mistaken for burnout) education and resiliency education can be huge assets. In nursing the focus tends to fall towards taking care of others (which is super important) but it doesn't put the same emphasis on self care. Another thing I've found helpful is volunteering as a nurse in a whole different area of nursing. I spend a week each summer as a camp nurse. Totally refreshes me towards nursing. Side note - i found my niche in nursing in the last area I ever thought I'd love. And a great schedule to boot - I work Tuesday - Friday 2nd shift with every weekend off. My employer has several different scheduling options. Good luck!
  5. vampiregirl

    question

    I wouldn't let this experience deter you from hospice if this area of nursing is something you are truly interested in. Maybe look for a well established agency in the future. I think from reading your post you figured out that there may be some concerns with some of this agencies practices. Hospice can be an amazing area of nursing.
  6. vampiregirl

    Writing order and having Dr sign later..your thoughts?

    I would encourage you to get clarification (preferably a reference to a written policy) in case this comes up again in the future. Good for you for catching this need for an order though during the audit process! Where I work, the only time we write a verbal order without speaking directly to a provider is if we implement a wound care order from our wound care protocol (which is a readily available document that lists specifics for the types of wounds we typically encounter). Otherwise, it is a call to the provider on call if we need it before the next business day. When I worked LTC, we had a "standing order" set that we could implement PRN orders from to address specific symptoms (nausea, constipation, cough, indigestion etc). There we also entered it as a "verbal" order but these orders were the only ones we implemented without speaking to a provider.
  7. vampiregirl

    Laundry Bins

    I know I've worked several places where we were required to bag all laundry prior to leaving the rooms but everywhere I've worked we've always had the bins on wheels. I've never seen the triple bin though - I always seen separate bins. Either different colored for trash/ laundry or the lids clearly labeled.
  8. vampiregirl

    Struggling to be a Christian Nurse

    One of the other posters inquired if you had considered a different speciality. Do you feel that your current area of nursing is a good "fit" for you? How about your unit? And your employer? Are there any hospitals or other agencies that are sponsored by a spiritual/ religious entity near you that you could scope out? Have you considered talking to a Chaplain at your place of employment - they may be able to suggest some coping tools or offer some perspectives that may help you find peace. Some areas of nursing have more of a spiritual component than others. Although I've found nurses in every area of nursing that draw strength from their faith, some specialities tend to draw nurses whom seek this type of environment and this contributes to the agency, unit or shift "atmosphere". For example, I'm a hospice nurse and spiritual care is an important component of this area of nursing. Even as I interact with others/ care for patients and families who have very different beliefs than mine the fact that spirituality is a part of my nursing adds additional meaning/ satisfaction to the work I do. Side note - I'm pretty sure every. single. area of nursing involves patients, family members/ friends and colleagues that have absolutely unrealistic expectations of what the appropriate role of customer service in healthcare is. Add in lack of coping skills and stress/ grief and you are either going to end up with moments of endless entertainment, disbelief or frustration on your part. Unfortunately (or occasionally fortunately related to comic relief) this is just a part of life.
  9. vampiregirl

    nurse doesn't do her charting

    I'm another one that missing assessments/ info drives me nuts and see the potential to affect patient care/ safety. Having been in management in the past (I finally decided I'm much happier in a bedside role), I also know that sometimes management is assessing and dealing with the issue but it may not be obvious to others. For example, the nurse may be receiving education and/or progressive action but this remains confidential between the manager and the nurse involved (as it should IMO). Another approach might be to ask your manager for unit education/ memo/ parameters of what charting must be completed prior to leaving, timelines, and procedure for addressing "missing" charting that directly impacts your patient care if such a formal document/ policy doesn't already exist. Sometimes people are given an inch and proceed to take a mile if there's nothing formally in place. Sometimes this process can in turn cause reevaluation of the workflow processes and initiate changes to make things work smoother and positively influence patient care.
  10. vampiregirl

    Macbook Air or Macbook Pro for Nursing School?

    I agree with the above poster who recommended you check to see what software is compatible with your school - I ran into one program during my RN to BSN program that didn't work fantastic on my Mac. That aside, I'm a Mac girl. My 9 year old Pro continues to serve me well:)
  11. vampiregirl

    Contact Precautions and ESBL

    I was floor nurse in a LTC and encountered a similar situation several years back. Struggled with the same lack of resources for guidance. If I recall we retested urine and still cultured positive. I think our solution was to room patient with an incontinent patient who did not use bathroom until urine tested clean. Reeducation and reinforcement of appropriate infection control procedures (including standard precautions!) was also implemented. Our facility policy also allowed for co-rooming if same diagnosis but this can also be problematic.
  12. vampiregirl

    Hospice IDG/IDT protocols/rules

    Good questions! I'd be interested to know more about the regulations themselves. I know that IDT/IDG review and update of each patient's care plan must occur a minimum of every 15 days per Medicare guidelines. If you haven't already looked at the NHPCO website, they have a lot of good resources for regulations and interpretive guidelines. The hospice I previously worked for the entire hospice team (nurses, manager, spiritual care, social work, medical director etc) all attended the entire meeting for all the patients on the entire service. Volunteer input was submitted to the volunteer coordinator who presented it on behalf of the volunteers. This hospice had patients who used their own physicians (not the medical director) in most cases, communication was faxed to them for review/ signature. We survived a Medicare audit with no issues that I recall regarding IDT. I currently work inpatient hospice, all patients are under the care of one of our hospice physicians. The physician, social worker, manager and spiritual care sit through the entire meeting and the nurse case managers rotate in just for their patients. In this case, the primary nurse case managers are the day nurses. This agency is pilot site for Medicare Choices Program, I'm guessing that Medicare only uses sites with strong histories of quality and compliance for pilot sites. This agency also has a strong quality/ regulatory department and provides frequent education.
  13. vampiregirl

    Down Time

    I'm another reader. I've already begun collecting a stack of reading material for my week of camp later this summer. I also took a puzzle book last year. My camp week is kinda a technology vacation for me as well (except for my cell phone - emergencies, weather, looking things up). Since the campers can't have electronics, I think it would be a bad example for me sitting on the front porch of the health center reading from my iPad. As for snacks, another consideration is bugs/critters! For me it's non-perishables that don't melt easily in containers that can be sealed tightly.
  14. vampiregirl

    Please help. Career over before it starts.

    Hospice RN Case Manager is an awesome job - but I will say it can involve a lot of not-so-ergonomically correct back positions/ maneuvers for skin assessments, repositioning patients/ educating family members on repositioning and procedures (catheter placement, port access etc). Not all hospice patients opt for hospital beds. Some remain in their own beds or recliners! Plus there may be very limited assistance since typically the hospice RN works alone.
  15. vampiregirl

    I'm so lost :(

    I've worked with many nurses who've gotten their start in med-surg with no clue what they wanted to "specialize" in. Some have ended up specializing in med surge. Others have discovered another area of interest because of the exposure to the variety of patients that med surge nurses care for. I agree with the previous posters... your first year is going to set the foundation and will likely have a steep learning curve! Congrats on already having a job offer and good luck!
  16. vampiregirl

    new grad OB interview

    A strategy that has worked well for me for various interviews I've had over the years is to do some research about the facility. Look up the mission statement and core values (or whatever this institution calls them). See if the unit has any special certifications, has won awards/ recognition relevant to the specialty or offers any special programs for it's patients. Think about how you personally align with or have particular interest in anything you came across during your research. This is how I selected to apply for my current employer. And now I feel like I'm a good "fit" with this employer, which is beneficial for the employer as well as myself. Side note about panel interviews - they are more about the team assessing whether you would be an asset to their team. Beyond the basics learned in school, much of the learning for a speciality and a unit occurs on the unit. What they are likely looking for is a positive attitude, strong positive character attributes, a willingness to learn and good basic critical thinking skills. Good luck!
  17. vampiregirl

    Thoughts?

    Another consideration would be to inquire what the hourly rate for inservice etc is.
  18. vampiregirl

    Need help with redness/open areas

    Agree with the previous poster that fungal would be a consideration for this area. In addition to what you are already doing, it might be worthwhile to consider if there is need to address moisture management and/or look at the turning/ repositioning schedule for this patient. Also, if available recent labs (albumin etc) might give some clues if there are other approaches that might need to be addressed. Promoting skin integrity is such an important aspect of patient care for patients in all specialities. Kudos for addressing this!
  19. vampiregirl

    Nursing Student Asks Should I Do Peds or CRNA?

    I chuckle because I was 100% sure I knew which nursing speciality I wanted to do when I got my license... yet I found my niche in a speciality that couldn't be more further from my original "plan". I think it's a great idea to have a good idea what speciality you are interested in and work towards that, but also keep an open mind in case something else pops up!
  20. vampiregirl

    How To Sell Myself...

    Looks like you've assessed your skill set thoroughly! I see lots of great selling points on your positives list - customer service/ networking is very important in HH. I would encourage you to maybe put a different spin on positive #5... maybe add a willingness to learn admissions. While a visit nurse is helpful, unless it's an agency that has exclusive admission nurses typically everyone "gets to do admissions". At first they are awful but get easier once you are more familiar and get a routine down. Telling an agency you are interviewing for that you would prefer not to do admissions if that's part of the job might not work in your favor. Teamwork, sharing the workload is something employers look for. Besides, admitting your own patients can be nice because then you know what's going on with them. Your ER experience can be invaluable in HH - critical thinking skills, prioritization, assessment skills, thinking on your feet all are great selling points. Good luck!
  21. vampiregirl

    Question about bowel programs

    We typically favor senna and bisacodyl with opioids as they are the most effective on Mu receptors. We don't have a set formula for increasing bowel regimens since everybody is different (and disease processes are different). Typically we increase the dose and frequency as needed. Some patients PRN is adequate (take if they haven't had a good BM in x days), others need 2 senna bid routine and go up from there. P.S. I love that you integrated non-pharmalogical interventions in addressing this patient constipation! I just learned a new one the other day from our medical director ... placing a warm towel across the abdomen and then massaging.
  22. vampiregirl

    Mental Health & Nursing School

    Have you considered exploring this from a different angle, like focusing on what challenges in life have taught you? This can be done without defining the challenges themselves. I'm one who did horrible my first go round with college (like flunked out!). Fast forward 25 years and graduated with honors for my RN to BSN. II try (not always successfully!) to focus on where I am today but my life's experiences are interwoven into who I have become. One of my favorite lines from the movie Steel Magnolias - "What doesn't kill you makes you stronger"! Good luck! Nursing school and nursing aren't easy by any means but they are so worth it!
  23. vampiregirl

    Online LPN-BSN Programs

    I got my ASN throughout Excelsior's online program and my BSN through a local college that had a one night a week BSN completion program for working RNs. Both programs were a good fit for my life/ schedule at the time.
  24. vampiregirl

    Transitioning from paper charting

    I was working at SNF when PCC was implemented. Change is never easy but in this case, so much for the better! If I recall correctly, the charting/ assessment modules were implemented in all units on the same date. We had training and "cheat sheets". Once we got the hang of it, most of us loved it. So much more efficient and easier to look up info. I think the EMAR/ETAR was implemented one unit a month (on the 1st of the month). Extra admin staff (who were familiar with it) were physically on the unit every shift for a couple of days. I recall those first couple days being really stressful, but it quickly got better. I think it would be that way for any program. Very easy to make sure all meds were passed. And helped with time management because you see when you had meds due. I don't remember when we implemented the CNA charting portion during the process. I did appreciate that it was super quick to verify all CNA charting was complete before they escaped at the end of the shift. Once you figure out how to run specific reports, it really makes life easy and can be a huge time saver. I work in a different area of nursing (in patient hospice) and I miss PCC compared to the EHR we use. Good luck!
  25. vampiregirl

    Denied by clinical sites, now what?

    Have you looked into Excelsior College? They don't have "traditional" clinicals. I'm not sure what their policies are regarding students with a history such as yours. It wouldn't hurt to call and inquire. This isn't an easy program by any means, but it is doable. I got a quality education, but I also was willing to put a lot of effort into the program and am self-motivated. Best of luck to you! I hope you are able to find a workable solution. It sounds like you've put a lot of heart and soul into getting where you are today. I also suspect this isn't the first "speed bump" you've encountered in your journey and probably won't be the last.
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