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vampiregirl BSN, RN

Hospice

Content by vampiregirl

  1. vampiregirl

    Stressing out about my TB skin Test...

    The reference to the site being 2 inches away from the previous site was likely a reference to when the administration of the tuberculin does not yield an adequate wheal and must be redone. It's not a problem for the 2nd step to be done on the same arm as the initial step. Here's a link to some info: https://www.cdc.gov/tb/publications/posters/images/mantoux_wallchart.pdf
  2. vampiregirl

    AHA CPR Instructors

    There is always the chance that the TC you worked with has been on vacation/ leave or another individual has been assigned that role. Also, I'm aligned with a small hospital and my TC is always crazy busy with many responsibilities in addition to being a TC, it took me a while to figure out delayed responses were nothing personal just not enough hours in the day. Maybe consider calling the hospital and requesting to be connected to her dept and try making contact that way. There may be an admin asst who can provide you with assistance or direction. My cards always get sent out quickly because the admin asst does those, not the TC. Also, in regards to your questions about bloodborne pathogens, have you checked the AHA instructor website - there's lots of good info there. Good luck in you venture!
  3. vampiregirl

    Renewal rate for Nursing Central app

    I've found several free and low cost apps that have the same info from reliable sources instead of paying the cost of nursing central.
  4. vampiregirl

    do any home hospices provide linens 4 hospital beds

    We provide pull-ups, briefs and disposable chux for our patients. No wipes or personal care products but we do provide barrier cream. As for linens, we have a limited supply available for patients with limited financial resources if we place a hospital bed but only provide 1 set (unless extremely extenuating circumstances). Those are purchased by a foundation associated with our sponsoring hospital from what I understand. Since the latest recommendation is 100% cotton for safety if oxygen in use, some families don't have 100% cotton sheets already. It's interesting for me to learn about how other hospices address things.
  5. I did what the previous posters recommended. I am an Excelsior grad who took all my classes except the nursing classes through my local community college. They had online options for many of the classes I needed. You may want to check with Excelsior to make sure they will transfer before signing up though.
  6. vampiregirl

    Distat. What Would You Do?

    Would an order for intrantranasal midazolam be an option? I've seen studies that have shown this to be as or more effective than distat, plus the method of administration is more "socially acceptable" compared to rectal administration.
  7. vampiregirl

    Dual Head Stethoscope?

    I so had the mentality of not needing to be able to hear/identify S3, S4... until I attended a CHF inservice at the nursing home I worked for at the time and learned why I needed to be able to identify especially an S3. Also, the bell can be handy in the assessment of peds. See if you have some friends who have stethoscopes already so you can see which dual head stethoscope you like and is comfortable for you. There is a lot of variation between stethoscopes, even within the same price range - and personal preference definitely is also a consideration.
  8. vampiregirl

    Punished for NP decision

    During my time in SNF management, I became familiar with state regulations regarding psychotropic meds. I'm guessing these vary from state to state. Often the issue isn't that a med isn't inappropriate for the patient, it's that there is lack of documentation to substantiate it's use. The facility I worked at had a process in place that included requirements of documentation of notification to the POA of any med changes, a way of communicating psychotropic med changes to the appropriate members of management and a review process in place to observe for effectiveness and/or side effects of any med changes. There was also a monthly meeting that included representatives from the psych provider group and the pharmacist to review every patient on psychotropic medication. Was this a pain to complete all the required steps and documentation? Yep. Did it serve to protect the patient and the staff? Yep. If the opportunity arises, maybe consider initiating a conversation with your manager about reviewing the current process. It also could be the patient happened to have a decline in condition concurrent to the medication increase. Sometimes family is not in a place to accept decline in condition and react aggressively without consideration of the patient's wishes and/or directives in place.
  9. vampiregirl

    When does less experience= higher pay?

    I once worked for a company that ended up hiring new employees at a higher rate than current employees (even those with several years experience) simply because we were short on staff and the market rate had increased. So, to attract quality employees to fill the shifts, they had to offer more. Eventually, those of us who had been there awhile were given appropriate pay adjustments (after we lost several good staff members I might add). This is a tricky subject to approach. One thing to consider is checking into what other agencies in your area are paying and present it as you've done some market surveying and this is what you've discovered. I also agree with previous poster who noted that often FT have a lower pay than PT employees as benefit packages are calculated in. Also, unfortunately the expenses/ lifestyle an employee has is typically a consideration in pay rate.
  10. vampiregirl

    RN-only or RN BSN - 35 & back to school

    I went to work as an RN with an ASN. I'm now in BSN completion program. Not only is the hospital that I work for providing tuition assistance, but I think some of the coursework is more meaningful now that I've worked as a nurse for several years. Plus, I get the added benefit of networking with the other nurses in my cohort - and ours is a diverse group with nursing experience in a varied areas.
  11. vampiregirl

    Guess where I found a tiny piece of cardboard?!?

    My absolute favorite object in the ear story is from my pre-nursing days. I was working in a group home for developmentally delayed adults. One of our gentleman was c/o his ear hurt so our group home nurse peaked in his ear with her otoscope. He earned himself a field trip to the doctor as all she could see was something green. The physician was able to successfully retrieve a sprouted seed from his ear. I'm still curious to this day to know what kind of seed it was:)
  12. I did not attend any CPNE workshops and passed on my 1st try. I did purchase Rob's CPNE video. I also found lots of helpful hints on allnurses threads and compared them to the CPNE prep packet sent by Excelsior to ensure they were up to date. I also watched a lot of youtube videos and googled many things. I saw lots of things done incorrectly per the current version of my CPNE prep materials but that was ok since I was recognizing the differences versus what is required for the test. I made my own wounds to practice. I think by putting my own study plan together myself, I was very conscientious of the details for all the aspects of the CPNE. I invested a lot of time and effort into preparing myself but the financial costs of my preparing were low.
  13. Nursing school would be so much easier if there was one magical study plan that worked for everyone. Just like each patient's plan of care must be individualized to meet the needs of that patient, each student's study plan must be individualized to meet the needs of that student. I was a good student in high school, but not so much in college. So, I ended up taking a lengthy break in my educational career and enrolled in the "real" world of working - waitressing, fast food, emergency medical technician were just a few of my adventures. Once I figured out what I wanted to be when I grew up (which took me over a decade!), I then had to learn how to study for nursing school. Different environment (online learning), different dynamics in my life (on my own, working 2 jobs) and different stakes for learning (so knew enough to take quality care of people and not kill them). Now I as have returned to school to complete my BSN, I have taken some time to reflect upon on some things that have allowed me to establish a study plan is successful for me. Ensure you understand the expectations for each class. Read through the syllabus upon receiving it to see what the objectives for the class are, what the assignments are, and how grades work. Ensure you have all the texts you need. Also ensure that you can access any online software required for the class and figure out how to use it. Nothing is worse that putting a lot of effort into an assignment only to realize you can't figure out how to submit it on time to be graded. Sometimes assignments will seem like busy work or unnecessary. In hindsight as a practicing nurse, you may view this differently. Look at your own schedule considering family obligations, work schedules, upcoming social events. Plan ahead for busy times to ensure you complete studying and assignments for your course(s). Figure out times to study that will work for you. Setting aside a couple hours to study early in the morning won't work if you can't get out of bed. Figure out what activities/ events you are willing and able to compromise to ensure you have adequate time for studying. Identify available resources. With all the technology and apps available today, there are so many resources. And many are portable to boot - no more carrying around the 50 lb. backpack straining at the seams from books! Network with others to find out about helpful resources and apps. Also explore what resources your school offers - often times there are awesome (and free) resources that are underused because no one knows about them. Also, don't forget people resources. Maybe you have a retired neighbor who used to be a teacher and would love to provide feedback on a presentation. Or the friend from work who's a whiz at science. Don't reinvent the wheel. Build upon knowledge you've already acquired and figure out how to appropriately apply it to your classes. For example, I had worked as an emergency medical technician for several years prior to entering my nursing program. I already had acronyms for several assessments to ensure I completed all the steps in a logical manner; I simply modified them to remember all the required steps of a nursing assessment. Appreciate differences and look for learning opportunities in clinical settings. I learn something from every person I meet. Sometimes cool new tricks or approaches that I plan to implement. Other times, it serves as a warning not to try something. Nursing and EMS are very different in regards to the theories and sometimes the goals. Identifying the differences allowed me to better understand the material in some cases. Differences are not always black and white, right and wrong. In diverse areas of nursing, approaches can be very different. It is understanding what is appropriate for a given setting and why. Also keep in mind that new research yields new information and sometimes changes how things are approached or skills are performed. Don't necessarily judge someone as doing something "wrong", they may be performing it as they were taught, according to a facility policy or it may be appropriate for that setting but not others. Look for appropriate times to ask questions and listen non-judgmentally to the responses. Reassess current study habits. Note how prepared you feel when you attend class. Monitor your grades. These are just a couple of ways to assess the effectiveness of your study habits. If all is well, great. If not, consider changing your study habits or methods before it is too late. Ask for assistance or investigate different study techniques. Try different methods of approaching studying. Reevaluate whether you need to get more organized or seek additional resources. Practice good self-care. Not only physical self-care (diet, exercise, and sleep), but also learning good mental and spiritual self-care. Learn strategies to help you with stress management. Make church a priority if it recharges you. Spend time with positive friends who provide encouragement and support. Unfortunately, learning does not stop when you graduate from nursing school or pass the NCLEX. It's just getting started. Throughout your nursing career, learning opportunities will continue to present. New research findings being implemented on your unit, changes to procedures, skills assessments - the list never ends. Developing effective study habits that work for you will make this process smoother no matter what area of nursing you find yourself in or where you work.
  14. If your supervisor does end writing you up for this error, I would place the information you stated above in my response if it was me. The key is keeping your response (verbal and written) professional.
  15. vampiregirl

    How is like working in an SNF?

    I would suggest doing your research about any LTC you are considering applying for. LTC's range from terrible to awesome, with everything in between. Sometimes different units of the same LTC have entirely different personalities. Getting organized is key, but don't expect to figure out what works for you on your first day on the floor. Watch for co-workers who provide quality care and manage to get things done in a reasonable time frame. Ask them for suggestions, as you figure out the best way for you to be organized. I had a really tough time not being discouraged when I was a new nurse in LTC - but the experience I gained has proved invaluable in my nursing career. LTC is hard work, but can be a great experience too. Prioritization, delegation, documentation, time management and lots of skills (wounds, IVs, lab draws etc) can be acquired in LTC. 2nd shift was actually my favorite shift:)
  16. vampiregirl

    Working in Nursing home is all the same?

    I did my homework before I accepted a SNF job. In my state, the dept. of health conducts inspections of facilities and the results are publicly available. That is one indicator of the quality of the facility. Another thing to consider is what resources nurses have available, this might be something to ask about at an interview. Having resources available to provide quality care was very important to me. Every job has it's benefits and burdens, it's each individual who has to figure out what is the right job for them at the current time in their life - depending upon personal goals.
  17. vampiregirl

    KPS & PPS

    KPS but some interest has been expressed to transition to the PPS. I find the criteria for PPS are more clearly defined, and therefore it's easier to more accurately score a patient.
  18. vampiregirl

    Considering a Change - Not Sure of Career Path

    I voluntarily left a management/ leadership position in a SNF for a bedside position in hospice. No regrets here:)
  19. vampiregirl

    RN in LTC

    Good Luck! I started my nursing career in LTC and learned so much. It gave me a great foundation. Organization, critical thinking skill development, learning delegation, exposure to lots of different diagnosis (and many patients with multiple diagnosis!) are just of few of the benefits. It is hard work, but worth it. Plus, I'll bet you'll get the opportunity to care for some amazing residents. If you get a chance, pick the brains of any retired nurses who are your residents:)
  20. vampiregirl

    ADN to BSN Schools on Campus

    Check with local colleges to where you are. With a little research, I discovered that several had options but one fit my schedule and interests (in respect to classes included) best. I did an online for my ASN, when I completed this program online programs were not the preferred option for potential employers. Even as the climate has changed, I wanted a brick and mortar BSN. I love the program I'm in, so glad I chose this option!
  21. Pleurx drains are a lot of fun to play with. So cool to be able to see the immediate symptom relief in most cases. Another drain that I was recently introduced to is "Aspira", same manufacturer as pleurx I believe.
  22. vampiregirl

    Hospice interdisciplinary care plan

    I've collaborated w/ several facilities on their care plans for hospice patients. One of the items to include on the care plan will probably be a statement about collaboration and communication between your facility and the hospice. I agree with the above posters. Most of us hospice nurses welcome opportunities to work w/ facilities who are also providing care for our patients. You could even collaborate on a generalized care plan template that could be customized for each patient... that's how the hospice I work for does care planning internally. We have a goal related to symptom management personalized with each patient's goal for care, one addressing pain management, and another that addresses responsibility for knowledge/ interventions. We have a separate goal that addresses collaboration with other facilities and one that defines the aide care plan. Any procedures (wound care, catheter, ostomy etc have their own goal). Theses goals also meet regulatory compliance on the hospice side. I will say one of the things I love about hospice is that the care plan really is a road map to the care we provide. When I worked LTC, we wrote care plans but they were too cumbersome, difficult to access to really implement as they are intended.
  23. vampiregirl

    Most common meds in Hospice/Palliative care?

    Typically the meds mentioned above. Also knowing what symptoms these meds address. For example - roxanol can be used for pain, dyspnea, and restlessness. Ativan is used for anxiety, restlessness, air hunger, and nausea. We also use atropine 1% ophthalmic drops sublingually for for secretion management. Also understanding the importance of bowel regimens and being able to display critical thinking skills to address symptoms. Understanding nutrition and hydration needs as a patient approaches end of life (many family members are worried about starving their loved ones to death). Hospice/ palliative care is an amazing area of nursing. Reputable companies provide awesome training and resources because this is a very different area of nursing. We look for compassionate staff w/ a willingness to learn and excellent critical thinking skills when considering new hires. My most valued and often used resource is the "Primer of Palliative Care" by the American Academy of Hospice and Palliative Medicine. If you get this position, I would recommend joining the HPNA (Hospice and Palliative Nursing Association) - they are also a wonderful resource.
  24. vampiregirl

    LTC emergency...sorry no meds today

    Some LTC facilities don't have a supervisor on evenings, weekends etc. When I worked in a LTC, I was often considered the "supervisor" by default if I was the only RN in the building, in addition to taking care of my residents. As previous posters mentioned, being organized and having a plan is the best way to deal with emergencies. But this plan comes with experience - both working as a nurse and at that specific facility. Check w/ a co-worker that you respect for suggestions - even if it's someone from another shift. Also, don't forget most DON's worked the floor before they were DONs. If you approach the DON in a professional manner at an appropriate time and pose this question, you might be surprised at the response you get. I had what I thought was a very intimidating DON (she was extremely by the book), but when I asked for her expectations in a similar situation I was pleasantly surprised at her realistic response and suggestions. Of course, it's also important to not be one of those nurses who encounters "emergencies" every single day they work. And trust me, even state surveyors understand an occasional true emergency - what they are looking for is that staff respond appropriately and follow regulations, policies and procedures. Which may mean obtaining a physician order to pass meds late (hint, I once got an order from the SNF medical director to pass meds late for all my remaining patients during a very unusual situation so I didn't have to call 10 different physicians).
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