RnRatchet

I had 4 years of experience when I took the exam. I studied the core curriculum and used the quiz book alone and with a study partner. The exam was more challenging then the RN boards for me.. just because many of the questions seemed to have more than one right answer. The new exam is computerized and you find out immediately if you have passed or not - that lifts a HUGE weight - the waiting many weeks was the worst! I definitely recommend any hospice nurse that has a couple of years of experience to go for the CHPN. I feel that I learned a lot from the study time and it refreshed me on things that we don't deal with real often. Good Luck and let us know when you pass!:redbeathe:wink2:

Our agency did give out window clings with our logo on them to anyone that wanted them. BUT they were also available to the public and our volunteers. (Free advertising..lol) Our company saw it as just a way to support a local business.. no different from someone putting their child's school logo sticker on the window I guess. I personally did not display one and do not have RN on my license plate since we go into some not so nice areas sometimes to see patients. We do not carry meds at any time, but I see no reason to give a drug seeking person an idea that my car might have some goodies inside!

Looks like you can get this from a european toy store.. http://www.elc.co.uk/toy-41104?&parent_category_id=534&category_id=604&showall=

When I took it last year, I felt like a large chunk of it came from my past experiences and relating it to the questions. There were several case scenarios that asked "what would you do next?" So, the studying that I did helped mesh my experiences with what the test was asking. I'm sure you're do great.. good luck!

Well.... if we have students or a resident that has stopped by to observe.. he likes to show off..lol He sometimes gets off on a tangent too.. :chuckle

we do a weekly report with the nurses and the CSM (clinical services manager) then acts as voice for the nurses during IDT.. it has really cut down on staff having to cram all their patients in to be seen around the meeting. Besides CSM the social workers, volunteer coord. and medical director are all present. Depending on how many times we have to reign back in the Medical director, it lasts anywhere from 1.5-2.5 hours

How very beautiful. Good for you and your co-wrkers to be with this gentleman as he left this life. I too believe no one should die alone. We have vigilant volunteers that work with our hospice that will stay with a patient around the clock if no family is available when a patient is changing.

LOL.. my sister is PG with her 2nd baby. When she went in for the ultrasound the Dr. told her husband he was sexist for wanting a boy..lol.. After he told her it was indeed a girl (what she was hoping for) the doctor said he likes girls better because they are better for business..lol

For what you would be willing to pay for him to stay at a hospice house (even though this particular one doesn't do residential) maybe you could look into a senior community of sorts? We visit several patient's in places where there is a LPN or RN who is the manager and helps set up med boxes and make Dr. appt's for residents. Most of them allow the pt to have their car is they have a valid driver's license and all allow the pt to come and go as they please. Most all include meals and cleaning services too. Good luck in looking for a place for dad to call home.:)

We also start with Phenergan and then go from there. One combo that we commonly use for any type of cancer involving the abdomen is a BRD.. Benedryl, Reglan, Decadron.. I've also seen variations with Ativan or Haldol in them depending on patient need. We do either pills (ends up being several to swallow), a topical cream compounded by one of the pharmacies in the area, a compounded suppository, or on occasion IV is used.

in our agency it's just the sop - it's a blanket statement i think to cya for the agency

at our hospice an lpn can do almost everything a rn does. the things lpn's don't do: hha sup visits, lab draws, admission assessments. good luck!

regarding hospice and dnr.. if the hospice accepts medicare.... eligibility-medicare hospice benefit 1. the patient must be entitled to medicare part a (hospital payments); once the patient decides to enter hospice care, they sign off part a and sign on (elect) the mhb. note: this process is reversible-patients may at a future time elect to return to medicare part a. 2. the patient must be certified by the hospice medical director and 1 physician to have a life expectancy 3. under medicare, dnr status cannot be used as a requirement for admission. info from.. medicare hospice benefit part 1. turner, r. january 2003. end-of-life physician education resource center http://www.eperc.mcw.edu

how very true. several times we've spoken with families that got scared and called 911.. but by the time they realize what they did they call hospice and the nurse gets to the house shortly after the ambulance. the family then says they were just scared and decline transport and we call the doc to get orders for whatever symptom changes they've had.

yeah! amen to that! that's why we always say patients and families first. sometimes what we know would be best clinically for a family and patient isn't what they are ready for emotionally. often times a little kindness, understanding, and education can go a long way. :)

We do our best to keep patients at home until they die with our hospice too... BUT there is always the occasional patient that doesn't WANT to die at home. In that situation, when time is getting close(days left), we direct admit to one of our area hospitals, that have a hospice suite. (Private room that is larger for more room of family and close by or attached sitting room) Sometimes we even direct admit for symptom management so we can have IV doses titrated quickly and get them back on a patch, PO, SL, suppository, SQ, whatever is needed so they can go back home. (this is still by pt / family choice if other pain control routes have failed) The only time we have a pt in the ER is when they have had a fall and obviously broke something.. not too often that happens. OR you have a family that got scared and called 911. In the 911 cases the nurse on call goes to the ER and discusses the pt / family wishes. When they are admitted to hspice care we tell them to use us as their 911.. we can handle things quickly at home and keep the pt from going through the ambulance ride and hospital ordeal. (Anyone know why things that are suppossed to be for transporting sick and injured people are so rough to ride in?? lol) BUT it's still the pt / family choice. Just because they've gone to ER doesn't mean we discharge them from hospice. In fact.. the family would have to revoke services.. "not be kicked out" Pallative care and Hospice Care go hand in hand, but are two seperate entities. Pallative care allows for more aggressive things still as the norm since it's the part that is bridging the gap between the curative to comfort care. I think several of us on here are coming at this issue with the same opinion just from different directions. We all want our patients to be comfortable and for their choices and wishes to be upheld. I just think everyone's background and experience causes them to approach the idea from a different way.

I'm a hospice RN, This is a common opinion of many nurses who aren't hospice nurses. We have several patients that aren't DNR's. You cannot force a family to choose DNR just because they are on hospice. It's still the pt / family right to choose. Although often times after we've been able to work with a family and pt and educate them on the dying process they change their minds. Without knowing the pt and family story it's hard to say why this pt was sent to ER. He could've had morphine SL or done a SQ infusion instead of going to hospital for PCA. Maybe this family just needed some more education and support from the hospice and they would've kept him at home and worked with the hospice for comfort care. We often times have inpt hospice orders for a morphine gtt and "may titrate for comfort" so the staff can increase by 1 mg increments every hour or so untill the pt is comfortable. Like another previous poster said.. many times these pts were on narcs at home that dwarf what we see at "normal" doses.

I'm an admission nurse, I work 830-5pm M-F. We take turns taking call for admissions.. once every 5 weeks. Some days are longer.. some are shorter.. it all evens out though.

We suggest the same at our hospice that they do at CANRN's hospice. Maybe you can volunteer as a patient care volunteer to get your feet wet. We have vigilant volunteers that stay with patients and families 24 hours a day during the last days of their lives if they wish. Each one takes shifts.. some 4, some 6, etc. This way you could see how the hospice staff interacts with families. I know we absolutely LOVE all our volunteers!

We don't require our pt's to be a "No Code" to be in our program. Often times though, after education of the patient and family and showing them how the body is slowing down they change their minds and make them a No Code. I'm an admission RN for my hospice and tonight when I talked to a family about Code Status, the pt said, "Well, I guess they can try for a little bit." Then he admited he wasn't quite sure what the differences were in the code levels. I explained all his choices and they are going to talk about it as a family and then decide and have one our SW's come and help them fill out living will papers.It's nice when families are open with each other and can communicate their wishes openly.

i was in a couple different types of nursing before i found my niche.. hospice. i love it! i don't think you could pay me enough to ever go back to the hospital. a hospice house maybe.... i work with a great group of people that truely care about each other.. which i feel is very important in a field such as hospice!

i had both of the books offered for study for the chpn - the core book and the study guide. the study guide was usefull to get you in the mindset of how the questions will be worded. good luck and happy studies! i took it for the first time this fall and passed. word of advice.. after the test.. don't talk about it! it's in the past and you will only get yourself nervous comparing what you answered with another tester. that had to be the longest wait i can think of for results though!

growing up we were always celebrating christmas whenever we could all be together.. sometimes early.. sometimes the day after.. my mom is a nurse so we sometimes stayed with our grandma on christmas day.. we had a great time playing with our cousins and we ended up having 2 christmases and loved it! i'm a hospice nurse and we all take turns taking call on the holidays. i'm lucky to work with a great group of girls right now. we keep track over who worked what and then take turns. besides the paid holidays we also take into consideration other holidays too.. mother's day.. etc. usually one of us will just say.. i was off thanksgiving last year.. let me take call that day.. so.. even though i now work a job that i don't have to go into the office on the holiday my pager can still call me to a patient. most of our families feel terrible calling on a holiday.. it's usually only death calls or pain out of control. they want to be with just family as well and always apologize for calling us. bless them.. we tell them that's what we're there for though!

hello, sue. i can't say we've had it happen yet, but it was attempted. unfortunately the patient died at the hospital waiting for transport to his home. we've been doing lots of things "outside the box" for our agency in the past couple of years. i know this is something that will come up again.. it's just few and far between. usually our patients we are admitting that are on the vent we go and meet with the family before and discuss the options they have.. most will keep the patient in the hospital though.. i'm sure it would be a beautiful experience for teh family, but lately our vent patient families haven't been the type to be comfotable with this sort of thing at home. i'm sure with your experience you understand what i'm trying to say..