prostreetrig

Hello there. I have been a Hospice nurse going over a year now. The day I dropped off my application I was questioning what I was doing. The problem is Hospice brings about terrifying emotions. Dead people, cancer, dying, pain, etc. Hospice is so far from that in so many ways. There is a huge lack of knowledge in palliative care and Hospice. As far as knowing if you can handle it emotionally I would say try it. For instance, my first death I witnessed was a gentleman who requested to be terminally sedated. He had lung ca with mets to the bone. THis guy was in severe pain with no help from Fentanyl, methadone, Roxanol, ativan, etc. I watched this man go from being a kind dying man who was enjoying life as best he could to a mad man. His pain was so severe and he was so dehydrated he began getting violent. The day I walked in his room he looked at me with glazed over eyes and said get out of my room. I told him I was his nurse and he said "you're supposed to be my nurse" He thought all of his family and Hospice was there to take his soul. Poor guy, anywho, long story short, he finally died after he was sedated for about a day. I actually handled it well. I knew he was in a better place without the pain, the cancer, etc. Hope this helps some. Good luck. "

Hello there. Yes, I did work full time while in school. Was it a wise decision? No. The only thing I can tell you is to endulge yourself in the reading. Work is work and school is school. Just keep in the back of your mind the end result. Yes you will be tired and cranky but just think, when it's done it's done. Good luck.

Hi there. I will start by saying it's in the genes. My mother was an OB nurse in the navy, aunt was a nurse at the prison, my twin brother and I are nurses, my other aunt and her daughter are nurses. So, why did I become a nurse? I worked eight years as a mental health tech. Loved my job but wasn't being challenged anymore. The first day I had PT contact I knew I had found my niche. Now I work as a Hospice nurse and absolutely love it. I am currently going for my RN online and then to CNS classes after RN for specilaty in end of life and palliative care. Hope that helps! Just remember, you will know right away if it's for you. It's not the happiness that comes with it it's an emotion. That's the best way I can tell you. Good luck.

Ok, I am an LPN with Hospice. THe other day I went to do an assessment on one of our PT's. She was constipated from Morphine and had been four days or so without a BM. PT asked me if I could give her an enema. Now, She had positive BS, no N/V, etc. I told her I couldn't give one without an order but her family could. She didn't have anyone to do it. I called my charge nurse to see about getting an order. She called me back and said to give it and she would get the order. Everything was fine then two days ago my DON asks if I had given an enema without an order. I was honest and said yes, but I am used to PT's having standing orders, one of which is normally an enema. THe charge never got **** and I had to fill out an incident report and a late entry for giving it. Any opinions?

Hello there. I can offer some advice but I don't know your regs. For one, being a case manager that PT's entire chart is your responsibility. That means when something is missing, it's your butt. So cover that butt tightly. There are very strict regs pertaining to Hospice. Just keep good communication skills and know when to speak up or shut up. Sometimes that's just the way it is. I keep a calender on who I need to see and when. And because I forget, if I had a med change I write it on the calender when the change was in effect. That way there are no questions. Hope this helps and good luck.

In my agency we do not do IV's. It's one of our regular teaching we try to do. I had a PCG concerend that her husband was dehydrated, mind you he was actively dying. I informed her that a dying body does not need fluids or food to function. She was surprised by this. I also explained that we could start an IV if she so wished but it may be more damaging to the PT than it would be good. She was very understanding. Our code of ethics is to manage pain and symptom control. Dehydration is part of the dying process. I hope this helps.

Hello there. I am a nurse with Hospice and we just got done doing terminal sedation on one of our patients. I will start by saying this gentleman had lung ca with bone mets. He was in excruciating pain, all day, every day. We had him on Roxy 4ml Q2H, Ativan 1mg QH, Fentanyl 300mcg Q72H, Methadone, etc. This mans legs were contracted right to his chest all day. We could never even move him to change him without hurting him. I will never forget when it happened. It was a Wednesday morning and this PT looked at me and said "I dont care what you do but I don't want to be awake to feel the pain, and I don't want to know what's going on, I can't do this anymore". Now mind you, two days prior to this he had started in with severe agitation and very delusional. He would tell the nurses to leave because we weren't who we said we were. He would spit on the walls, pee in his bed, all of these things on purpose. We sent the order to doc and it was made. Ativan 1mg QH, Roxy 4ml QH, Demerol injections, shortly after the first seven hours he was finally lightly sedated but enough to not have the pain, not know what was going on. That afternoon sadly he took his last breath, it was his adrenaline that was keeping him alive. This man had been ready to die emotionally but his body was doing nothing but hurting him. So, do I think it's justified, depending on the situation on hand, absolutely. The family was so thankful for what we had done. The best thing was it was his wishes. He was able to tell us what to do. Our first and most important issue is the PT pain and symptom management. We did tell the family it wasn't the drugs we gave him that killed him, we gave him drugs to be lightly sedated and once his body could stop fighting the pain he was able to let go. I hope this helps and I would hope for more answers to this age old conflict. Take care now.

Hi there. I am employed with Hospice in my area and one thing I have noticed is as soon as we introduce MSIR or Roxanol families flip! They all do the reading and figure that Morphine will stop someones respirations. I have done so much teaching regarding the safe use of the drug and still people are afraid. We had a gentleman in the dying process with lung ca and bone metz. He was in so much pain and was taking Methadone, Fentanyl, and some other pain meds. As soon as we brought in the MSIR the family freaked. It got so bad that when he was actively dying we had to do continuous care because the family was afraid they would give him the Roxanol and he would take his last breath. Is this common in everyones area or are people just really that scared? Let me know what you have run in to.

Good morning out there. My name is James and I am an RN student. I work at Hospice of the North Country and have to say it is the best place I have ever worked. First of all, I have tried to find my niche in the hospital, nursing home, rehab center nothing made me feel needed. I was then hired by Hospice and I finally found that niche. My job is very rewarding and it's not really that complicated. The hardest thing to adjust to was that I wasn't trying to rehabilitate anyone, I was trying now to make them comfortable for the dying process. I also found I handle death pretty well. There will always be tears but you get to spend so much time with PT's you become attached. The best part of the job is your role in someones dying days. Whether it's getting pain meds on board, preparing the family, arranging funeral, it's all very rewarding. I also get to go to the office in the morning, leave for about half the day to see my patients in their homes, come back to the office and finish up loose ends. The best part is there are no bosses hovering over my shoudler! It is a very autonomys role in nursing. Just wanted to drop a few lines and tell those who are not happy, go out and venture. You never know what you will find. Good luck to all of you in your endeavors.