Al Stephens

here at our hospice, I work Mondays, Tuesdays, from 5pm until 8 am, and every other weekend from 5pm on friday until 8 am on monday, for regular salary. I also get 25 for any visit I do before or after my regular hours, and 50 for extra admits. I also get mileage. Any other time i put in, as in filling in for the other on call staff if they are off, is overtime, and I get of course holdiay pay for monday holidays. (yes, I get all the monday holidays). I do ok, and have been at this for over 6 years now, but, as in all Life, it is time to move on..I am moving to another, bigger city, and a bigger hospice, I hope. I like the work.....and the feeling of truely helping.

for the pat 5 years, I had received a bonus of over 800 each year, but this year, due to the low number of patients, we did not get one, but we know that when the census goes back up, then next year, there will be bonuses again...when I worked in both of the local hospitals, well, at one, we got approx 100, and at the other, we go the chance at at turkey..if we were quick enough....

Hey compadres, I think we gave rachael a good assortment of jobs, and ideas for her paper right? Rachael, if there are any more needs for ideas, I think you will always find an answer or two, and then have to make your own mind up. Being a nurse, to me, is not a job, or a career, but rather it is a calling. Everyone starts with one idea, but those who stay, stay for a reason, and that usually is the care and feeding of our fellow human beings. Life is good, and in my work, we try to make the rest as good too. al

sounds like it is time for a sit down, with the family, the caregiver, the wound care nurse, you, and the social worker assigned to the family. point blank ask her what she thinks should be done, then what you and the wound care manager think should be done and then let the family be involved in the decision. the main objective is the patient, and it sounds as if the caregiver wants to prove something to either the family or themselves. Time to let everyone in on the work.

Lets see if I can answer some of your questions.... 1. I am an on call nurse, for a Hospice. 2. I have worked as this for over 6 years now. 3. There is no formal training for such a position. I basically am a triage nurse, handling any and all emergencies at night and on weekends. 4. Although I had no degrees to specifically do this job, I have taken, and passed the national certification as a Hospice and palliative care nures, CHPN. 5. The most rewarding aspect, is that I get to deal closer with families during a very traumatic time in their lives, the dying of a loved one. I get to see what I feel is the best, and worst of them. 6. The hardest part, the one thing that there is no training in any nursing program, is how to let a patient die, and not try to save them all. 7. High school? that was over 36 years ago..I dont remember much about that. 8. be prepared to cry a lot, and smile a lot, and you will have the most rewarding time you could ever think of. 9. refering back to number 6 above, to be involved in Hospice, you have to be able to accept that all people, all of them, will die eventually, and do you want them to go in comfort and peace or in some other way. We try to let a patient go in a dignified, comfortable manner.

actually, after 5 years of being on call for a Hospice, there is a burn out factor, and that has to do not with ones heart not bing into it, but rather, being so deeply involved that your emotions become freyed, and torn..and you know that you are hurting, that is what makes Hospice nurses get out. to let their hearts heal......

great, and welcome aboard one of the most rewarding, and most tearjerking areas of nursing. It is hard work on your heart, but in the end, when the family looks at you and says thank you. you know you gave their loved one your best. And when you see your name in the paper, you want to cry, and say, "I didnt do much, Just kept them comfortable...". welcome....

thanks, now that is a full em kit, I talked with my DON and medical coordinator, about all the other em packs out there. We are undergoing a pharmacy change, from one to two, primary during regular hours, secondary for us oncall after hour types. So the em pack is our pirmary means of emergency comfort, but we dont have any pain meds in them. They contail compazine supps, abh sups, 3 ativan, and a scope patch. I have asked that we consicer atropine drops, and that we as soon as possible get ms sublinuguals out to the pt. This is being considered and is very likely. Your exampls of em packs have been helpful. Thank you.

LA, your experience is nothing unusual really, when dealing with the dying, you see things like this all the time and it is very hard to explain to the family, let alone the patient. My wife used to see a little boy standing at the end of her bed, for years before she did pass, and she passed in my arms this year. to the patient, the experience is very real, and who are we to say they are not? who was the gentleman? you cal call them a guardian angel, or a lost relative, but who ever it was, he was there to offer your mother guidance, and the chance to hurt no more. The easiest way to describe to my patients what is going on is that they are so close to both the other side and this one, that they accept both as real worlds. Yes, there is some hallucinating going, probably due to both the meds, and the cancer. In one, they see many others around them, some are known loved ones, some seem to be strangers, and in the other is us standing here, looking confounded, and your mother thought you were going crazy for not seeing him. Also, that she offered you a check for your birthday was a way of her telling you that she knew she was going, and wanted to clear up something before she went. she had probaly accepted the offer from the gentleman, and was finishing something that she wanted done. I have had patients tell me they were going at a certain time of day, and do it, and others for something in general, such as waiting for their anniversary so that they can go with their loved one. you experienced a good, and wonderful experience of the fact that there IS something for us after this life, whether it is one religion or other, we cant say, but there is something and your mother was able to show you some signs of what she found. make sense? I have just got off work all night with some of my patients...so I may not have made much sense, but what you went through, is not only common, but good for her and you.

dont know if it was just a temp problem, but we now have the scope patches again, i would not want to go back to the injectables, but. we take whatever we can get...I passed on to our powers that be that something like roxinal would be a good idea...they are thinking on it... our other usual emergency pain meds, which at this time is not in the em pack, is morphine sublinguals. 10mg..

When I first graduated I worked a Med/Tele unit at two different hospitals, but when I had a chance to work as a Hospice nurse, I made that my specialty, including getting my CHPN cert. I loved Med/Tele, and if I had not the opportunity to go Hospice, I would have stayed that for a long time. That was because yes, you had hearts and that possibility of edge of crisis situations, you also got whatever ER sent, from gunshots, to hangover drunks. It was always interesting and gave you a taste of everything. But now, It is the love of Hospice that makes it for me.

your master plan can work, depending on what they want, but do you not have a second plan? if you have to take student loans, that is not the greatest, but may be the only way...I worked at the state school in san angelo and took out two small loans while I went, but i did get through, thank goodness...just keep trying, as nursing is a calling (yea yea, it is a profession,but I think that the only good nurses are called to it, as you seem to be hearing) and you will make it. If I can help, even if it is doing nothing more than cheerleading, Ill do it...go girl...

we have been using mysis for almost 2 years now, and use it for all, yes it at first took a long time for the admissions, and some assessments, but in time, when you learn what areas expect, well, i am able to do an admisson in under 2 hours, and an assessment in 30-45 minutes. That is not in the home with the patient. Being on call, i usually dont have time for that, so i bring my notes home, and put them in then. I think it is a good system, and we know that it keeps getting upgraded regulary, but I like the system. ( I know, being a computer freak also helps...)

thanks for the feedback, i wanted to ensure that most of us oncall did not carry anthing with us (I dont and even though there is no comparable "rough areas" to some major cities, it can still be tight in parts of this city). In our em packs we carry compazine, abh suppositories, ativan, and scope patches. we used to carry scope injectables, and atropine drops, but dropped the last two for the patches. I am wanting to get the drops back. Also, we dont put liquid morphine, or roxinal in the packs, but that would be beneficial for many of my needs at night...thanks for the suggestions.

I have a simple question for all the experienced Hospice Nurse out here. does your hospice order some sort of emergency pack for the patients home (I would like to know what is in it, but that is up to your Hospice policy or not), also, for those other on-call Hospice nurses, do you carry an EM Pack, or anything with you? My question is being brought up by my Hospice switching to another pharmacy in town for the on call staff, and they will not carry the meds that we can get from our regular pharmacy, but they are too undermanned (with a pending retirement of one pharmacist) to be able to continue being available for us at nights...Any Answers?