katie'sangel

I'm beginning to think organizations like NHPCO could help. But the hospice agency has to belong to NHPCO first, then the employees, nurses, can join. I'm looking for some protection from the co-oprate greed that pushes the needs of the nurses and patient down to increase their profits$$$ each quarter The Center for Medicare/Medicaid Services is just this year starting to require hospice agencies to perform and report quality assessment information. But the regulations, as I understand them, have little "teeth". The agencies are asked to police themselves and the results of their quality reports will not be readily available to the public. Patients are health care consumers. They and a potential hospice employee need a way to evaluate a hospice agency before signing up with an agency.

I just started working at a for-profit hospice agency in Houston Texas. I am per-diem and shocked at how many patients the full time case managers carry. 15 to 20 or more patients. The standard of care at this agency is just one visit from the RN case manager each week. If the patient needs more visits, an LVN or the per-diem RN (myself) can help. We have IDG (or some call it IDT) meetings every other week and case managers have to prepare and present each of their patients to the MD at that meeting. It takes hours to prepare for and the meeting itself takes one to two hours at the hospice office. And of course the case managers are putting over a 100 miles on their car each week. Seriously, who can give dying patients the care they need and support the families when you have 5 to 7 patient visits to make each day spread out all over town. And the trend in Houston is for all the agencies to work their nurses like this. Is it like this every where:(

The agency I work for has a dedicated team of after hours and weekend nurses. So I rarely am required to help on weekends and never after hours. Pay is 50cents a mile and I'm at $30/hour because I'm per-diem. But per-diem is another story. My problem with my current agency is how many patients they expect the case managers to carry. 15 to 20 patients per case manager. It's insane. Patients get seen once a week. It's impossible to give good quality carry to families that way. That's why I have to stay per-diem. I don't have guaranteed hours but I can give quality care and still have a life of my own.

OK I know I've already posted this subject somewhere else, but I'm SERIOUSLY not happy with my current employer. But I DO love hospice nursing. Just need to find a good one in Houston. PSS I'm a RN and I know a LVN also looking for a change.

To angel's assit, Near Death Awareness, I like that term. I AM fairly spritutal:) but not in the traditional christian sense:stone . Both of these stories ,about talking to some unseen person, I find very reasuring. Our understanding of the spiritual side of life is only a fraction of what I know we will enjoy when we pass over to the other side. Thanks for sharing. Katie'sangel

I copied it and sent it to all the administrators at our corp office. These nurses sit in their nice clean offices and have forgoten what we bedside nurses do. And the incredible significance of our of humble personal sacrifices we give to help people in need each day. I wasn't brave enough to send it to the hospice docs (besides, I don't have their e-mails) but they could realy use a dose of nursing reallity too.

Jennie Glad to hear your enthusiasum for nursing. It's a job that has been flexable enough to allow me to follow my husbands career across the nation. The pay is good in the hospitals and I feel it's a job that carries a great deal of respect among most folks. They think your florance nightngale and such - hince my name is fashioned after a angel of mercy. Good luck.

So sorry to hear about your father. From what you've said, it's probably good idea to not put him through the chemo. Advantages of Hospice: First, The nurses are wonderfull. It's our buisness to assist the family as much as the patient. We help prepare them for whats to come. You and your dad both need lots of emotional TLC and, if you have a good hospice, you'l get it. Second, The doctors know how to releave pain as well as other uncomfortable symptoms I can't encourage you too much to get involved with hospice. Even before your dad gets "realy bad" my prayers and best wishes Angel

I have a solution for the MD uncomfortable with hospice level narcotics. He/She should admit the pt to hospice program and let the hospice MD cover the patients care. Our hospice MDs understand how much Rx isneeded and because thier specialty is hospice, there's little question about the large doses:)

OK it's me again, Katie'sangel, and Here's a perfect example of the common problem I have on this unit: I'm having difficulty getting my patient's air way clear because I don't have the right suction equipment! The details here aren't important, but here's the bottom line. Am I responsible when the facility/myemployer doesn't give me the equipment I need to take care of my patient safely? This guys a No code, hospice patient, but he's been admited to a in-pt-unit on a hospital ward so he can get better care than he'd get in his home. I worried some family member is going to sue us for not taking care of the patient. The only defense I'l have is that I've told my supervisor repeatdly about the lack of appropriate supplies Employment laws and nursing laws are designed to assist a employee to stay at their job. the answer isn't "just quit" got any other ideas?

I've always done 8 hr shifts until the last few weeks. I Like having three days off on my weekends. I spend less time commuting, and that means less gas spent also. And my commute is one hour long, one way. Also, I notice the day shift nurses are saying the 12hrs go by fast and the night nurses say it can go slow sometimes. That's been my expericense also so far. So Thats my two cents worth

:uhoh21: Some of the policies on our hospice unit may put the nurses here, me included, on thin ice legally. I have some legal questions and I know I can't get professional legal advice on a discussion board. I'm just looking for some feedback. #1 we have no policy and procedure book. How are narcotics re-ordered? Who can/can not do various procedures to patients? How are orders taken off and varified? These are things that should be in a policy book and if I'm employeed here with out a policy book, where does that put me? #2We take full code patients on our unit, but we don't have the equipment for a code. No CPR board,crash cart and so forth. Ofcourse most of our pt's are no codes, but some are Full Code. So we're supose to just call 911. but then-again we don't have that as policy any where either! I could go on but I think this would get alittle weary to read. To summarize: Where does my legal professional responsiblity end and the responsibility of the unit/employer start? FYI I'm a BSRN and often in charge of one LVN and one CNA for 5 to 10 hospice patient at a small community hospital