Really Tired of Fighting Hospice Ignorance......

[tencat]

Hi all. I'm feeling SOOOO discouraged right now, and I hope some non-hospice folks are also looking at this thread because I am beyond knowing how to address hospice issues with non-hospice clinical people. I wouldn't dream of telling an ICU nurse, or a Cardiac nurse, or a PACU nurse how to do his/her job, so why do non-hospice clinical folks think they can tell me how to do mine????? Twice in a week I've been dealing with several frustrating issues: We have one patient with a g-tube that leaks around the site, and we've been through four different feeding solutions with the same results: Massive amounts of diarrhea and patient still looks like a breathing skeleton. Eating produces horrible stomach pain for patient as well. Pt. kept asking to have tube removed, a surgeon agreed to do it, then at literally the very last second before surgery, asked the patient, "Are you sure you want to starve to death? Because that's what will happen if we get rid of it." So patient panicked and said no. Sigh. THEN the surgeon's nurse proceeds to call me and chew me out because we're starving the patient to death, and isn't hospice about comfort? What kind of nurse ARE you, she asks me.....

Today I get another call from a nurse because our physician feels we shouldn't change a foley catheter on a patient who has prostate cancer and a propensity to retain urine due to blockage issues. He's worried we can't get it back in (as am I) and if that happens we'll have to send the non-ambulatory patient to the ER. This nurse chews me out for being a bad nurse because every nurse knows you change a catheter every four weeks, and what kind of nurse am I that I don't do that for the comfort of the patient?

I'm so tired. And it's got me questioning myself. Yes, indeed, what kind of a nurse am I? Sigh.

Thanks for listening.

[AtlantaRN, RN]

i needed to add to previous post, not only did foley flush fine, but what returned in the tubing was the clear saline i flushed in.....

[Leda1st]

As a nurse who works PRN for a Hospice agency, and does Med Surg, Tele, and ER for a hospital (also PRN), I can tell you that the biggest thing I have learned is never to "judge" other areas of nursing. The friction between the ER and the floors is a primary example (I won't go into all the issues). I do my best just to educate people as best I can - to a certain extent. If someone were to use the phrase, "What kind of a nurse are you?" to me, I probably wouldn't bother to try to educate them. They don't want to hear it, because they are probably "always right" anyway. If someone ASKS me, "Why are/aren't you going to do that?" I will explain.

One of the biggest things I get regarding Hospice is this attitude that I am somehow Kevorkian-esque. I personally don't advocate assisted suicide, and I make a point to explain that very firmly. And I always make sure to inform people (especially other nurses) that we are ALL going to die someday (including myself and them), and that I think we should ALL be able to decide if we want to die hooked up to everything (which some people DO want to die that way, and although that is not MY preference, I respect a person's right to make that decision) or to die at home as peacefully as possible given the circumstances of the illness. Somehow, reminding people that THEY TOO will face death one day can sometimes help with their perspective. Very few people that I work with in ANY setting say, for example, that they themselves would want to have a feeding tube placed - most people say they would NOT want that. And, as some folks in this forum have pointed out (and that most folks in Hospice know from experience), it is really, really hard to "shift" from the "saving lives at all costs" mentality (prevalent in hospital settings) to the QUALITY of life mentality that prevails in Hospice.

After my rambling, I'm not sure what my point is anymore - I guess to say that nurses need to try to understand that different areas/specialties in nursing have different philosophies and foci, and we all need to try to respect each other (even if we don't agree with or understand each other).

[SoCalRN1970]

I have had many horrific responses from not only idiot family members who know nothing to staff RN's who are freaking out because I am sending a dying patient home on medications that they'd never even think of. CaDD pump with ms 6 mg basal, with 2 mg bolus every 15 minutes.. "Oh my god, you are going to send him into respiratory depression". There is alot of ignorance. I am willing to excuse family members who know nothing, but when nursing colleagues or MD's get in my way of symptom management it's a big fail in my book.

FYI... ususally the holier than though experiences I have had extend to nursing and MD's who fall into a speciality area, oncology, ICU, CCU and ER primarily where they usually have egos bigger than all get out. LOL

[tencat]

There is alot of ignorance. I am willing to excuse family members who know nothing, but when nursing colleagues or MD's get in my way of symptom management it's a big fail in my book.

AMEN! It's frustrating as I'm in a small town with about 9 doctors, and it feels like every single one of them is adamantly opposed to what we do. And I have no support from my management to try to address the problem. I got accused the other day by a physician of liking to give too much morphine to patients and hurting them. I was ready to tear his head off, but have been cautioned to let it go by my bosses...I don't WANT to let it go, but I guess I need to decide if my job is more important or my reputation as a nurse.

[JenniferSews]

It's partly just judgement of any nurse not in your field/facility/unit. I got a call today from an ER nurse that the patient was covered in dried feces. Well she was cleaned up by a CNA and her skin was assessed (per our policy for obvious reasons) by 2 of our best nurses prior to leaving the facility. She then sat in your ER for 5 hrs. Naturally we are to blame according to the hospital and family.

I'm sorry about the ignorance. I love my experiences with hospice nurses and hospice in general. In my field we sometimes admit patients for that one last attempt at going home, and it may not be feasible. But when hospice is involved the patient is happier, the family is happier, and I can sleep at night knowing my patient was as comfortable as they could be at the end of their life. I know some people think it's all about roxinol, but it's so much more than that and I and my patients appreciate you!