Who cares for hospice peds after hours??

[pixiec11]

Hello,

In your organization, who cares for the pediatric population after hours? Your on call staff? The primary nurse? What training is given for caring for pediatric hospice patients? This recently came up at our Hospice and I am trying to gather info on what other Hospices do. Usually, we have the primary nurse cover these patients 24/7, however, at this time it is difficult for her to do around the clock and we have very few nurses with any pediatric experience. What's your take on this dilemma? Currently, we are considering pediatric training for the on call nurses and/or having 2 nurses go to assess this patient after hours. It's a difficult case, so I am a bit unsettled about assessing this patient at all without some kind of training. Seems like a ticking time bomb waiting to go off to me. Am I making too much of this, or should I just go and assess this patient to the best of my ability and report findings to the MD?

Thanks,

Lisa

My thoughts for today:

:prdnrs::cmptradct::wtosts::oornt::aln::urgycld:

[nrcnurse]

We used to have a specific peds team that took care M-F 8-5, then the on-call staff took over 5p-8a and weekends. In someone's infinite wisdom, the peds team was dissolved, and each team handled peds as any other case. Then, the agency started giving peds classes and "certifying" nurses (RN and LPN) in pediatrics. We have an ARNP who handles all the peds cases, so she is available as a resource, but there are no more peds-specific nurses. I work for the Continuous Care team, and only "certified" nurses are assigned to peds cases. Also, peds are covered 24/7 when CC is ordered. Sick kids are allways sensitive cases, so the more training, the better. As with most hospice cases, the patients are fairly straightforward and it's the families who are a mess. Well-trained social workers are allways good support, too.

[leslie :-D]

a lot of it is knowing what is age appropriate, as well as dealing w/the dynamics of family grieving and anxiety.

when we did peds, i was on call 24/7 and honestly, didn't last long.

it was too much, being the only nurse...

and, i was somewhat forced into the position, which i didn't want to do.

so i had my own issues to deal with.

anyways (sorry for rambling), i would only send nurses who are experienced w/peds, or who have received certification.

especially where you said this case is complicated, that only reinforces my thoughts.

much luck to you.

it's a tough, tough specialty.

leslie

[pixiec11]

Thank you for the responses so far. I am the on call nurse and was just faced with the fact that I would be taking calls for an infant out of the blue. With no pediatric experience, I was very shaken by this. According to professional misconduct guidelines, I can not accept this responsibility without proper training, and my supervisors can not delegate this to me. However, it is very difficult to place myself in a position to enforce this. It has been very stressful for me and I feel like this is being dumped on me without warning. I do not want to put this child or my license at risk d/t my lack of training.

[leslie :-D]

Thank you for the responses so far. I am the on call nurse and was just faced with the fact that I would be taking calls for an infant out of the blue. With no pediatric experience, I was very shaken by this. According to professional misconduct guidelines, I can not accept this responsibility without proper training, and my supervisors can not delegate this to me. However, it is very difficult to place myself in a position to enforce this. It has been very stressful for me and I feel like this is being dumped on me without warning. I do not want to put this child or my license at risk d/t my lack of training.

i would hate to see this infant not get any prn pain meds (if this is the case) r/t one's reluctance in administering (which i wouldn't blame them!)

it's very unfair for them to dump this on you, and frankly, would refuse, citing bon guidelines.

if they fire you, you could collect unemployment until you found another job...i'm sorry to say.

but ultimately, i think it comes down to remaining true to your conscience (which is your soul whispering).

of course you need to adhere to bon regs, but even if it was allowed, we ultimately still have to respect ourselves.

i know not all think as i do, but i'm sensing you fully understand what i'm saying.

let us know what happens, pixie.

and you'd be better off working for a facility that recognizes ethical and legal boundaries.

leslie