James worked on-and-off as an LPN for over 20 years. In 2014 he completed a bridge program and became an RN. James became a hospice nurse in January 2015. He lives in the Kansas City area with his wife of over 30 years, 4 daughters and 2 sons in law.
For this episode I review the fallout I received after posting the following visit schedule.
6 patients who will be known as 1-6
All Charting completed at the bedside.
Patient 1 – 8:00am – 8:45am (no new orders)
Travel 43 miles to Patient 2
Patient 2 – 9:30am – 10:30am (Actively dying)
Travel 30 miles to Patient 3
Patient 3 – 11:15am – 12:00pm (pillbox)
Travel 0 (same building)
Patient 4 – 12:00pm – 1:00pm (pillbox)
Travel 25 miles to Patient 5
Patient 5 – 1:30pm – 2:30pm (new orders)
Travel 23 miles to Patient 6
Patient 6 – 3:00pm – 4:00pm (no new orders)
Drive 5 miles to where my daughter works to pick her up since her car is in the shop. She gets off at 5:30pm.
Worked from 4:00pm-5:30pm to do Recert notes on patients 5 and 6 above. Also completed IDT notes on 3 patients for a nurse who is out sick.
Start nice and early. Chart at the bedside. Be intentional!
I discuss that my main goal of the post was to show that bedside charting can be accomplished in any situation. This post turned into more than I ever imagined with a lot of different feedback. Some was positive and some was negative.
I then discuss the following color wheel, and how it completely changed how I looked at my day. I also share what I learned from the color wheel.
I then engage in some reflection and discussion regarding the color wheel and how it applies to all of us.
To close out the episode I challenge all of us to begin to take the next step in our journey to complete as much as possible at the bedside of our patients.
I also provide some updates on Hospice Nurse Training (click HERE) and how I will be changing the free trial period to 3 days instead of 14 and why I’m making the change.
As always, don’t forget to call, text or email to leave feedback! I would love to hear from you!
I could hear him coming down the hall with his walker. His wife was on twice a day visits, and I was helping for the weekend.
I started on Friday evening, and planned to visit each day at 9am and 6pm. I don’t like running twice a day visits very close together. I just don’t feel like a short time between visits provides the kind of support a family needs.
Anyway, this was Sunday morning, and to this point, her husband had not said anything to me or entered the room.
I saw the walker first, and knew it was him. He poked his head into the room and looked around the corner at me. I was sitting in a chair up agains the wall next to the door.
He started the conversation.
”We are getting closer to the end, aren’t we?”
She had been unresponsive since my first visit on Friday night. This was a sign that she was days from the end.
“Yeah,” I responded, ”It won’t be much longer.”
“She looks comfortable to me. How much longer do you think?”
“I really can’t say. Everyone is just very different,” I responded.
He entered the room and sat down next to me. He started to share his life with me..
“I’ve owned a barber shop here in town for 40 years. For many of those years I cut hair for the local army base. Most of the men would bring a picture of their sargent and tell me to cut their hair exactly like his. He had a flat top. That’s the hardest haircut to do.”
He went on to explain the challenges of trying to give someone a flat top.
“You have to cut the sides so much longer than the top for all the hair to hit at the same point above the head. Every head was just so different. Those men would line up outside of my shop, and I would be cutting flat tops all day long.”
I love hearing stories like this. I sat and relaxed, and let this gentle man share his life with me.
After several minutes he looked at me and said, ”I guess hospice is like haircuts. No two people are the same. Everyone is just a little bit different and needs some kind of special touch and consideration.
After about half an hour, he got up, grabbed his walker and slowly returned to the living room to be with the rest of his family.
I don’t know if hospice is really like haircuts. What I do know is that for this kind man, on the day he was going to lose his wife, hospice needed to be like haircuts.
In episode nineteen I go into detail my strategies for managing visit frequencies.
To start out the episode I discuss the importance of following agency protocol regardless of any advice I provide. I also challenge leadership to reconsider any expectations that do not make sure patients get visits from their primary nurse for all crisis.
I discuss how increased visits help build the two most important tools we have in our nursing bags.
I compare the hospice experience with a good book and explain what the first 7 days should look like and what the last 7 days should look like.
I discuss situations when we should put patients on daily visits even though they are not in steep decline or actively dying.
At the end of the episode I provide an update on my new website Hospice Nurse Training, and I discuss the upcoming training schedule.
In episode nineteen I go into detail my strategies for managing visit frequencies.
To start out the episode I discuss the importance of following agency protocol regardless of any advice I provide. I also challenge leadership to reconsider any expectations that do not make sure patients get visits from their primary nurse for all crisis.
I discuss how increased visits help build the two most important tools we have in our nursing bags.
I compare the hospice experience with a good book and explain what the first 7 days should look like and what the last 7 days should look like.
I discuss situations when we should put patients on daily visits even though they are not in steep decline or actively dying.
Don’t forget to call, text or email to leave feedback! I would love to hear from you!
It has been seven-and-a-half years since I started in hospice. At about the two year point I developed this strong desire to have the biggest impact on hospice patients as possible.
I really thought this impact would be to work my way up the ladder to hospice administrator. I felt that this was the best way to have the biggest impact.
At my five year point in hospice, I accomplished this goal. I was the administrator of a hospice. I was convinced this was the pinnacle. I was convinced this would be my chance to affect the most hospice patients for the best. While being a hospice administrator is an enormous responsibility, and certainly very important, the role just was not for me. At least, not at the time.
The community response has been just simply overwhelming. Nurses from all over America have reached out to me over the last year thanking me for the content and help. I am simply humbled by this response. I never imagined being this much help to so many nurses.
My dream of helping as many hospice patients as possible has expanded to helping the nurses who serve those patients. My level of fulfillment has skyrocketed over the last year. I am overwhelmed by the compassion and kindness I have found among hospice nurses. Their commitment to their patients and the communities they live in has simply been an inspiration.
Last week I decided to launch a private community specifically designed to bridge the gap from podcasting to real world engagement. I launched HospiceNurseTraining.com into the hospice community.
The response has been absolutely fantastic. Nurses from across America have joined this community. It’s not a big community, but it is a beautiful community.
Probably what has been the most amazing thing, is the humility I see in the group. These nurses are providing hope, help and encouragement to each other. They don’t just provide advice. They also provide love and kindness and understanding. They give and receive help without concern for themselves. It’s about the patients they are serving and how they can have the deepest impact.
I will be providing all kinds of trainings and education in this group, but I truly believe the real value of this group will be in its members.
My favorite quote from the week comes from Cindy who stated, ”Hospice Nurses are not in it FOR their patients. Hospice nurses are in it WITH their patients.”
After just the first week, I am more convinced than ever that hospice nurses absolutely need this type of community. A super safe place to share experiences and provide support for each other.
I’m so excited for the future of this community. Avoiding hospice burnout has a new face and it is Hospice Nurse Training. I hope you will consider joining and take your hospice career to the next level.
Throughout this episode we discuss many of the challenges hospice faces when providing care in LTC facilities.
Towards the end of the episode we address a very difficult situation a nurse named ”Peggy” has recently had to deal with.
At the end of the episode we conclude with some practical advice to help build deeper relationships with staff and leadership.
In my final thoughts, we discuss the importance of considering the bigger picture when working with all facilities. We discuss the fact that working with any facility is about long term goals, and how it takes time to build a mutually beneficial relationship that will ultimately help hospice patients and their difficult journey towards end of life.
Don’t forget to call, text or email to leave feedback! I would love to hear from you!
I lost my aunt Joyce (far right) in 2013. Today I want to share with you how she has shaped my life forever.
During her funeral anyone who wanted to speak was allowed a few minutes on the stage. What I shared that day, is what I will share with you in this article.
Aunt Joyce was my spiritual counselor. Any time I was having a crisis of faith or was faced with a big decision, I would go to her for advice. Her infectious smile gave me relief the moment I entered her presence. She would listen to what I was struggling with, and then she would give me advice that was always biblically based and always encouraging.
I never left her her presence without feeling encouraged. No mater the situation, she would find a way to encourage me. Even if she had to give me bad news, she made sure I felt a sense of purpose and the possibility of success in the months and years to come.
She always saw what I could become, and spoke that into my life. She was a master encourager.
I try to be like Aunt Joyce in everything I do. When coaching my staff, or when visiting with my patients and their caregivers. I never want someone to leave my presence without feeling encouraged and empowered. I want them to see what they can become, and I don’t want them to be overwhelmed by what they are not. This can’t be accomplished by just pointing out their mistakes or errors. This is accomplished by focusing on strengths and making those strengths the focus of the conversation. Everyone has hidden skills and abilities. EVERYONE!
A good leader (everyone is leading someone) will always try to discover the hidden skills and abilities in those around them.
How about you? How do you make sure you provide positivity and encouragement in every interaction you have with others? How do you make sure others feel more capable once you leave the room?
The power to do this is in your words. It is how you end every conversation. Do you end your conversations with encouragement and a sense of possibility? Does someone feel better or worse about themselves after interaction with you is over?
Be like Aunt Joyce. Spend your energy helping others see what they can become. The power of life and death are in the tongue. Speak life and possibility into everyone you ever meet.
In this episode I share my strategies for managing patients and their symptoms in the last 7 days of life.
I discuss when to start patients on daily visits, what what science and mathematics I use to calculate scheduled and as needed medications to maintain control of symptoms.
I discuss the difference between transitioning and actively dying patients. I also discuss some changes in terminology that will help cut down on confusion or misunderstanding between hospice staff and our caregivers.
I discuss what kind of schedule to keep when making those visits in the last 7 days of life including visit times and how to help our caregivers feel more at peace with the schedule.
In this episode Brian and I finally coordinate our schedules to record the first of two episodes to address the challenges working interdisciplinary with staff inside of facilities.
This episode was very eye opening for me, and I think it will be for you too.
Hold on to your hats, because this episode comes in at a little over 90 minutes. Hopefully, you find it to be as inspiring as I do.
Brian shares with us his journey from hospital ICU, through a 16 year hospice journey and why he decided to move to ALF leadership.
Throughout this episode there is plenty of practical advice. There is also some insight into what it can be like to run and work at an ALF.
By the end of our visit my appreciation for the staff inside of an ALF skyrocketed. Inside of the hospice community there is just too much complaining regarding our ALF partners. As we wrapped up this episode I was filled with a new appreciation for the hard task ALF staff have.
If I were to sum up the whole episode in one word in two words it would be, ”Accountability.” That accountability is on our part. The only people we have control of is ourselves. That is an obvious theme in this episode as it is in just about everything else that comes out of this website.
I hope you will embrace this episode and find it to be the kind of motivation you need to help you be that much better when you are working with our friends in ALF.
Don’t forget to call, text or email to leave feedback! I would love to hear from you!
