All posts by James

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.

The Last Prayer

Photo Credit Sukanto Debnath (click the image)

I don’t get asked to pray very often. We have chaplains in hospice. That is their job.

William was just different. He didn’t do anything like anyone else. I had a feeling his story would be different than any patient I had ever had.

William lived his life by the facility smoking schedule. He would wrap himself up in his warmest clothes and go outside with his two cigarets to light up.

Facility staff would escort all the smokers outside several times a day. I would see William between smoke breaks. He spent most of our visits talking about his pain problems. I worked with facility staff to get it under control. It took almost a month to really get it managed.

After about a month of seeing William, he started talking about is faith with me.

“Jesus is my lord and savior,” he told me one day out of nowhere..

“He’s mine too,” I replied. “I know I’m not the chaplain, but can I pray for you?”

Without hesitation he replied, “Yes.”

I sat down next to him, grabbed his hands, and I said a prayer. When I was done the most amazing thing happened. He said a prayer over me! I’ve been doing hospice for a while. I have never had a patient pray for me. It was overwhelming to say the least. I left his room in tears.

Over the next month his health started to decline. He was sleeping through his smoke breaks. To help him out, I started taking him out during my visits. He would just share his life experiences with me. He just talked about his family. He loved them all very much.

He got to where he would not let our visits end without me praying. I would pray for him, then he would pray for me. Our prayers were simple. I would pray that his pain would be controlled. He would pray and thank God I was his nurse. I always left with tears in my eyes.

He started getting confused towards the end. I was visiting him one day, and he was very confused. He was terrified of me. He didn’t know who I was, and he no longer trusted me. He went from hugging me to total terror of my presence. I went home that day totally dejected.

I didn’t know what to do next. I wanted to continue to take care of him, but I didn’t want to cause him to be scared. I didn’t want to contribute to his fear and anxiety. He had not been eating for several days, so I knew I needed to see him again the next day.

The following day I made a visit. It was a Friday. I remember walking down the hall and peering into his room from outside the door. He was sitting on the edge of his bed with his eyes closed. I quietly walked towards him making sure I was completely silent. I sat down next to him and grabbed his hand.

”William, it’s James,” I whispered.

“Hi, James,” he replied without opening his eyes.

“How are you feeling?”

“I’m sleepy.”

“Can I pray for you?”

He was too sleepy and confused to answer this question. Desperate for my own closure, I prayed for him one last time. I asked God to provide him with a peaceful transition from this life to the next with his Lord and Savior, Jesus Christ. He died that weekend with his family at his side.

I try to teach everyone that hospice is not about the hospice nurse. Since going back into the field to be a case manager, I have been reminded how hard it is to maintain boundaries with our patients.

Sometimes, we just meet patients who change our lives in their own way. Instead of avoiding the situation, I think it’s okay to embrace it. The best hospice nurses will eventually make deep connections with some of their patients.

Sometimes, those connections are so deep, we are the ones changed forever.

New Community Subscription Options

I wanted to send out a quick message letting all of my subscribers know about some changes at The Hospice Nursing Community.

We have totally redesigned the website to make it easier to navigate. Please watch this short video for details!

You can also click HERE to watch the video on the landing page at The Hospice Nursing Community website.

Once again, I want to thank all of your for your support!

I just learned recently that The Hospice Nursing Podcast is in the top 10% of all podcasts hosted at Buzzsprout.com! They host just under 120,000 podcasts!

Episode Twenty-Three: For Hospice Nurses

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In this episode I interview Shelley Henry with Amity Staffing.

Shelley shares her 20 year experience in hospice and how it lead her to starting Amity Staffing.

She shares with us some of her strategies on bringing awareness to the challenges hospice nurses are facing in the field.

We discuss some of the details of her “Your Opinion Matters” survey for hospice nurses.

Shelley shares with us her social media journey, and how she is trying to help hospice nurses in her own unique way.

I highly recommend you follow her. Please use these links to follow Shelly on your social media outlet of choice.

Facebook
Tiktok
Instagram
linkedIn
Amity Staffing Contact Page

Be sure to take a few minutes right now and complete the SURVEY!

We spend a few minutes at the end allowing Shelley to share some of her hospice insights with us.

At the end of the episode I provide a few updates for The Hospice Nursing Community.

This Friday, December 8th, the website will take on a whole new look. I am rolling out a $10.00/month plan that will give you access to 90% of what is happening inside.

This includes my personal journaling of many of the hospice cases I am managing right now. My focus is to give my members an inside look on how I manage my patients in the last 7 days of life, and how I communicate effectively.

As always, don’t forget to call, text or email to leave feedback! I would love to hear from you! If you leave a voicemail I will play it on the air!

816-834-9191
James@confessionsofahospicenurse.net

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Episdode Twenty-Two: Case Management and LTC Success

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Ten weeks ago I left my role in leadership and went back to case management.

In this episode I review some things that I have had to learn as well as some things that have been reinforced.

I also discuss my assignment to a hospice friendly facility, and the strategy I used to gain favor with the staff.

I discuss the importance of communication, and I also discuss some of my own struggles to adjust from leadership to full-time case management.

I review how to be a leader from a case manager position, and I discuss some psychosocial strategies I utilize when case managing.

At the end of the episode I discuss some major changes coming to Hospice Nurse Training including a name change and tiered pricing for members.

As always, don’t forget to call, text or email to leave feedback! I would love to hear from you! If you leave a voicemail I will play it on the air!

816-834-9191
James@confessionsofahospicenurse.net

Episode Twenty-One: The Admissions Process

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In this episode I go into depth on best practices for the admission process.

I cover the following points in depth.

First impressions
Time Management
Admission in-home schedule
Importance of calming presence
Review of services
Records review
Consents

Click HERE to download the clinical data sheet and watch an instructional video.

I provide some additional updates on Hospice Nurse Training community and all the extra content available for members.

As always please don’t forget to reach out to me via email or text message with your comments and suggestions.

James@confessionsofahospicenurse.net
816-834-9191

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Episode Twenty: Oops?

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In this episode I pick back up on my ”Avoiding Hospice Burnout” blog series with part 7.

Check out the whole series by clicking HERE!

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!

816-834-9191
James@confessionsofahospicenurse.net


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Hospice is like haircuts?

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.

Episode Nineteen: Visit Frequencies

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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!

816-834-9191
James@confessionsofahospicenurse.net


Subscribe Via Email!

Hospice Nurse Training is Live!

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.

Fast forward 2 years, and I decided to write my Avoiding Hospice Burnout Series, and subsequently, start The Hospice Nursing Podcast.

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.

Episode Eighteen: Welcome To Your Community

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In this episode I announce the creation of a special website I have launched for my listeners.

At the end of the episode I give away 5 free memberships to this new community. Listen to the episode to get the instructions!

In this community you will be able to count on the following deliverables.

  1. Live Q&A following each episode (2nd and 4th Monday Night)
  2. Monthly recertification round table (zoom call to help you)
  3. Monthly work shops – First one opioid titration with deliverables 
  4. Camaraderie with like-minded hospice nurses
  5. Private groups for each specialty (on-call, RNCM, Administrator, PRN)
  6. Weekly disease process discussion groups
  7. Weekly prayer live streaming
  8. Daily hope, help and encouragement (keeping negativity at a minimum)
  9. Less than a dollar a day (2 week Free trial with launch party and give always on October 1st)

Don’t forget to call, text or email to leave feedback! I would love to hear from you!

816-834-9191
James@confessionsofahospicenurse.net


Subscribe via email!