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.
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!
For Episode Fourteen I pick back up on my burnout series. In this episode I address some of the biggest reasons nurses get stuck for long periods of time with their patients.
Here is a quick list of topics I discuss.
Some visits are just long
See everyone twice a week
Understanding the two types of nursing visits
Be the calm in every situation
Avoid power struggles
No triangles
Don’t invent problems
Know your patients
Chart at the bedside to end the visit
I also share the following visit schedule I performed right after I published part 6 of my burnout series.
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.
I ask my listeners to let me know what they think of the above schedule. Was this a good schedule I should be proud of, or are there problems with it?
In Episode Fifteen I will discuss the above schedule and what I feel like I learned from it.
Don’t forget to call, text or email to leave feedback! I would love to hear from you!
I’m a big fan of boundaries for hospice nurses. I have written BLOG POSTS and recorded PODCAST EPISODES dedicated to the subject.
There are limits to a nurse’s ability to remain completely neutral when doing this work. We do this work because we think it is important. Anyone doing this for a year or more is doing it because we feel it is our calling.
I’m not sure there is another area of nursing that demands as much emotionally from nurses as working in hospice. We insert ourselves into the end of someone’s story. We provide education and support as aunts, uncles, sons, daughters, husbands and wives stand watch over their dying loved ones.
While we try so hard to not fall in love with our patients and their families, we still inevitably end up with a hand full of people we just connect with in a special way. There are many ways this can happen. Most often it is because they remind us of someone in our own lives. Maybe even someone we lost to death at one point. We connect in a deep way, and friendship blossoms. We can’t help it. We are human, and we were created to love other people.
Then there is this abrupt ending to the relationship for us. A patient we truly enjoyed spending time with dies over the weekend or during the night. For us, a deep relationship comes to a crashing end. Imagine being so close to someone that you have stopped even knocking on the door when you show up to visit? We became close friends without even trying. It was just the result of visiting them multiple times a week for what can sometimes be more than a year. Now they are completely yanked out of our lives and we didn’t even get to say goodbye. Sometimes we are able to reach out to the family following the death. Maybe we even stay connected for a while. Even then, eventually, that relationship comes to an end. It’s not on purpose, but life for everyone moves on.
Then we might meet a family member in the community somewhere. We may be in the line of a grocery store, or tying to find a new pair of shoes. We make eye contact and, after a second or two, one or both of us will recognize the other. Someone starts crying and asks the other how they are doing. It’s awkward and generally short lived to minimize the awkwardness. We part ways and, for me, I sit in my car and relive some of the memories. There is no doubt the family member I just met is REALLY living the memories. Sometimes, I can hear them telling the person they are with who I was, and what I mean to them. It’s a heavy moment.
So what do we do next? We go to work the next day and risk our hearts all over again for complete strangers.
This is what we do, and we love it. Sometimes we just love it a little to much, and it hurts. It hurts because our friends keep dying.
In this episode I review that last two weeks of orienting my new nurse. I discuss how impressed I was with her ability to read a room when we made an emergent unscheduled visit.
I review how we performed 3 recertification visits and I introduce a new tool that can be downloaded using the “Download Tools” section of the web site. There is also a youtube video on how to use the tool available on the download page.
To close out the episode I discuss the challenges all hospice nurses experience due to our ability to tell the future in certain situations.
Don’t forget to call, text or email to leave feedback! I would love to hear from you!
Welcome to part 2 of my series on the my strategy for orientation of a new nurse.
In this episode I explain how I feel like I learned the most. My biggest take away from the week was that I need to create a more robust training program for new visits. I’m great at having all my visits organized and planned out. I need to put together a more detailed plan for the week for introducing new staff to hospice, hospice philosophy and hospice guidelines as required by medicare.
When I finish creating this program, I will share it with my listeners/readers and make it available in my ”tool download” section of the website.
Here are my main points from today’s show.
4 visits per day is perfect when orienting new nurses to hospice
Every day should end with all work complete and nothing left for the next day
The more questions we ask our patients/caregivers the more likely they are to discover the answers on their own.
Not everyone learns the way I learn. I need to adjust some of my trainings to be sure to incorporate multiple styles of learning.
Hospice is a heart job
As promised, you can find an updated menu item above that will take you to available tool downloads. Be sure to watch this menu over the next week as I will be adding a Hospice Test to the menu for download to use when helping new hospice staff learn the regulations.
Don’t forget to call, text or email to leave feedback! I would love to hear from you!
In this episode I start a series explaining my strategies for orientating new nurses.
I read an email from listener Holly and how I got my inspiration for this series from her. I also read an email from Kelly that I received the day before recording this episode and how it ties in quite nicely.
Here are a few of my main points.
While in orientation the new nurse should aways ride with everyone. No following in his/her own car.
Set the standard from day one that hospice is an 8-5 job.
Be strategic about the very first visit the new nurse will be a part of and explain why you chose this for the first visit.
The most important tools you have are Influence and Trust.
People never forget how you make them feel.
Don’t forget to call, text or email to leave feedback! I would love to hear from you!
