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In Episode Seventeen Brian returns to discuss strategies for success in long term care facilities.

We answer several great questions from The Hospice Nurse Support Group on Facebook.

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.

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James@confessionsofahospicenurse.net

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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.

Towards the end I discuss the opioid conversion chart I created. I have added a download to the ”download tools” area of the website. I also created a video explaining how to use the conversion chart.

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James@confessionsofahospicenurse.net

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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!

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James@confessionsofahospicenurse.net

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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.

1. Some visits are just long
2. See everyone twice a week
3. Understanding the two types of nursing visits
4. Be the calm in every situation
5. Avoid power struggles
6. No triangles
7. Don’t invent problems
8. Know your patients
9. 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.

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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.

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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!

816-834-9191
James@confessionsofahospicenurse.net

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Welcome to part 3 of my orientation strategies!

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!

816-834-9191
James@confessionsofahospicenurse.net

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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.

1. 4 visits per day is perfect when orienting new nurses to hospice
2. Every day should end with all work complete and nothing left for the next day
3. The more questions we ask our patients/caregivers the more likely they are to discover the answers on their own.
4. Not everyone learns the way I learn. I need to adjust some of my trainings to be sure to incorporate multiple styles of learning.
5. 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!

816-834-9191
James@confessionsofahospicenurse.net

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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.

1. While in orientation the new nurse should aways ride with everyone. No following in his/her own car.
2. Set the standard from day one that hospice is an 8-5 job.
3. 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.
4. The most important tools you have are Influence and Trust.
5. 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!

816-834-9191
James@confessionsofahospicenurse.net

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In this episode I have the distinct pleasure of interviewing Tania. She has over a decade of weekend on-call experience. This interview is filled to the brim with practical advice for success with your on-call visits.

Tania shares with us how she ended up becoming a hospice on-call nurse and how it works for her family.

We address the 7 following subjects:

1. Establish why you are making the visit with the family
2. Identify the type of visit (Only 3 real categories)
3. Car Stock Ideas
4. Documentation
5. How to separate family from work on the weekends
6. How to handle challenging environments
7. Tania’s favorite resource for families

My two favorite quotes from the interview.

”Sometimes, you end up where you need to be,” and ”No visit is ever wasted.”

My favorite part of this interview was the very end. Tania shares with us how she uses Barbara Karnes’ Blue Book for her families when she visits. This is the most powerful and intentional use of this book I have ever seen. I plan to implement this strategy starting this very week!

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As always don’t be afraid to reach out to me personally should you have any questions or show requests.

Phone feedback line: 816-834-9191
Email: james@confessionsofahospicenurse.net

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In this episode I share why it has been exactly one month since I published my last episode. I also explain why it might be a few more weeks before my next episode.

Most of this episode was shared without extensive notes and just an outline. The outline was 3 simple points.

1. Turn off your phone
2. Don’t have favorites
3. it’s not about you (or me)

I recommend 2 books with one of the books also available as an audio message by Andy Stanley.

Choosing To Cheat – Renamed ”When work and family collide”

Audio Message

I also highly recommend ”Boundaries” by Henry Cloud and John Townsend.

As always I highly encourage you to check out my ”Avoiding Hospice Burnout Series” page for all my articles related to hospice nursing burnout.

As promised here is the youtube video I played during the show.

As always don’t be afraid to reach out to me personally should you have any questions or show requests.

Phone feedback line: 816-834-9191
Email: james@confessionsofahospicenurse.net

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During this episode I read a portion of an email I received from a listener when I asked her if she had any questions I could build a show around. In that email she asks me what my sacred activity is.

After much thought, I have decided to share my sacred activity during this episode.

The truth is that I am completely incapable of doing this complex and emotional work under my own power. This work can be overwhelming to the mind and soul at times. In this episode I explain how my faith and spiritual practices help me provide the kind of medical care and emotional support my patients and their caregivers deserve.

I also promise to upload a sermon series that really helped me balance my faith with my work habits. That series can be accessed HERE. I have also added it as a menu item on my website.

I explain in detail the following 6 concepts I try to employ every day to the the best I can be.

1. Repetition is a mode of learning.
2. I try to remain in constant contact with my own brokenness.
3. I try to always see what someone can become instead of what they currently are.
4. I remind myself daily that all persons have eternal value and existence.
5. I remember that I can leave all my fears and concerns at my place of worship.
6. I can’t always control outcomes, and I will never survive this work if I try.

I also share the two following quotes by C.S. Lewis

Highlighted Text Below

As always don’t be afraid to reach out to me personally should you have any questions.

Phone feedback line: 816-834-9191
Email: james@confessionsofahospicenurse.net

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