It has been a pleasure to work with Stacia during her formative time as she becomes an RN.

Stacia brought to the table vast knowledge and was eager to utilize it. I felt she did not hold
anything back from day one. She always presented herself in a professional manner, dressed
appropriately for the work environment and was always on time for the morning shift change.
She has a very pleasant demeanor and was quickly blended into our small work environment .
All staff enjoyed the time she spent with us.

She continued to utilize the 6 rights for medication administration and then would follow up
with my charting to make sure our charting was the same during the work day and in the
closing of the work day. She consistently would check and recheck her dosage calculations to
ensure proper dosing for each patient . We started every morning with report from the off going
shift. She would ask questions if she had any. Following that, Stacia built herself up to
performing the narcotic count at shift change. We then would restock the medication room and
then utilize the computer to write down all medications that were to be given to each patient at
any given time throughout the day. We then would verify that the orders were correct in
comparison to the physical chart orders and see if there were any orders that had changed or
were not yet in the computer system. We would then commence our day.

As with any nursing field of study, no two days are alike…even if it is the same patients. Due to
the small work environment, Stacia was able to participate in several reports and discussions
on our patients with the healthcare team, thus effecting their Plan Of Care and changing their
medication regimen in order to enhance their quality of life.

As hospice has grown through the decades, it is no longer considered an older generation part
of the nursing profession. Stacia was able to care for individuals from 40’s-100 y/o. She was
able to see that age does not change the fact that ANYONE can have a high burden of
comorbid conditions and can be at risk for polypharmacy and adverse drug reactions. She also
was able to see many different End Stage diagnosis and their effects on a human. It used to be
assumed that most of the hospice populace consisted of Cancer, but through the years, other
diagnosis such as dementia, lung disease and cardiovascular disease have come into the
forefront. She also had a unique experience of caring for a young individual with Ehler Danlos
Syndrome.

In her time at Dove house, she had the opportunity to utilize many “high potency” medications
with increasing doses for proper symptom management. It is always assumed that all daily
medications are stopped in hospice. Of course, this is not the case. When patients are
admitted to hospice, medication reconciliation is done to reassess a patients medication
therapies and determine the treatments that are most beneficial and least harmful at the end of
life. Many factors come into play at this time, including the individuals ability to swallow
appropriately as not not aspirate into the lungs. At this time of the individuals life, we continue
and institute medications that are beneficial for comfort for quality of end of life. We do,
however, discontinue medications that no longer provide benefit and may even be harmful for
the patient. It is essential to educate the patient and family on the WHY of the continuing and
discontinuing of medications in order to provide optimal pharmaceutical care of our patients at
the end of life. Throughout their stay at Dove house, we are in an ongoing assessment mode.
We need to be able to stay “ on top “ of the patients continuing change of symptoms as end of
life approaches. It is of utmost importance that each patient has individualized care for the best
outcome of symptom management at end of life. Hospice promotes quality, not necessarily
quantity of life. Symptoms at end of life typically require utilization of opioid and nonopiod
analgesics, anxiolytics, antiemetics, corticosteroids, laxatives and antipsychotics. Stacia had
the opportunity to provide patients with medications such as Acetaminophen, Morphine,
Haloperidol, Lorazepam, Prochlorperazine, Atropine, Methadone, Lasix, Senna, Ipratropium,
Omeprazole, Scopolamine, and hydromorphone. She had the opportunity to see medication
effectiveness as well as ineffectiveness. When medications are determined ineffective for the
patient she learned the rationale and experienced the changing of that individuals medication
regimen in order to find the correct medications for their symptom management.

Stacia did extremely well working with our patients and families. She was able to utilize a
holistic approach by working with the family unit. She realized that the end of life care is not
strictly care for the patient but for the family as well. She used wonderful active listening skills
and would always follow through with all she said and did. Families and staff alike were
impressed with her abilities. She was immediately accepted into our small group and worked
as part of our team, nothing was beneath her as a caregiver. That being said, she also knew
when to delegate tasks, and who to ask for help, whether it be a Tech, a Chaplain, a Secretary,
she was able to delegate for positive outcome for the family unit. She has a very
compassionate ear and demeanor which is so very important at this time of an individuals life.
She was able to see, and work with our families, noting that each family member is at a
different stage in their acceptance of their loved ones illness. She recognized critical thinking
for the family unit is essential in all aspects of the dying process. Whether for medication,
physical care , emotional, spiritual, she recognized that the family unit was an integral part of
nursing care.

Thank you for having Stacia take part in the hospice setting. I hope she gained good and
essential training with us. I personally enjoyed being part of her personal and professional
growth as she completes her nursing training and would love to be able to work with her when
she becomes an RN.