ICU to hospice nurses (and GrnTea), please advise :)

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    Odd title, I know. I don't know if it's proper etiquette to ask for advice from a specific member, but I did. And, GrnTea, maybe you have done hospice nursing; I don't know. I know you have said in previous posts that you have done a lot of different things in nursing, including ICU. So, I'm playing my odds.

    So, here's my question for all ICU nurses who have transitioned into hospice nursing. (And, GrnTea who has done ICU, but may or may not have done hospice; you just tend to give really good advice, so I'm hoping for the law of averages here in that you'll, too, give me stellar advice lol).

    What was the transition like? Were you happy you made the switch from ICU to hospice? Or did you regret it? Is there the kind of rapport in hospice that there is in ICU? Do you get to direct care like we do in the ICU? You see, I don't hate my job. Or nursing. I understand that no job is perfect, and my job is way better than other jobs I could be doing because I do make a difference.

    Yes, even when I have to run all over the unit looking for IV channels that I called for an hour ago anticipating that my patient that is now crashing is, indeed, crashing. Yes, even when the family asks me to pull the patient up in bed even though I just did 2 minutes ago, and restless 300 lb patient slides down in bed. Again. I'm not a disgruntled employee looking to run away from the bedside. I applied for a bedside position as a hospice nurse in a hospice house because I enjoy direct care.

    I don't hate the ICU. I enjoy it most of the time, but the reasons I applied for a hospice position are probably apparent to anybody who has worked in ICU for any length of time. (I haven't been an ICU nurse forever, just a few years). But, I have seen medical futility. I have seen good deaths, and I have seen bad deaths. I find that the most rewarding part of my job has been terminal weans, and end of life care.

    Advocating for my patient at end of life and having the team initiate that discussion with family, easing the transition. Helping to make the patient as comfortable as possible during the dying process are some of my most rewarding days. I have had families ask me to follow them to the hospice floor during those times. (Obviously, it is equally rewarding when a patient makes a full recovery, but elderly people with multiple comorbitities have the odds stacked against them).

    It's a tough decision, and right now, I don't even have the decision to make. I just started the interview process. I'm very, very excited about the potential opportunity, and I think that if I get the opportunity, I will ask for a shadow day to ensure how satisfied the staff are, staffing ratios, etc.

    But, it looks like a beautiful facility. Holistic. A place where the dying can die in peace. And, with dignity. A place as home-like as possible. I always feel bad when my patient dies in the ICU after a few weeks of treatment, but understand that that's just the way it is sometimes. I do believe that hospice care is greatly under-utilized. Treat, treat is the modality, and that's not always appropriate.

    If you made it to the end, I applaud you. And, I appreciate your time. I love Allnurses! . I just learned about Haldol for intractable nausea, and Haldol Gummy Bears in hospice from none other than.....the hospice section on Allnurses! We're a pretty awesome group, aren't we? (Meaning everybody on Allnurses is awesome, not just the hospice section ).
    EMSnut45 likes this.
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    I made it to the end! Hahaha!

    I am an icu nurse gone hospice. Home hospice, but hospice nevertheless. I went into it for the same reasons you did. I've seen good deaths and bad deaths. The good ones were usually the terminal weans, the bad, cracking the ribs of a 99 y.o. LOL. I've seen people kept alive for social security checks. Horrible.

    You sound very well cut out for this position.

    A big difference is in hospice it is really a fully involved family nd patient dynamic. You get very deep into the psychosocial aspect of nursing. In the hospital, in the ICU, even we may speak end of life or decision making, but many more feelings and dynamics re brought up in hospice.

    Helping a patient achieve a comfortable nd dignified death is no easy feat. But very rewarding.

    Good luck!
    GrnTea likes this.
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    Thank you! I hear you on everything you just described as far as good deaths and bad deaths. I'm hoping I'll hear something soon as far as what my next step will be in the interview process. I am drawn to hospice, and it's not something I'm looking to do temporarily. I hope to possibly even open a hospice house in an area where it's marketable to do so (an area of the country that needs a hospice house) in the future. I fully realize that might not happen as I plan on starting a family, raising kids, but one can dream, right? Maybe it's something I could do once the kids are more self-sufficient, high school age. It's something that would require an incredible amount of time invested.
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    I'm so glad I'm not alone! I love the ICU, but hate the futile end of life care that is pushed upon many of the patients. By looking at your profile, I believe we have roughly the same amount of time in as nurses. My goal is to end up in Hospice as well. At the moment I have stepped away from the day-in/day-out bedside, but still am using my critical care skills as a transport nurse. I find this allows me to focus on the immediate stabilization with a max of 3 hours with any one patient. I'm not smack in the middle of the family dynamics or becoming emotionally involved in the care of the patient. Once I lose my need for adrenaline rushes, I will be joining the fantastic nurses at the local Hospice House!

    Best of luck to you as you find your niche!
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    I actually did work briefly as a hospice liaison nurse, doing patient, family,and community education about the hospice benefit and services. It was probably officially a marketing position but I came to it after listening to hospice nurses do similar work with my patients when I did inpatient case management, coming in on moment's notice to explain what hospice was and more importantly, what it wasn't. I was so impressed by their ability to be so fully in the moment, that their practice was almost 100% NURSING, and the idea (after years in ICU) of allowing and working actively towards achieving good death was something we could --and ethically, should -- all do. It was work I loved and was very committed to, and I got great reviews from many sources, but within three months of my hiring there was a massive reorg and the newest hired were all let go....::sigh::

    I still advocate and educate for hospice whenever the occasion arises, keep all my lists of qualifying diagnoses, and just noticed that the clipboard I use to do the Sunday paper crossword is a hospice handout. I know that many ICU nurses do go to hospice for the reasons described above-- we have seen, and alas, sometimes done horrible things at end of life in the name of "do everything," and we know better than most what "do everything" means. We know that "giving up hope" is not what hospice does-- we may not be able to hope for cure anymore, but we can hope for comfort, symptom management, and knowledge that loved ones will be cared for after the death. Hospice does that; if there is balm for a recovered ICU nurse's soul, it's that knowledge.

    Don't know if that helps, GMG, but hope so.

    And if you ever want to contact someone here personally, using the PM thing is the way to do it-- click on the poster's name or search it, then click on "Send a PM."
    Esme12, Good Morning, Gil, and EMSnut45 like this.
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    Thank you guys! EMSnut, it sounds like you're in a similar boat, but I'm glad that you're enjoying being a transport nurse; that wouldn't be for me as I like the continuity of care in the ICU. But, I could see how that would be a perfect fit for someone that was or is currently doing EMS (I'm assuming based on your username ).

    Thanks, GrnTea! Awesome advice, and it sounds like you are enjoying your work, which is important. It does seem that ICU nurses go into hospice more often, but it makes sense. And, then there are those that knew they wanted to do hospice from day 1. That wasn't me obviously. 10 years ago I didn't know I would be a nurse let alone have a passion for hospice or the hospice heart as people sometimes call it. I have talked with another person whom I formerly worked with elsewhere, and, while she does home hospice, she loves it. And says it's the most rewarding nursing position she has ever had.

    So, for now, I'll play it by ear as the decision is not in my hands yet. I'm hoping I'll have a decision to make , but we'll see. I will most definitely still stay in the ICU on an as needed basis even if the position is offered to me, and I do decide to take it.
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    I'm not an ICU nurse, and I'm not GrnTea. I'm ~*Stargazer*~ and I'm an ED nurse, though I've done a few different types of nursing.

    Your post interested me because I, too, have considered Hospice "some day".

    Some of my most rewarding experiences as a nurse have been working with dying patients; I've been forever changed by some of these experiences, and I share your views about how hospice care is so under-utilized.

    I just want to say good luck with your transition, and keep us posted on how it goes!
    Good Morning, Gil and GrnTea like this.
  11. 1
    Check this thread too, for more good info on hospice:

    http://allnurses.com/general-article...209-page2.html
    Good Morning, Gil likes this.
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    I am an ICU nurse but work in an inpatient hospice on a PRN basis. I got into it for precisely the same reasons you did. I love the excitement of a sick ICU patient, there's nothing like feeling that you saved a life today. Unfortunately, it does seem like an awful lot of the care is futile in the ICU.

    I have been rather disappointed with my job as a hospice nurse, although that's probably because of the facility rather than the actual nursing. It's very difficult for patients to qualify to be brought in to the facility and I often feel that the patients aren't benefitting by being there. There has also been a recent overhaul in administration and they're currently lacking a decent physician since theirs left. I find that I frequently disagree with the practices at the facility. I also truly expected the nurses to be a little more compassionate.

    I still feel like I enjoy my "comfort care" patients waiting to be moved out of the ICU more than my hospice patients at the inpatient facility. I do realize that this is probably strictly related to my experience at my hospice facility.
    Good Morning, Gil likes this.
  13. 3
    I went from ICU to Hospice, and I have found it to be a great transition. I was never really the "adrenaline junkie" type, and although I enjoyed holistic patient care, being detail-oriented, and working with families, it just wasn't my cup of tea. And, of course, you always run into the "futility of care" dilemma at some point in ICU. Like you, I did greatly enjoy the teamwork and camaraderie in ICU. I miss a little of that in Hospice, perhaps, since there isn't a mass of people converging on a code, but I still have great conversations with co-workers as I learn the ropes in Hospice. They are always willing to let me bounce something off of them or offer a creative solution to a tricky problem.

    Additionally, I have found that many of my ICU skills are well-used in Hospice. The assessment skills, the ability to recognize when a patient is changing at end-of-life, and the ability to plan ahead for possible emergencies are all pertinent in Hospice as well. Oh, and both ICU patients and Hospice patients tend to be hard sticks, so I'm quite popular for blood draws and starting IVs.

    The only advice I would venture to offer is that in Hospice, you must really embrace caring for the family as well as the patient. (I find this to be similar to ICU, actually). Many times, the family actually requires much more care, education, and reassurance than the patient does. Some find this exasperating; I find it natural and rewarding when I can help them through the difficult process of losing a loved one.

    All in all, I love Hospice. It's been my favorite job so far. It isn't easy, but as GrnTea mentioned, I do feel that I am able to perform almost 100% nursing care. I get to do that emotional/education/spiritual piece that wasn't often integrated in the ICU. Best of luck to you whatever you decide!


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