Advice for a new nurse about hospice

redheadedvixen · May 7, 2009

I would ABSOLUTELY recommend a year of med-surg or another type of hospital experience first. I became a hospice nurse after two years of experience in cardiac and oncology and still sometimes I worry that I'm not making the right decisions. You are on your own 99.9% of the time and while I can call the office to ask for advice there isn't always time to do it.

So yes get some experience at just being a nurse first and good luck!!! :)

Maryann RN · May 7, 2009

I absolutely agree with the last writer. I've been a nurse for 19 years. I worked in med/surg, L&D, day surgery and psych ( even did a couple of years as a travel nurse) before I went to hospice. It is a wonderful fit for me now but I am grateful for the prior experiences, which helped prepare me for hospice. Hospice requires good assessment skills and the ability to communicate comfortably with doctors as well as work on you own. the autonomy is one of the things I like about hospice, but it can be intimidating. I would recommend at least a year of some type of medical and a year of psych if possible. I started in a hospice inpatient unit which was a good place to begin. I am now a hospice home care nurse/case manager. No way could I have done this right out of school. Good luck and congratulations on your graduation. You've chosen a wonderful and diverse profession.

gt4everpn, BSN, RN · May 7, 2009

well in hospice, alot of what nurses do if geared toward ''comfort care'', so your main focus is keeping the patient free from pain etc.. i work in a hospice unit from time to time and it can get busy with admissions, paperwork, working with hospice agencies, working with families, giving out some meds etc.. but you do loose alot of other skills you would learn in med-surg or other areas. if its what you want to do them go for it

KateRN1 · May 7, 2009

I think that a lot of it depends on what kind of hospice you're talking about. If it's a hospital-based palliative care unit or a hospice home, then you're probably okay to start there as a new grad. If it's home-health-type hospice where you visit clients in their homes, then I would seriously recommend at least a year of hospital/SNF experience. It's not about the technical skills, it's more about developing interpersonal skills and your "inner nurse." When you are in the home, you have a lot of autonomy and a huge amount of responsibility. A year or two to learn how to function as a nurse is very valuable.

BandEmom · May 7, 2009

I struggled with this too as a new grad. I was not happy about working med-surg. But honestly, you need to listen to lots of sick lungs with someone else around to agree with you, before you can confidently assess one out there by yourself where you have to make a decision about whats a new change or decline. You will benefit from talking to many doctors with other nurses around "on your side" before you can confidently advocate or respectfully disagree with one on your own. Your passion and great heart will still be there after you get all this stuff under your belt and hospice will still need you.

JNF RN · May 8, 2009

I did just over a year in an acute care hospital before hospice. I think I benefited from that experience. Believe me, a year goes by real fast when you are a new grad!

NurseMarla · May 9, 2009

I'm a new grad too, and I started my first nursing job on Thurday (5/7) as a Home Hospice RN Case Manager. I have mixed feelings about this. This is, without a doubt, where I belong and I have felt confident while at work. All the other nurses and supervisors have been very supportive and encouraging; I couldn't hope for a better team. We have one other RN who was a new grad when she started there 6 months ago, and they have nothing but praise for her.

The mixed feelings come in when I get home and start thinking these people must be nuts if they think I'm a nurse :nurse: :wink2: That would probably be the case though regardless of where I started.

When I was hired, I was told that the company does not shy from hiring new nurses because everyone as to be trained, but at least we don't have to be trained out of the bad habits we've picked up elsewhere. I did work for a year as a PCA doing in-home care during nursing school and that went a long way toward acclimating me to the environment and patients.

So to sum it up, yes, the ideal may be to hone your nursing skills in a more traditional area; however, if you can find a supportive company with good orientation then you shouldn't rule it out. And this is not based on my experience (since I only have 2 days worth), but what I have seen & been told by those I now work with.

heron, ASN, RN · May 9, 2009

All the above posts are good advice. I would just add that it would be interesting to ask those instructors who feel hospice would be a "waste of skills" to explain exactly why.

The ability to assess patients with often complex medical issues is key ... takes quite a bit of skill and critical thinking to do this.

Just what skills are they worried about?

tencat · May 9, 2009

I agree with KateRn. If you have an inpatient job, then out of school is fine. If it's a home hospice job, get 6 months to a year in med/surg. I had 8 months med/surg experience. I really don't like med/surg, and at times felt like a glorified waitress/maid, but I learned a lot from it. The autonomy in hospice is wonderful, but it is intimidating if you are new and need a lot of support from your peers. I couldn't have done hospice without having the support and training I had in the hospital with med/surg.

What is that ignorant crappola from the nursing faculty that hospice is a 'waste' of skills????? Ugh. So many medical people are so clueless and ignorant about hospice, and so many of them don't want to learn about it, either because we're not 'saving' the patient. Drives me NUTS. Ok, off soapbox now....:angryfire

thekid · May 11, 2009

I was hired as a hospice nurse right out of graduation as well, the company provided me with excellent training and support. There was always another nurse on call that I could contact. Before that I had worked in nursing homes as a CNA and LPN so I already had some experience.

best of luck to you, of all the agencies, homes, etc I've worked, hospice has been the most rewarding.

rnboysmom · May 11, 2009

Went into home based hospice 6 months after graduation but had worked on a busy med surg floor as a student nurse for a year then 6 months as a graduate nurse. Would I do it again----probably not. I had a lot of life experience even prior to starting nursing school at 30 so I dove in head first. I probably wouldn't have done it at a younger age and agree with the above about the psych experience. Definitely, you need to have some significant life experience or some psych experience, if at all possible. Death is one of the biggest stressors of the family unit and people tend to do strange things that they wouldn't ever THINK of doing at any other time in their life. It takes a lot of composure, compassion and sometimes some quick thinking on your feet. Good luck with whatever you decide to do!!!!!