Advice please!

  1. Hello everyone!

    I'm a new grad, been working on a med/surg floor for 7 months now. I really enjoy my job but I'm interested in Hospice. When I was doing my pre-req's for nursing school my Grandpa was dying of cancer. I remember what an impact the Hospice nurse had on calming our family's fears, answering questions, and what great care she took with my Grandpa. I can remember watching how great she was with everyone and kept thinking "wow! I want to do this!" I hope this doesn't sound terrible, but my greatest feelings have come when I held a pt's hand as they passed away, when I was with them as they went to a better place. I find myself more interested in the hospice pts on the med/surg floor. I try to take extra time with them, even if it's just talking about their families, or giving them a hug when they say they're scared. I think I would enjoy Hospice.

    My question is.....would it be better if I stayed on the med/surg floor a little longer to work on my skills, or would I be ok with 7 months med/surg experience? What are the pro's and cons of Hospice? How do you deal with families that aren't ready to accept a loved ones death? Is the pay comparable to the hospital? I'm not trying to sound materialistic with the last question, but I still have student loans to pay off! Thanks for any advice you have!
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  2. 10 Comments

  3. by   aimeee
    Hard questions. Pay here is maybe just a little under hospital rates. As for your readiness, it depends somewhat on whether you are talking about inpatient hospice or home hospice. For home hospice I think you would better serve your patients after having some more experience. Do you have a separate oncology ward? Some experience there would be very beneficial. Why don't you give your local hospice a call and express your interest and ask them what they would like to see in an ideal candidate?

    Dealing with family members, or patients, who are still in denial is difficult. There is no one answer. Often the counselors on the team are of great help. You feel your way through, I guess, trying to tactfully pull back the curtain on reality and urging them to look through.
  4. by   Pammy
    I agree with aimeee that you need to spend more time working on your skills, before you try hospice. In this profession, you are kind of out there on your own; and these people look to you for everything!

    Hospice patients are not all terminal cancer patients, either. You have COPDers, Dementia, and a variety of other terminal illnesses in hospice. Most Hospices require a variety of experiance before they will hire you.

    Keep in mind that you will be dealing with more than a client's illness.... they each have emotional, religious, and family issues that you will be involved in resolving. And often, the family issues are extreme. Be prepared for fist fights, attempts at suicide, anger directed at you because there is no one else.

    Hospice, to me, is a challenge; and it is wonderfully rewarding. Difficulties aside, I knew I belonged in Hospice years before I started doing this type of nursing. Do check with some of your local hospices, as aimeee suggested. Perhaps if you signed up for rotations through the different areas in your hospital, you could widen your experiance.
  5. by   namaste
    I have my certification in Hospice and Palliative nursing. I would recomend to give yourself a full year in med surg and/or oncology. You will be in situatuons by yourself and want to be able to give the best care possible. Start learning all you can now about comfort care. It won't take much to know more than most doctors. The pay is generally better, but it is hard for benifits to compare with larger institutions. There is usually call time involved in addition to regular hours. It is field that has made me feel like I have truly made a difference in my patients lives. I love it and hpe you will also!
  6. by   rainfallrx
    I just recently started a new job in Hospice. I have been a Med/Surg nurse for 2 years. I really want to be able to do this job, but I doubt myself at times. I feel as if there are more experienced and talented nurses that work there. I don't know if I am good enough for this job. I have never before had to decide on my own what med a patient should have. I'm used to calling the MD and saying.....Mr.(whatever) is having increased pain in his abdomen and is asking for his pain medicine every 4 hours on the dot, WHAT WOULD YOU LIKE TO DO? I just feel a little uncomfortable and afraid that I won't be able to be a good hospice nurse. Hospice nursing is so different from hospital nursing. Is this a normal feeling? Has anyone that was new to Hospice felt this way before? If anyone has any comments, I would greatly appriciate it! Thank you!
  7. by   dosamigos76
    Quote from rainfallrx
    I have never before had to decide on my own what med a patient should have. I'm used to calling the MD and saying.....Mr.(whatever) is having increased pain in his abdomen and is asking for his pain medicine every 4 hours on the dot, WHAT WOULD YOU LIKE TO DO? I just feel a little uncomfortable and afraid that I won't be able to be a good hospice nurse. Hospice nursing is so different from hospital nursing. Is this a normal feeling? Has anyone that was new to Hospice felt this way before? If anyone has any comments, I would greatly appriciate it! Thank you!
    I work in hospice and I still would present the information to an attending as you presented it. Some nurses have a different style and will tell the MD what they want and it works for them, but that is not my style. I also feel as their MD, it is THEIR call. I will sometimes call our pharmacy and get a consult on the phone for their suggestions and have that in hand when calling the MD.

    You WILL do great! We all feel the same way at one time or another, especially in new situations. I absolutely LOVE hospice. It's hard sometimes making the transition in thinking from hospital to hospice.....but you will. It would be hard for me to go back to hospital work now that I've been doing hospice, but it all works together and works for the betterment of your patients.

    Good luck, and you'll do great!!!!!!!!

    Cheryl
  8. by   Mais-Rose
    Quote from dosamigos76
    I work in hospice and I still would present the information to an attending as you presented it. Some nurses have a different style and will tell the MD what they want and it works for them, but that is not my style. I also feel as their MD, it is THEIR call. I will sometimes call our pharmacy and get a consult on the phone for their suggestions and have that in hand when calling the MD.

    You WILL do great! We all feel the same way at one time or another, especially in new situations. I absolutely LOVE hospice. It's hard sometimes making the transition in thinking from hospital to hospice.....but you will. It would be hard for me to go back to hospital work now that I've been doing hospice, but it all works together and works for the betterment of your patients.

    Good luck, and you'll do great!!!!!!!!

    Cheryl

    Thanks to the one who asked this question and many thanks for the response. This is similar to a question I had posted earlier this morning. I think maybe I have my answer from your reply to the other user's question. However I will repost my question and hope for further input. I also must add that my 4 years nursing experience have been sporadic due to home situation. I often have to resign to take care of sick children at home etc. I have been home for 6 months and before that I was in a clinic for 1 year. So maybe I need to some recent med/surg experience before tackling hospice, huh?

    Here is my earlier post copied and pasted: :spin:

    >>>Hi everyone. Please help me decide if I want to take this job I was offerred. It is in an 8-bed inpatient hospice center, staffed with 1 RN , 1 LPN and 2 NA's. I will be the sole RN on the floor. I have never done hospice nursing, but have 4 years of nursing, 3 in med-surg. I want the job, but I wonder if I will need another RN to orient me to the unique aspects of hospice. Please answer ASAP, I have an intervierw tomorrow. Just got the call yesterday. I do appreciate any input. Thanks<<<
  9. by   aimeee
    Your new employer should be thoroughly orienting you to the unique aspects of hospice. This is a good question for you to ask in the interview.
  10. by   ex1140
    Quote from rainfallrx
    I just recently started a new job in Hospice. I have been a Med/Surg nurse for 2 years. I really want to be able to do this job, but I doubt myself at times. I feel as if there are more experienced and talented nurses that work there. I don't know if I am good enough for this job. I have never before had to decide on my own what med a patient should have. I'm used to calling the MD and saying.....Mr.(whatever) is having increased pain in his abdomen and is asking for his pain medicine every 4 hours on the dot, WHAT WOULD YOU LIKE TO DO? I just feel a little uncomfortable and afraid that I won't be able to be a good hospice nurse. Hospice nursing is so different from hospital nursing. Is this a normal feeling? Has anyone that was new to Hospice felt this way before? If anyone has any comments, I would greatly appriciate it! Thank you!
    Please...you are definitely intitled to feel this way. I just started in hospice nursing a little over 6 months ago and at first I felt like I didn't know anything...I was really just feeling my way through. :spin:

    However, I am starting to appreciate it more and more...I have been really blessed because my patients and their families have been super. I pray that this will continue because going into a strangers home is no fun. You don't know what to expect. I don't make a lot of money, but I can say this about hospice nursing it's the least stressful of the areas I've worked. In fact, I've had more headaches trying to educate families than the actual patient care.
  11. by   ex1140
    Quote from Scarlette
    What are the pro's and cons of Hospice? How do you deal with families that aren't ready to accept a loved ones death? Is the pay comparable to the hospital? I'm not trying to sound materialistic with the last question, but I still have student loans to pay off! Thanks for any advice you have!
    CONS:
    1) Watching someone die, with sad family members at bedside, can be depressing.

    2) The pay is usually low.

    3) Unless you find a Hospice unit in a facility you'll be going into strangers homes.

    4) SOME families think that the hospice nurse is a slave to the patient and they should be doing something for the patient every 5 minutes.

    5) Some families are frightened by Morphine...and even when the patient is in pain they don't wont you to give it, same with Ativan.

    6) Some families will pick you apart with questions on the patients disease process as if they are receiving curative care...and some may ask about your salary...

    7) Family will often fight about a patients care...they are often in denial about what they should receive.

    8) MANY families will continue to treat your patient like they are receiving curative care which can be very frustrating. Mothers and fathers are often treated like little babies by their grieving kids.


    PROS:
    1) If you work in a patients home he or she will be the only patient. :spin:

    2) The patient has a DNR order. (no reason to be nervous about coding)

    3) Families can be very nice, offering food and refreshments, tvs and even the use of a bed if you stay over night and the patient sleeps well. (no I don't accept):trout:

    4) You get to see a different side of nursing, the opposite of what you are accustomed to...it's not curative.

    5) You can very well start to value your own life more.

    6) Unlike working in facilities when you work in someone's home you may feel more relaxed.

    7) Because of the nature of the situation...family members can help by giving medication and assisting with baths and other activities involving the patient.

    8) There is a satisfaction you get in knowing that you have comforted someone and hopefully made their last day or hour a little better.

    I know most nurses don't venture into this area for money because the concenus is pretty much the same...the pay is low in comparison to other areas.
    And last, but not least...I think Hospice nursing is a calling...because of it's nature it is not for everyone...but for those of us that love it's God Bless!
    Last edit by ex1140 on Nov 14, '07
  12. by   introspectiveRN
    Given your previous experience and your own description of what you are perceiving hospice to be, I would strongly suggest working in an inpatient hospice unit first. And IMHO you can go ahead and apply now. If you are highly motivated and a quick study, working in an IPU should be doable. In starting in an IPU you will be around other nurses so that you ask questions (not so in homecare), you will be in closer contact with the attending physician (not so in homecare), you will have a charge nurse/clinical resource (not so in homecare), and you will get to see a variety of clinical pictures simultaneously that will provide you with a much better base for assessing terminally ill or actively dying pts and giving palliative pharmacological care (not so in home care), as well as learning the meds (via formulary or MUGS etc.) so common to pallliative care- (you can guess what to put here).

    In home care settings, you are the defacto Doctor. With some rare (in my experience) exceptions, physicians expect you to make the ultimate judgement call determining what medications will best benefit your patient at that particular point in the clinical picture (which can change pretty quickly). Physicians and patients alike are placing an enormous amount of trust in confidence in you and you must be ready for this responsibility. Working in an IPU would give you time to mature/ripen into this very different culture of care.

    I liken hospice home care to a three-legged stool:
    leg one: you must have excellent assessment skills- both physical, cultural, spiritual, psychosocial and emotional (to name a few). For instance: if your patient is experiencing increased episodes of anxiety, you must be able to differentiate the etiology. Is it increased WOB? is it spiritual distress? is their caregiver stressing them out, are they getting any sleep? etc....Hospice is holistic (really, whole-istic) medicine at it's finest.
    leg two: you must have excellent communication skills (read: emotional maturity and tolerance). The psychosocial/therapuedic communication skills in many cases will make or break your enjoyment of your job as a hospice nurse. This is not just in how well you communicate with your patients and their caregivers, it is also how well you communicate with your team and how you talk to yourself about all that is surrounding you.
    leg three: Administrative/attention to detail. You MUST be prepared to spend at least one third of your total time on paperwork if you work home care. You will have work littered in every corner of your life: your car, your house, your purse etc. You have to be able to document well and on time because this is how your office gets paid (and then is able to pay you). You must also be comfortable with feeling something hanging over your head because there will always be one more thing you need to write out.

    I see no reason to continue working med/surg. The truth is that if you decide to take the plunge in any job change in nursing it will be a new experience that absolutely overwhelms and intimidates you. There are very few truly easy seguays from one specialty of nursing into another. Nursing is too diverse for that. Just expect to be overwhelmed. Expect to feel lost. Expect to question "what on earth was I thinking?!". Because this will be the case with any change you make in nursing.

    Good Luck!

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