Can a new graduate be a hospice RN?

[fireball78]

Hi there.

I just finished my 1st year of nursing and will graduate next May. I have pictured myself as a hospice nurse, even before I entered nursing school! I was with my step-dad who battled lung cancer for 7 months before he passed away. His death was the first that I have experienced, and I was surprised by the experience. I was witness to him slowly dying day by day, lose of his independence little by little, pain (which was managed very well), and eventually he lost his hope (which was the worst of all for me to see). When he died, surrounded by his family, I felt relief that he was no longer suffering...no more pain. I am a spiritual person, and I found the experience of being with a human as they transitioned from earth to heaven, very rewarding. I felt honored to have been there...I was also relieved that he didn't die alone! That was my worst fear as his disease progressed. I was very sad at the loss of my step-dad, but never felt anger as I knew where he went...no more pain, no more suffering. From then on, almost 2 years, I have wanted to be a hospice nurse. Even though I am spiritual, I realize that not everyone is, and I am not preachy about my beliefs. I am just explaining my experience.

I would like to hear from hospice nurses, if I can be trained as a hospice nurse right out of college, or if I have to "do my time" in a specialty such as Med-Surg? The thought of working in Med-Surg makes me nauseous! I would not be a good Med-Surg nurse, as having 4 or more patients to focus on at one time will not leave me any time to build a proper rapport with my patients. As I am still a student, having only 1 patient on clinical at a time, I haven't figured out how a nurse priorities care -- medications, wound care, trach treatment, foley insertion, and head-to-toe assessments! During clinical, I tend to spend more time with my patient than my classmates. I love talking to them and getting to know them. Being a hospice (or a home care) nurse appeals to me as well, because I would be with one patient at a time (as least from what I have read/heard). I am 32, never married, no kids, so being on-call, working nights/weekends isn't something that would bother me. I have lots of friends and family, and I do know that having a social life and taking care of myself would be of importance as a hospice nurse, so I don't burn-out. I just don't want to be any other kind of nurse, other than a hospice nurse!

Does anyone know of agencies who hire graduate hospice nurses? I currently live in PA, but will ultimately like to relocate to CA where I am originally from.

There is a hospital in my area that offers a 6-month internship for new home-care nurses. The first 3 months are spent in Med-Surg/Oncology and the next 3 months are spent training as a home-care nurse. I am thinking about applying for that, but there is certainly no guarantee that I would get it!

Any advice you have would be appreciated. Thank you! :redbeathe

[fireball78]

HI FIREBALL,

My first job out of school was with Hopsice. I loved it. I don't think it mattered whether I had M/S experience or not because the RN's I worked with taught me what I needed to know anyway. Well.... I left Hospice and now work on a M/S floor (my husband likes the whole union idea), and let me say... I MISS HOSPICE very much. I learned a great deal. New nurses go right inot M/S or ICU or other places without knowledge, why not Hospice. I say go for it, if that's what you feel is your place. Good luck.

Hello Mightymitern,

Thank you for the encouragement! I have such a passion for Hospice, and know that it's the area I want to specialize in. Going into M/S after graduation just seems wrong, because it isn't where my heart is. I start volunteering with a hospice agency next month. I am really excited about it, and know that I will learn a great deal.

[kdrntx1]

I love seeing the "love" for hospice in new grads! I would hire a new grad, but probably at an inpatient unit until there's experience with skills. Reason being is you have to be very comfortable when you are in the home, doing a catheter insertion, in a dark room, with a large female, and her family standing around the bed watching your every move. Haha! Or, your pharmacy delivers your IV and no pole. Hmm.. a little innovative engineering with a coathanger and hallogen lamp works. Being "in house" with other experienced hospice nurses also allows you to get comfortable with the "talks" all hospice nurses eventually have to give. The talks about AHN, DNR's, starvation, the truth about CPR, when the pt has been without food or fluid for 30 days and family is second guessing their hospice decision. Everything that made me an expert in this field, I learned from other more seasoned hospice nurses.

That being said, the one thing I can't teach is the love of hospice. You already have that, and I love seeing that in applicants - no matter what their experience! Good luck to you.

[dixiesnurse]

you can totally do it. i have been in hospice for a year now right out of school. if thats what you want to do go for it. i personally am getting bored with it kind of and wish i could practice more clinical skills but i have learned so much in a year. it can be emotionally draining more than anything and a lot of paperwork. I work for a great company that pays well and is supportive and that helps immensely.

[fireball78]

Dear kdrntx1 and Dixiesnurse,

Thank you both for responding to my thread and providing support and advice.

Even though I have a year of nursing school ahead of me, I have been checking out hospice job postings. They say they want 6 months to 1 year of experience in an acute setting. When I start applying for jobs next year, should I go ahead and apply for these positions even though I don't have the experience they are looking for? Would that be wasting their time? How/where should I look for a graduate nurse hospice position? Do they exist because I haven't actually seen a job posting yet for an inexperienced nurse....very discouraging!!

I love the Allnurses website! I spend a lot of time on here researching and just reading what nurses/nursing students are feeling....knowing that I am not alone in my fears. This is a very supportive blog!!!!

Thank you!

[mschelee, MSN, RN]

I am a new grad and got hired into hospice. I had previous hospice experience though. But I've seen hospice companies hire new grads. My advice is to think about volunteering one day a week with a hospice company, this might get your foot in the door.

Ellie

[NewRN12109]

I graduated nursing school and got a job as a GN on a med/surg/oncology floor. I worked that for 6 months when I accepted a job offer at a in pt hospice unit which I work in for 8 months, I LOVED it but get bored easy. It was the same thing morphine, Ativan, Atropine turn and fluff. After the 8 months I had a chance to take a full time on call position salaried M-F from 4:30PM-8AM working from home. I average 1-2 calls a night but go on the call and turn around and come home again.

So this said to answer your question I think the 6 months of med/surg/oncology was the best thing that I ever did. Going into the hospice unit I was scared and not sure but caught on quick and the AMAZING nurses on the unit taught me all I need to know. I am confidant and do very well in the on call position and there isn't much that I cannot do or have to call in on. I say if thats what you really want GO FOR IT but the 6 months experience on the med/surg/oncology really prepared me well for hospice.

[JaclynRN789]

Hi...I just graduated in May, and SEVERAL of my classmates are Hospice nurses now. My area which is Southwest Florida (Fort Myers area) loves to hire new grads, other than our local hospitals they employee many of us. Many of us did our preceptorship with Hope Hospice. If you like Florida, this is an area your should consider. They have an excellent internship program, and there are so many areas you can go in other than the typical hospice houses. There is home health, nursing homes, hospice houses etc. If you like the one patient ratio then home health would be the way to go. The Hospice houses you will have at least 4 patients. I have an interview with them tomorrow for home health. It is one of the few agencies that hire new nurses for home health as well. Very few places will hire a new grad for home health. Good luck with everything!!!

[EmilyLucille523]

I have almost a year experience with cardiac and med/surg floors and the Hospice place that I've been wanting to get into since I graduated last year still is very reluctant to hire me. "We're worried about your lack of experience," even though I worked as an LPN for 2 & 1/2 years before getting my RN in a long-term care setting with Hospice residents.

Their reasoning is that you are on your own. There is no one there looking over your shoulder and making sure you are doing it right. No one there to run to when you patient is agonizing because they can't breathe. Then there is the trust your patients will lose in you when they see that you don't know what you are doing, so they request for another nurse.

The other issue is that new grads tend to burn out faster (or so they say) because they are not only emotionally strained but mentally have to learn what an experienced nurse already knows (i.e. patient is constipated what do you get them, patient is already on Roxinal put pain is not controlled what do you do next, pt has an open wound that has a very strong odor and you need something to minimize that smell, what do you order?) Then you got to deal with the psychological issues of the families who are not ready for their loved one to die, or the opposite: the family is ready but the patient isn't anymore and changes his/her mind about dying.

I too went into nursing school to be a Hospice nurse. I never even heard of the word "Hospice" until my Mother passed away under their services 8 years ago. The Hospice nurse who took care of her is the reason why I went to nursing school in the first place. But I have a little less than a year of Med/Surg/cardiac acute care experience, is it enough??? I sometimes ask myself that same question, especially when I learn something new every day I work. I hate my Med/surg job and hate that I have to spread myself thin among 6 - 7 patients, but if this is what I need to do to be a better Hospice nurse so that I can give them the BEST nursing care possible, then so be it...I'll just try again next year!

[mylittlelulu]

I am just curious. Would experience as a CNA in a hospice setting help at all? I am already a CNA and have almost a year of experience working in LTC. I want to apply to work in either home health or hospice to get the experience before I graduate as an LPN.

Perhaps that is an option for you, too, Fireball. CNA courses are pretty affordable and average about 3 weeks (here in GA anyway) or it might be possible that because you have your first year of school under your belt you could become a CNA with that and get some experience working in home settings. This will prepare you for hospice later and look good on your resume too.

Good luck in all you do. I have heard the calling for hospice, too.

[teach_hospiceRN]

you will get all sorts of advice from everyone. here is my 2 cents: i graduated from ns and went straight into trauma surgical icu. i had a 3month internship and had a mentor who drove me nutty and so scared i couldnt do one thing right with him. i changed hospitals and learned more in 1 month there. i then started doing agency work wich was unheard of for a relatively new grad. but i wanted to be an icu nurse! so, i learned everything i could.

when i became a homehealth/hospice nurse after icu i was very graterful for the expereice i had in icu learning what i feel i needed to know because out in the field it is you and your gut, oh yeah, and the telephone to the doctor to tell him what is going on. if you learn your a&p and feel comfortable with your assessments, go for it! does your school have any hospice or home health clinicals set up? when you interview with the hospice agency, ask what kind of orientation you will have. just remember, they will tell you most anything. ask what their turn over rate is and why. ask why do they need a new nurse? has their census grown or are they losing nurses because of interoffice yuck as i call it.

i love hospice too and wish you well.

sue

[netglow, ASN, RN]

What if the company has a team: RN, CNA and RN Case Manager?

Anybody have that arrangement? I'm learning about this, and wonder if the RN Case Manager ever in this grouping above, rolls up her sleeves and gives patient care. If you do have to cover call, are you then the bedside RN, administering meds, all care etc? or no? Wondering if this is a total admin/manage job title, and no patient care? Or, do you do mostly the admin/manage and have to jump in when needed to do total care.

This confuses me as far as who does what.

[mschelee, MSN, RN]

so Ive worked as a hospice case manager now for 6 weeks. I am a new grad, but had 3 years in hopsice prior ( 1 in admissions and 2 as a nurse intern) heres my thoughts. I didnt have a hard time with hospice concepts, the diaeases, the meds, the family dynamics ect.. BUT the big thing that will either help a new grad into a hopsice career or have you running for the hills is how well the company you go to work for orients you, especailly if you start in case managment!!!! If they give you 2-3 "ride alongs" with other case managers then toss you to the wolves with a quick "we are here for you if you need it" you will feel overwhelmed and likely run away from the job quickly.

So look carefully at the company you choose to go to, even if they seem sweet and you really like the boss if they are un-organized you will likely end up doing work that belongs to someone else and find yourself stressed.

A good company with a clear cut training program will make it much easier, even if you are not a new grad!

Mschelee