Day in the life of a hospice nurse
- 1Jan 27, '06 by FirstYear2005i am so curious about various areas of nursing. what is a typical day in hospice (nursing) like ? thanks
- 7Jan 27, '06 by aimeeeI'm cutting and pasting a post from long ago. Pretty much the same except we now have computerized charting and address care plans with each visit. (It did not result in any time savings really in charting time but it has made the chart accessible to us when we are not in the office. This is very beneficial to our triage/oncall teams and to people who are doing prn visits.--an aside for others who might be wondering)
A typical day starts with about an hour in the office getting organized for the day, finishing up paperwork, conferencing with others on the team about patients, etc. Then its off to visit usually 4 to 6 patients. Length of visit depends greatly on what is going on. Some might be as short as 20 minutes if they are stable and no symptoms are out of control. Or it might be as long as two hours if there are lots of problems to be addressed. Then back to the office to finish off paperwork and return phone calls etc. for about an hour.
There is a LOT of education involved. Pain management, skin care, signs and symptoms of death, medications and side effects, etc. We are providing the framework and the support for families to take care of their loved ones by themselves.
Paperwork is pretty minimal (aside from admissions). We use a check off system so it doesn't take long to document the routine. Care plans are updated every two weeks and also use a check off system for goals and for interventions so they don't take too very long either. This should go even faster after we get our new laptops and software implemented.
Caseload is pretty manageable at 10 patients per full-time RN. This is assuming there is a good mix of stable vs. rapidly declining patients. If they were all in their final days then that would be very taxing.
- 11Jan 27, '06 by flamingochicI will reply to you on one of my typical days this week. I usually start the day at the Nursing Home. We have several pts living there. I check with the nurses at the center about any changes, i do a complete head to toe assessment, chart all of this in their chart and do a family contact (if the family is not there when i visist). I basically do the same thing at a pts. home, however, there are much greater needs there. Teaching, education and support of the caregiver is the greatest need to me (besides promoting comfort to the pt). They are the ones left with the pt when i go home and i must feel, within myself, that when i leave, they will feel comfortable taking care of their loved one. Now the reality of hospice nursing is this...work a 8a-6pm day, come home start supper and then (you are on call that night) you get called out for a pt.s death- drive 30 miles to the home, comfort the family, be the "strong one" leading the way in what to do, clean the pt up and allow the family time to say their goodbyes, call the funeral home, wait for the funeral home and while you are waiting, we must remove all the pt meds in the home, finish paperwork and oh...did i say WAIT on the funeral home to arrive...after this, you get home, supper is done, the kids are in bed and you lay down. .............the phone rings, you are on call, and you have to go out again.......etc... I love it, live it and I am blessed by it.!!!!
- 3Dec 12, '06 by nurseangel47Use to be a hospice nurse...based on my experience and memory I can answer basics. Started in the office:would first check ongoing log book which had new admits/discharges/deaths/admits to our hospice home, admits to a hospital, etc...quick glance and you'd be updated insofar as the above categories...then quick team meeting in our general clinical area. Had a week's worth of visits already made up the week before which could and did change on a dime depending on pts.' needs and acuities/ that sort of thing.
Called pts. homes before leaving office and told them an approximate time I'd be arriving that day, asking them if they'd be needing any supplies such as dressings, incont. pads, hygiene products like rinseless body wash, wound care products etc.anything nursing or that family needed to provide ongoing care in the home when we weren't there. Obtained lab supplies to take out in case labs needed to be checked, any special procedure supplies like central line cleaning kits, foley caths., etc.
quick smoke with buddy nurses in the outside smoking area to vent before hitting the trail...then off to the trenches!
Usually saw a total of 5 pts. in a day. That, plus travel time made for a full day's work. One part of an afternoon per week was predesignated as a team meeting which was mandatory unless you had a death or other event which needed your presence. Lab drop offs were counted in to your day if labs were drawn but the lab wasn't too far from the office.
Multipe calls while on the road via cellphone to various doctor's for new orders and others on the multispecialty team of hospice such as social workers, other nurses with consult questions, etc.
Lots of paperwork, sometimes had the time in a typical day to either do it while in car parked somewhere safe in between pts., while in a pts' home if they'd let you and not talk the entire time so you could concentrate!, or if near office, pop back in to finish your day so you don't have paperwork at home on your time off when you should be spending it with family, SOs, anyway. Updates to team leader during day if any significant changes in pt's status or condition. Ordering via phone to durable medical suppliers for oxygen equipment, hospital beds, bedside commodes, overbed table, etc.
Calls to pharmacy inhouse to reorder meds if pt was close to needing refills or to their pharmacy of choice outside of our hospice pharmacy to make sure no one was out of meds and had to call our oncall nurse after hours.
Lots of teaching in the home to SOs to provide basic education of what was going on with their loved ones, what to do in case of emergency or urgent situations(emergency kit in refrigerator of all pts. in case of new symptoms/impending signs of death, new breakthru pain symptoms current pain meds didn't relieve).
Hope that this helps.
- 3Dec 12, '06 by WrenNurse Angel did a good job of capturing the "typical" day. The only thing I'd add is that in some agencies (mine!), the Team Leader or Coordinator helps out with a lot of the phoning stuff. For instance, getting equipment or supplies ordered and out to the home, calling pharmacies and sometimes even the doctor if we are busy. How much support you get in the field depends on where you work but it can make a big difference.