home care vs. hospice house

Welcome to hospice!!! I have never worked in a hospice house, but I can tell you that there is nothing like providing hospice care for people in their own homes. It is the most wonderful experience (in my opinion) that hospice can provide. You are part of a team, and work with all your team members. Your Social Worker, your Spiritual Care, and your Home Health Aide are priceless. The family will count on you to guide them through this journey, and you [b]will[b] have the tools to do what is needed. Boundaries are extremely important for you and the family. Ask your peers and your manager for help when you need it and keep your eyes and ears open. Help out when you can and they'll help you when you need it and it's all a learning experience. Make sure to always have enough medications in the home and teach something each interaction with the patient or the family.

Good luck and welcome again!

Welcome to hospice. You are right that the field nursing job is totally different from the facility nurse. I prefer the field. It is often a difficult transition for a new grad RN because it can be a very very autonomous job. But, I know new grads who have done wonderfully so don't be overly concerned. Just remember that although you may be the only hospice professional physically present in the home, you have colleagues in all disciplines who are just a phone call away who are invested in your success and the patients experience. My guess is, unless you despise the travel, you will love visiting these families in their homes! GOOD LUCK!

Hospice admissions are LONG, no question and no getting around it. Hopefully you work for an agency that acknowledges this fact and actually plans for it. My only suggestion is to keep on keeping on. It takes about 6 months before you will really feel like you know what you are doing in the field most of the time. It takes about a year before you feel like you can handle most things that might come up. I personally feel that no nurse new to hospice should be doing admissions. Unfortunately, most agencies do not have provision for admission teams or admission specific nurses and so they just get spread around. Just remember that you will get better, and faster as you gain experience with the assessments, with the software, and with the overall documentation. 4 hours is about average though.

It is helpful when going to do an admission, first pull out all the paperwork that will need to be signed by family and set that out to one side with a paperclip. If you have a folder that you will be giving to family, put all the packets for their information on one side (stuff for them to read later including your end of life book). I only go through legals and do the careplan with the family, then do the physical assessment while in the home, and go over the 24/7 coverage by the hospice team... As long as patient is stable, I can usually do this within an hour. I tear off any copies that they have signed and put them in the other side of the patient folder. give them stickers for their phone. As for their medications, I tell them I will bring a copy of their medication list on the follow up visit (that way I have a chance to put the meds in the eho system and print out an MAR and mark WHAT IS COVERED based on their diagnosis). The second visit is usually 1-1.5 hours to reinforce hospice services and a nursing physical assessment.

The last two admissions I have completed, i've been suprised as the families thought medicare/medicaid would provide nurses 24/7. I reinforce that we have an inpatient unit for patients in rapid decline, or for respite...

as for working at an inpatient unit. I LOVE our inpatient unit, and I still work there PRN during the week. I work the weekend on call for our homecare hospice patients and I love the flexibility. If I didn't do the weekend job, I would like to work full time at the inpatient unit, because you do your shift and you are done. Thirdly I would work in the field monday through friday, there is alot of driving and you have a caseload of 12-14...

linda