Home hospice care ?

Hi Rascal,

When I worked as a home hospice nurse, my job title was a "Primary Care Nurse", or PCN. I was both the case manager and the patient care nurse who made home visits.

We were given caseloads of 15-20 hospice patients. We made visits to these patient's homes in order to do nursing evaluations and assessments, do patient and family teaching / education, perform nursing care such as inserting Foley catheters, manage and re-fill med prescriptions and many other duties. The case management work involved A LOT of paperwork and many phone calls. In hospice, you work together with your co-workers as part of an "interdisciplinary team" or IDT. Once a week, we all got together at the hospice office and had an IDT meeting, with all the PCNs (nurses), CNAs (aides), Patient Family Counselor (Social Worker), Chaplain (pastor), Clinical Team Leader (nurse manager) and our hospice ARNP (nurse practitioner) and hospice physician. We would discuss the care of all our hospice patients on our team and we would do our care plans together. Our hospice physician relied on us PCNs to give detailed reports on whether our patients were improving or declining and whether our patients were still hospice appropriate or needed to be evaluated for discharge from hospice (yep, some patients graduate from hospice alive). Obviously, with hospice, we saw and cared for many people who were actively dying at home.

We nurses are called Case Managers and we do oversee the other disciplines but so much more is involved. The nurse does a complete assessment every visit, teaches the caregiver to do any procedures such as wound care, trach care, etc. A lot of teaching is done about end of life care, skin care, signs of the dying process. The nurse provides emotional support and if no Chaplaiin is involved, spiritual care as well. We check meds and assess pain and symptom management and call for changes as needed. There always is paperwork and recerts and care planning. There is always family support involved, lots of listening and would you believe the whole person to care for in this field, not just a heart or a sugical site. It is very rewarding and sometimes a little dangerous but always exciting.

Shrinky,
Tell me more about the "dangers" . . . .

The dangers? We live in a rural area but this area has a high crime rate and drug rate so some areas we go into we have to be alert to this. We know to go into these areas in the morning while people are still sleeping. We need to be alert to the area we are in and look for things like a group of people just hanging out or a deal going down. Sometimes at night we will take a deputy with us to make a house call. Some homes have bugs, guns ( this is a big hunting area ), which we make them lock up or remove from the home. There are some structurally unsafe homes and sometimes we have had to remove the patient from the home. I have been in homes without running water or heat, a lot without air conditioning. Those are some of the dangers. Then sometimes the families can get out of hand emotionally at the death and have to be defused. Don't let this deter you from Hospice as it is one of the most rewarding jobs I have ever had in all my ears of nursing. The dangers are few and mostly safe, you just have to be alert and aware, our patients and families always look out for us in bad areas.

Reply to rascal1, I did not think that you came across as trivial or anything else. You are OK.