Hospice in hospital setting

[Ayonti]

Hello everyone,

I am currently in a med surg oncology unit and have been there for 4 months. I am considering going into hospice but in a hospital setting because I really do not want to have to drive to other settings, homes, etc. What is a typical day like working in this setting compared to med surg...patient ratio, screaming doctors, running around for 12 hours trying to get everything done, labs, writing orders, , discharge, admissions, etc. Thanks for any feedback.

[Never_too_late]

I would guess that a 'typical day' differs from one institution to the next. Here is mine:

unit has 14 pts

daytime ratios: 3-4 pts / nurse + 1 PAB (4 nurses)

evening/nights: 4-5 pts/nurse + 1 PAB for evening only (3 nurses)

nights : 7 pts/nurse + 1 PAB (if short 1 nurse)

admissions/discharges occur at frequency of: death, transfer to hospice, or return home (some pts come in for acute pain crisis then go back home when problem is resolved). sometimes we go a week w/o a death sometimes we have 3-4.

same type of care as a med-surg floor, just less of it: baths, enteral feeding, trach care or colostomy care or wound care, meds, foleys, Picc lines/port-a-caths, IV meds, tranfusions, seringe drivers, antibiotics, CBI, etc...

Some pts are level 3 (treat reversible conditions) some are level 4 (end of life comfort care)

Some days can be very crazy and then some: opiod toxicity, delirium, family crisis, pt/family support, labs, surgery!(for spinal cord compression, for example), respiratory distress, gi occlusions, nausea/vomittting ad nauseum, last hours of life, admission still dealing with cancer diagnosis (some people consult late and wind up on our unit really fast) .. basically these are advanced cancer cases with all the symptom management that goes along with that..

Doctors are amazing. We have daily rounds where nurses and doctors sit down for 30 minutes to discuss cases on unit. Of course, discussions occur one on one throughout the day. There is a staff support meeting every wednesday morning to discuss how cases affect us personnally. Thursday's, there is the interdisciplinary meeting: nurses, doctors, OT, psychology, music therapist, death bereavment specialist, volunteer coordinator, pain service nurse, etc... We all make time for these meetings, they are very helpful.

We have 8 and 12 hour shifts. Staff pick the length of their shifts and suggest work days for a 6 week rotation. When I leave late, it is because someone died at the end of my shift or the admission we were waiting for came in really late. That doesn't happen too often. Sometimes we are short staff (only 2 nurses) or pts are tough cases to manage.. I have gone with shorter breaks.. but we get overtime for that. I have accumulated 15 hours time owed since september so I haven't gone over my hours too often.

The hospital setting is for the pts whose symptoms are not managed so they tend to be the most difficult cases. I am on a great team and the work with this clientele is very rewarding.

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[Ayonti]

Thank you never too late,

Your details really gave me a picture of how your day is. I am really considering hospice after I gain some experience in med surg. I feel that I can really make a difference in the life of the family and patient in their most difficult time. I dont feel anything in med surg except like a glorified maid to some patients. Thanks again!