Hospice...not what I thought it was going to be

[Louisepug]

Hello everyone. I am in desperate need of advice. In fact I am so in need I have fumbled around with the idea of leaving the nursing field all together because I am so disappointed in it!! It is not what I thought it was going to be. Here is my story in a nutshell:

I excitedly graduated nursing (RN) school 1 year ago. Since then I have had 2 jobs already! My first one was in geri-psych, which I really loved. I felt like I was an advocate for my patients, I bonded with them, laughed with them and cried with them. The problem was, I am a very small woman and there was a lot of lifting and moving people with strokes, etc and I did some MAJOR damage to my back, to the point now where I'm only 29 and I'm on baclofen and vicodin per day because of the chronic pain! So I left there and applied to a local hospice thinking I would love it because it had a psych component to it and I love to provide palliative/comfort care, teach, and I am all for the Hospice philosophy. I always believed I'd end up working hospice, just maybe not so soon. So, I went into it thinking it was going to be like that book, "final gifts." I thought I'd be hand holding, praying with patients, giving palliative meds and nursing care, but this is not so!! I am a case manager. At first when I was told about this position I felt pretty proud of myself, here I was a new grad making more money than my fellow nursing friends and with a prestigous title. Well, I am sooo disappointed with this position. My day consists of seeing 4 patients in either facilities or homes, taking their vitals, checking for pain, and breifly chatting and the charting the same amount of time I spent with the patient. I then get in my car and drive to the next place and do it again.BORING! There is so little patient care in this job...it's administrative! Is this what "Hospice" is? Glorified paperwork nurse? Would I like inpatient hospice better or should I just go back to psych or maybe LTC? I became a nurse so I could bond with my patients, do nursing tasks and make a difference...not write notes on them all day long repeating the same things week to week. Please help, I'm so fed up and unfulfilled!!! Thank you.:trout:

[cherokeesummer]

I'm sorry to hear that. I'm not a hospice nurse and don't know that I could handle it...so bravo to you for desiring that bond and that care - that is a true nurse to me! I do care for my patients, don't get me wrong, I just fear that my heart would break every day in hospice...but I could be wrong.

At any rate, hopefully you can get some answers. I'm sure there is more than just paperwork, maybe its just that particular job. My FIL just started hospice care this week so I am learning first hand from the patient side of things, seeing what he is going through. So far the hospice team has been wonderful, just wonderful. Lots of paperwork but they do talk with you so again, maybe its just that job?

Good luck!

[rn/writer, RN]

Maybe the problem isn't hospice. Maybe it's the case manager part. Case managers are the ones who do the bulk of the paper shuffling. Perhaps you can stay in hospice but work as a staff nurse rather than in administration. Still some paperwork but lots more patient care.

[medsurgnurse, RN]

There is paperwork in hospice just like any nursing job. I believe it is what you make of the time that you are there with the patient. I have found it to be very rewarding.

[aimeee, BSN, RN]

Is this what "Hospice" is? Glorified paperwork nurse? Would I like inpatient hospice better or should I just go back to psych or maybe LTC? I became a nurse so I could bond with my patients, do nursing tasks and make a difference...not write notes on them all day long repeating the same things week to week. Please help, I'm so fed up and unfulfilled!!! Thank you.:trout:

Consider this a loud and resounding NO. You sound like you have been blessed with a caseload of very stable patients without a whole lot of needs. They won't stay that way for long. Very soon one or more, or maybe half of them all at once, will hit a point where they enter a period of rapid change and need lots of symptom management, and then there will be family members falling apart because they can't come to grips with their imminent death because they have been stable so long, etc. etc. There will be lots of opportunity for teaching family and staff about medication administration, techniques of caring for the dying patient, collaborating with your social worker and chaplain to help the family with acceptance, etc. etc. Be patient. You will be challenged and you will be tested and you will have many opportunities to truly make a difference in the days to come. For now, count your blessings and enjoy this period of the calm before the storm and use it to hone your organizational skills and broaden and deepen your knowledge base so you are ready.

[doodlemom]

I agree with aimee. Case management is much more than paper shuffling. You have a great opportunity here to get to know these patient's and their families while they are stable. As they decline, you will be a stable presence in their lives and you can help them get through the tough times. There can be a lot of hand holding - but there is a great opportunity to learn how to control symptoms and make them comfortable. Admittedly, there is not as much of a reward with patient's in the nursing facilities as there is with the patient's in the home - but these patients need you just as much - if not more. This is a job where you really have an opportunity to be a nurse - unlike what it feels like at the hospital.

[Louisepug]

Thank you all so much for your replies. It really does help to hear the different perspectives on this. Aimee, I do agree with what you are saying about the calm before the storm. The patients I have ARE really stable so it just feels like I'm doing the same thing every day as of now. On the other hand, someone mentioned inpatient, and I feel maybe I would like that better. More "immediate gratification?" Anyway, We'll see what happens. I'll let you all know. Thanks so much again...:loveya:

[heron, ASN, RN]

One caveat about inpatient hospice ... the physical work is just as demanding as in any other inpatient setting. Before you jump into it, check on the staffing at the unit you are considering. My own unit is beautifully staffed ... 11 beds, 2CNAs, 2RNs on nite shift, 3RNs on days. Even so, we are often horribly busy. Keep in mind that pts generally are admitted to inpt for problems that can't be managed at home ... out of control pain, severe agitation, caregiver breakdown, etc. My own agency has an "open access" policy, meaning we sign pts on to hospice as soon as they possibly qualify. Thus we do a lot more palliative (as opposed to terminal) care than you might expect in a hospice setting. Vents, tube feeds, IV tx ... all of it with anxious families visiting 24 hours a day ... I guess what I'm saying to OP is that the same issues that drove you out of LTC exist in inpt hospice, especially if your agency keeps staffing tight to limit costs. Meanwhile, I second other poster's advice ... wait a bit ... things'll change. Have you considered an on-call position? Good luck ... Heron

[aimeee, BSN, RN]

I had the same thoughts about inpatient hospice...although the staff/patient ratio is generally low, the acuity can be quite high and nurses often do a lot of demanding physical hands on care. Probably not a good fit for someone with back issues and chronic pain.

[kstec, LPN]

louisepug

I just wanted to respond by saying I think working at a respected LTC facility would possibly be for you. I work there now and I get very involved with my patients care. Since you work with them so often you get to learn everything about them. Also, there is not alot of lifting in LTC, unless you are helping out the CNA's. We have just about everything there except trachs, and I 'm not sure if it's because we can't or just haven't yet. You get to know the resident families and you get to be the one to take care of them until the end. It saddeneds me very much when they die, but it feels nice to help make the transition as smooth as possible. Good luck in whatever you choose, but nursing needs nurses like you, so don't give up.

[RNorBust]

Being a case manager is going to end up being what ever you make of it. When I was doing it I loved it. There are the hum drum days where there isn't much going on, but the blessing comes when your patient starts to decline and you are needed more frequently, you do more teaching, you spend time with this patient and their family and help them through the last phases.... It is so rewarding. I remember very clearly when I think I really fell in love with the job. I had a patient that was dying, and when she passed, her son in law said to me " thank all of you for what you have done. I am so impressed with it all that I hope some day you can do the same for me...." It is an incredible rush to have somebody thank you for helping them through the hardest time in their lives. I love that I had the time to do it. I may spend only 1 hour at some of the houses that I went to, but there was always that one or two that was starting to decline that I spent more time with. It is a pattern you develop when you have been in it long enough to have patients that you can care for from the time they are referred until the time they die. It is so nice to be able to spend 6 hours with a patient because they are in distress and you are there to ease there discomfort, anxiety, SOB, nausea, whatever the problem they have is... just call the others and reschedule. Anyway, I could spend all day on this subject.

[caliotter3]

With a serious back injury in your medical history, you are lucky to be working in nursing. If your current position is too much paperwork for you, perhaps you could consider some type of education position where you could get some satisfaction without the possibilities of personal injury. Maybe you could become a Certified Diabetes Educator. You have to pretty much consider that any nursing job with little or no patient contact (back injury) is going to involve a lot of paperwork. Good luck in finding something that allows you to express yourself as a nurse without exposing you to further injury. It can be done, just a little bit harder path to follow.