Hospice nursing for a nurse with depression and anxiety....mistake???

  1. Hi,

    I have been offered a position as a hospice home health nurse. The agency said they will provide me with 1 month training where I will be paired with an experienced hospice field nurse.

    I have only been a RN for 2 years. I have worked in home health for most of it, but have not been working for 6 months d/t relocation and traveling.

    I had a couple of hospice private duty cases in the past and I really enjoyed it. It was very rewarding to provide comfort care and support to the families. My new position will be as a visiting nurse/case manager.

    I know there is a big difference between private duty and case managing b/c I have done both.

    I have depression/anxiety and I am being treated for it. I am worried my depression and anxiety will exacerbate while being a hospice nurse.

    I know hospice is sad, but it can also be very rewarding. I also know there will be steep learning curve since I do not have a lot of experience with terminally ill patients or case management.

    Do any hospice nurses suffer from depression and/or anxiety, but are not affected by hospice care?

    Is this the wrong specialty to go into for a RN with only 2 years experience with depression and anxiety?

    Thanks!
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  2. 15 Comments

  3. by   cmfrt_care_rn
    agrice, I don't think that anxiety and depression would be any different in hospice than anywhere else. I would think working in a fast paced hospital unit would be more anxiety provoking than home care, but it's different for everyone. Are you comfortable making decisions independently? I just started as a hospice case manager but have years of end-of-life experience to draw from, and I had some anxiety during training because it was so different from any kind of healthcare I had done. Now that I'm getting the hang of it (on my own for a week now) I love it. I think you have to be comfortable with death and dying to be a hospice nurse and not be upset by it. If you see it from the point of view that death is a natural process and you are a great help to the patient and family, you can actually enjoy it. Sure some people strike you differently and you get sad, but it reminds you that you're still human!
  4. by   grice007 RN
    Thanks for the reply

    I feel comfortable making some decisions independently, but not all. That is actually one of the my "fears" of working in home health. It is very nerve wracking not to know what to do or say. I wish I could have had more training working with critically ill patients though. After I graduated I tried and tried to get into a multiple residency program at the local hospitals so I could improve my critical thinking, assessments, and skills. As you are probably aware, new grads are having a lot of issues finding jobs.

    Anyways, the agency that offered me the position is aware that I will need a lot of time and that I will have a lot of questions. The DON is not expecting me to learn everything during my 1 month training. He said it may take months to years for me to feel comfortable in this specialty. He said that he see's a lot of potential in me and is willing to invest the time needed.

    I am glad to hear that you are enjoying your new job. I hope I feel the same

    If you have any suggestions or information to share about hospice HH, I would love to hear them.
  5. by   MissIt
    I think for nurses with depression/anxiety, it is most important to find the speciality that is the best fit for you. I, personally, find hospice to be much less anxiety producing than other places I have worked. But, there are people who find it more stressful. Yesterday, I was talking with a nurse who said she wanted to go back to working acute care at a hospital. That was a better match for her and her strengths. I would say try hospice. Just make sure you know who your support network is and use them!
  6. by   Oceansunset
    I would tend to agree with misslt. Everyone needs to find their niche in nursing. Weather you have depression and anxiety or not is not the question. Hospice nursing, in my opinion, is a vocation. It's very different then any other kind of nursing. You need to follow your heart. If you feel that hospice is for you then go for it. I agree with your DON. It will take 6-12 months to feel comfortable and competent in this field. The bottom line is that if you have a nursing position that you love, your depression/anxiety will undobutedly decrease. I wish you the best of luck!
  7. by   OneDuckyRN
    I think it's good that you are self-aware regarding depression and anxiety. I also have been diagnosed with depression, and thanks to medication, I feel like I'm on a pretty even keel most of the time.

    I want to share my (limited) experience with hospice/end-of-life care. In nursing school I always said I did NOT want to do hospice nursing, but in my current area (pulmonary/medical intermediate care) I have had to take care of hospice patients on occasion. Usually these patients are people who have recently made the decision for comfort measures only. It can be very sad and emotional. But as you also pointed out, it can be very rewarding. For me, it's one of the few chances I get to really get to know my patient and his or her family, as well as what's important to them, and what I can do for them as a family unit to make this time as comfortable as possible. It's a time when I can focus on talking to and educating patients and families instead of focusing on fixing their problems. It turns out that I'm actually pretty good at the talking/educating part of nursing, so I really like that aspect of it. It also turns out that I don't hate doing end-of-life/comfort care at all. I still don't think it's what I want to do in the long term, but I could see doing it either on a per diem or short-term basis. At the end of my days caring for these patients, I didn't feel sad and depressed as I expected to. I felt like I had made a difference. And isn't that what we went into nursing to do?

    What's my point, you ask? Maybe hospice nursing is your niche. If you spend most of your time feeling like the work you do is rewarding, and you feel like you're able to connect with patients and families, then it probably is. To paraphrase Oceansunset in the previous post: loving your job = decreased depression/anxiety.

    Best of luck to you!
  8. by   grice007 RN
    Thanks everyone!
    I have to let the DON know my answer by tomorrow.

    Some of my friends say wait until I feel better mentally and get more RN experience.
    Then other's (passed co-workers and friends) say "Do it, it is not as depressing as you think it is. You will feel wonderful helping people."
    I'm scared to take the plunge. I feel like I would be great at this speciality, but nervous. I know it's natural to be nervous doing something new.

    I keep going back and forth about this position b/c I do not want to leave it after a couple of months if I do not like it. That would be a great disservice to my patient's and my agency. My depression although it is getting better with my new meds has really put a lot of doubt in mind about my nursing abilities.

    Maybe this position will help me grow as a person and a nurse as well as helping my patient's be as comfortable as possible.
  9. by   softrbreeze
    It sounds like you have a supportive DON and that's REALLY important going into this line of work. You sound very mature and realistic, so I would hazard a guess and say you would do well in hospice. Let us know what your decision was!
  10. by   DelaSue
    I am currently a Hospice nurse and I love my job. Out of all the areas I have worked I love this one the most. I do not find it depressing at all. My pts and their families are generally greatful for all the support and attention. I get to spend time really getting to know my pts. We do a lot of education and I get lots of education, information, history. I also get to expand my nursing horizons with pts point of view. I hope if you choose Hospice you get as much joy as I have gotten from a very wonderful field of nursing.
  11. by   Blackcat99
    I suffer from anxiety and depression and I was doing much better when I was working hospice. I am now working LTC and my anxiety and depression has gotten much worse.
  12. by   mountainaireNP
    I suffer profound depression and anxiety and compared to the job I just left (a LTC facility that was very toxic, I'll just say) this hospice job is like a dream come true. I'm not religious, either, but agnostic. I had some of the same worries as you, starting out, but have found the job, so far, to be delightful. I know that most of the patients are reaching the end of a long struggle and are ready to move on. The younger ones do make me reflect a lot more and realize how fragile life is, but so far I'm handling it well. We do have a woman on hospice who is my age, so that is a little different. I don't know how it will affect me at the end. Right now she is still hopefull and trying alternative tx, and I'm rooting for her, I hope she gets off hospice, but know it's not likely. I just hope to help help her on her journey whatever the outcome.

    Even getting called out in the middle of the night to a death isn't so bad, I turn CoasttoCoast on the radio in my car and go on my merry way. So far, I've not run into anything I was unable to handle. It's a good job. I'm trained as a NP but have not been able to find a NP job, so, desperate for a fresh start, I signed on with this hospice agency. As long as I enjoy it, I'll stay. I don't think it has made my depression worse, maybe the opposite. I'm feeling more satisfied, for sure, because I feel like I'm making a difference.
  13. by   grice007 RN
    Hi all,

    I did not take the hospice position. I thought about for MANY days and just did not feel ready for it. My heart said "yes" but my gut said "no" right now. I initially applied for the inpatient unit but the DON offered me the home health position because of my experience in home health. I felt very sad for about a week after, but I feel I made the right decision.

    Honestly, every time I thought about going to a patients home and calling a death it freaked me out. I do not think that is a good sign. I want to learn and gain more experience about end-of-life in a controlled setting with more support before I go out on my own.

    The DON was very understanding and the lines of communication for future nursing positions are open.

    Thanks for all your input and support.
  14. by   grice007 RN
    I am sorry . I felt the same way during my clinical rotations at the LTC's. I learned from it and do not apply to them. I hope you feel better soon.

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