Quote from CJsGirlRN
After working in Med surg for 4 years on two very difficult units, I have been offered a job as a home hospice nurse. No more working every other weekend, no more working holidays. On call requires only 2 days a month. And i'm hoping for once i will be in a position where my nursing skills will be much more appreciated. I am so excited to be working with families to help them through their difficult times and to make the patient comfortable in their last days of their life. I am a little nervous, but excited at the same time, for a big change. Any advice to a new hospice nurse out there? Any good tips that you wish someone had told you when you started? Thanks!
Welcome to Hospice! This is what I wish someone had told me...
Be aware that all hospices are not nice places to work, so pay close attention to the management style and agenda in your new work place. If this employer does not acknowledge or honor good and reasonable personal/professional boundaries set by their professional staff - begin to look for another job immediately. If the tone of the work place is not upbeat and positive, begin to look. Lots of hospices are hiring so you do not have to work in an unhappy or abusive environment. Hospice is a very emotionally demanding job and your employer should not add to the burden recklessly.
As many posters have stated previously...on call expectations can vary wildly and can be vastly different from the pitch one may get during the interview/hiring phase. On call can be a huge issue for full time case managers. If "excessive" it is exhausting at best and dangerous at worst. You will hear of case nurses who work 50 hours/wk managing large case loads and also provide as many as 150 hr/mo of on call coverage (mandated). If your management team seems disinterested or insensitive to how on call adversely affects the staff (you), I would suggest you be very cautious. Self care is very important in hospice and self care is difficult when you are overworked and exhausted.
I imagine that you possess some reasonably fierce bedside skills...so the technical skill part of field case management should present no significant challenge. We do see some pretty complicated wounds, drains and tubes of all sorts...the obvious things like foley's and ports. Your technical skills will be appreciated by your team. Many hospice nurses I have known over the years are not comfortable with intravenous skills...not starting, not drawing, not infusing...IV therapy has a very small role in hospice care overall. So your comfort/skill with that will be helpful. The challenge for you will be learning bag technique and developing your own style of working effectively and efficiently in the living space of other people. Mostly it requires a learned and stubborn foundation in fundamental skills of asepsis, etc with a huge dose of creative flexibility.
Focus on the nursing process...what can you do for these people, as a nurse, that can help them along this pathway. Remember that you have a team. While you can offer guidance and prayer you do not have to be the chaplain or the social worker...in fact, you shouldn't be.
Embrace the notion of "point of service" documentation now...it is NOT going to go away.
I hope you love Hospice, I do...it is rewarding work in so many ways. Good luck.