New hospice nurse: Burned out!!!

[MsPrettyHospiceRN]

I HAVE BEEN A HOSPICE NURSE NOW FOR 10 MONTHS NOW AND IM FEELING COMPLETELY BURNED OUT. I HAVE CONSIDERED LEAVING MY JOB FOR THE LAST 2 MONTHS. THE PROBLEM WITH THIS IS THAT I LOVE HOSPICE. I LOVE THE FACT THAT I GET TO BE THE NURSE THAT I ALWAYS PICTURED IN MY HEAD. THE ONE THAT IS MORE THAN A DOER BUT ONE WHO IS A CRITICAL THINKER. I CONSIDER MYSELF A NEW NURSE AS I HAVE BEEN IN THE FIELD FOR 3 YEARS. I PREVIOUSLY WORKED ON An ONCOLOGY/MED-SURG FLOOR THAT WAS EXTREMELY SHORT-HANDED FOR OUR AREA, AND IT WOULD BE NOTHING TO COME IN AND HAVE 7 CANCER PATIENTS. WE ALL KNOW HOW MUCH ATTENTION A CANCER PATIENT NEEDS SO THIS LOAD WAS CRAZY TO ME. I LIKED WORKING IN THE HOSPITAL, BUT I FELT LIKE ALL I DID WAS FOLLOW ORDERS. I WAS NOT ACTIVELY BEING A NURSE I FELT. WITH HOSPICE I AM ALLOWED TO REALLY USE MY CRITICAL THINKING SKILLS. ANOTHER REASON WHY I WOULD HATE TO LEAVE IS THE AMOUNT OF KNOWLEDGE THAT I HAVE OBTAINED WHILE BEING ON MY JOB. I HAVE BECOME A MUCH BETER NURSE BECAUSE OF THE DAY TO DAY LEARNING THAT I RECIEVE ON MY JOB. I HAVE LEARNED MORE IN HOSPICE WITHIN 10 MONTHS THEN I DID IN 2 YEARS ON MY ONCOLOGY FLOOR. MY PROBLEM IS THAT I AM CONSTANTLY WORKING. I WAKEUP AND WORK AND I WORK WHEN I GET HOME. AS SOMEONE WHO HAS NEVER WORKED IN THE HOMECARE SETTING I FELT THAT I NEEDED ALOT OF ORIENTATION TO THE JOB ALTHOUGH THIS DID NOT HAPPEN. I SPENT 4 DAYS WITH A NURSE WHOS POSITION I WAS TAKING AS SHE WAS LEAVING TO TAKE ANOTHER JOB. I FELT MY ORIENTATION WAS RUSHED AND MY WORKLOAD WAS TO HEAVY TO FAST. I STARTED OFF WITH A FULL TEAM OF PATIENT AT 13. I KNOW IN HOSPICE NO ONE HAS THE TIME TO MICROMANAGE YOU BUT I DID NEED TO BE MANAGED. THE MANAGER WHO I HAD AT THE TIME WHO I ADORED WAS UNABLE TO HELP ME DUE TO THE FACT THAT SHE WAS OVERWORKED. I RELIED HEAVILY ON MY SISTER WHO WORKED FOR THE COMPANY AS A PATIENT CARE MANAGER AND A CASE MANAGER FOR 10 YEARS. SHE LEFT AFTER 2 MONTHS OF ME BEING AT THE COMPANY BUT SHE WAS BASICALLY MY MANAGER WHO I COULD CALL ON WHILE OUT IN THE FEILD IF I HAD QUESTIONS WHICH I HAD ALOT OF. I WAS GIVEN NO RESOURSES WHICH MADE A DIFFICULT JOB EVEN MORE DIFFICULT. TO TOP IT OFF AFTER BEING THERE FOR ABOUT 4 MONTHS STATE CAME!!!!! DURING THIS VISIT MY COMPANY WAS CHEWED UP AND SPIT OUT ON THERE DOCUMENTATION AND WAS LEFT WITH 30 DAYS TO GET IT TOGETHER BEFORE THEY CAME BACK. WELL THIS SET OFF A CHAIN OF EVENTS WHICH INCLUDED 2-3 MEETINGS REGARDING CHANGES A WEEK(ALONG WITH IDG), DAILY AUDITS, POLICY CHANGES, AND INSERVICES. DURING THIS TIME I STILL HAD TO FIND A WAY TO SEE ALL MY PATIENT HAS PRN HELP WAS UNAVAILABLE. NOW THAT STATE HAS COME BACK AND EVERYTHING TURNED OUT FINE I AM STILL LEFT IN THE SAME WORE OUT CONDITION. I DONT KNOW WHAT TO DO. I DEAL DAILY WITH ATTITUDES WHEN YOU HAVE QUESTIONS. I DEAL WITH MANAGERS WHO TALK TO YOU LIKE IN THERE MIND THEY ARE SAYING " OH WHY DONT YOU KNOW HOW TO DO THAT YOU BEEN HERE FOR 10 MONTHS". I WAS NEVER EVEN TAUGHT HOW TO DO AN ADMIT BUT WAS SENT OUT TO DO AN ADMIT AND WHEN QUESTIONS AROSE FROM ME I WAS TOLD THAT ITS PRETTY SELF EXPLAINATORY. AS ALL HOSPICE NURSES SHOULD KNOW, WHEN YOU ARE A NEW HOSPICE NURSE NOTHING IS SELF EXPLAINITORY. I REALLY JUST DONT KNOWN WHAT TO DO AS I LOVE THE JOB AND MY PATIENTS AND FAMILIES DEARLY AS I HAVE GONE THROUGH MUCH WITH THEM AND THEY HAVE HUNG IN THERE WITH ME WITH NO COMPLAINTS AS I LEARNED AS I GO. I HAVE DISCUSSED THESE ISSUES WITH MY DOC AFTER SHE CAME TO ME TO ASK WHY I WAS SO BEHIND. I LET HER KNOW THAT I HAVE EXPRESSED THAT I NEEDED HELP SEVERAL TIMES WHILE OUT IN THE FEILD AND HAVE BEEN TOLD THAT THIS PERSON IS OFF AND THAT THIS PERSON IS OFF AND THAT YOUR PRETTY MUCH JUST ARE GOING TO HAVE TO HANDLE IT. I KNOW THAT TIME MANAGEMENT HAS BEEN AN ISSUE WITH ME AND I AM RESOLVING THAT WITH MANY TIPS THAT I HAVE LEARNED FROM THIS SITE AND COWORKERS. BUT I FEEL THAT IT IS SO MUCH MORE TO IT THEN THAT. I FEEL LIKE I HAVENT BEEN GIVEN THE TOOLS TO SUCCEED AND IM STRUGGLING TO STAY IN A JOB THAT LOVE. IF ANYONE HAS ANY SUGGESTION ON HOW TO PROCEED PLEASE LET ME KNOW. I AM SO ON THE FENCE BECAUSE I KNOW THAT MY RUSHING AND SITUATION CAN POTENTIALLY PUT MY PATIENTS IN A BAD SITUATION WHICH I REFUSED TO DO. SO PLEASE HELP A STRUGGLING HOSPICE NURSE IF YOU CAN. THANK YOU!!!!

[samoanluver]

sounds like the 1st hospice i worked for. there's a BIG difference between and for profit and a nonprofit hospice. i LOVED working at the nonprofit, i gave quality care, ya it was crazy sometimes but the good outweighed the bad. there's a lot of different hospice companies out there, i think the for profits are the worst, watch out for your license because they want numbers and sometimes keeping ppl on hospice that are not appropriate, i left because of that, if you don't protect your license, they won't. i also got paid more at the nonprofit. i hope you find a good place to work that actually gives a damn about their employees because hospice is already emotionally draining and if you don't have the support you will need, you will hate your job. after being at my 1st hospice job @ the for profit company, it made me feel like i didn't want to be a nurse anymore (THAT BAD) but i was blessed to be hired at the nonprofit and not saying my days are all sunshine and rainbows but i feel like i'm valued and feel like i can give quality work. good luck!

[PNWPCN]

I agree and like to add that when a patient enters hospice care, if they are not actively dying, they are still having their long list of medical diagnosis' managed. We wont ignore their diabetes, asthma, dementia, low braden score, ect...

[StJohnRiver]

I have heard this tale of woe before. The thing with being a hospice nurse is that when you visit a home, you have no on-site backup, no fellow RN you can pull aside and ask for guidance when you encounter something new. And as a new hospice nurse, everything will be new. So adequate training is a necessity. Non-profits definitely do it better than for-profits, but even they can fall short. The new RN must ask for more training time. That is about the only way around it. Or you need to establish some type of phone support that you can count on -- someone you can call at anytime to guide you through a situation. Don't accept "Oh, you'll figure it out" as an adequate response. If you could have figured it out, you wouldn't be calling. It's a shame that too many hospices scrimp on the training, because from what I have seen that is the No. 1 reason nurses leave. They feel overwhelmed and don't see a way out. If you can hang in there and get past that initial phase and gain some confidence, hospice nursing is a great job. I'll never be leaving.

[evelynkarirn, BSN, MSN, RN]

I'm trying to think of CRITICAL skills needed for hospice. Pain and anxiety management is all; patients are not being medically treated.

I disagree - critical thinking skills are very much needed in this type of nursing.

Last week I saw a gentleman with extremely painful 4+ pitting edema and ascites. He had been seen by two other nurses -the first initiated furosemide and the second increased the dosage: Neither of them questioned why it had gotten so bad so fast. In doing a more thorough hx, it was discovered that family had d/c'd his anti-hyperglycemic meds for T2DM. The high sugars had contributed to excessive thirst, his fluid intake (of sugary beverages) was greatly increased, and his CHF was exacerbated, thus the fluid retention, thirst, and extreme edema.

I had family re-initiate anti-hyperglycemic meds to decrease thirst and blood sugars, change fluid quantity and type (sugar-free), initiate spironolactone, d/c potassium, and continue Lasix; his edema and pain were greatly relieved. Pathophysiology was key in understanding how to help this client with his pain.

[KYRNCA, BSN]

I'm curious about WHY the "all caps" is such a big deal that you would consider not helping an obviously frustrated fellow nurse. That's no way to show how caring you are.