New to Hospice Nursing... a bit overwhelmed! Need advice

  1. 0
    Hi!
    I just got a job as a hospice RN case manager. :wink2:

    I have 4 years of experience in Telemetry, and have been raising my family for 6 years, and now I am back. I had my first day was yesterday, basically signing all the forms and trying to read about all the regulations, levels of care, reimbursement, medicare, etc... I love the concept of hospice, and I love teaching patients and families and conversing with them, and I think I will eventually really love hospice, but I feel very overwhelmed. Do you have any advice on what I need to know FIRST as a hospice nurse, what are the bottom line things that I need to understand, etc... just something to give me a bit of focus during this overwhelming time of learning. Thanks guys, and I am proud to join the group of hospice nurses!!
  2. 15 Comments so far...

  3. 4
    Ask questions, hopefully you will have an awesome mentor. Are you in home hospice or in an inpatient setting? If you have access to Nursing Spectrum, they have an awesome CEU for getting started in hospice care. Give yourself 6 months to a year to get acclimated. You don't have to learn it all in the first day, week or month. Good Luck!
    shrinky, eternalsunshine, tewdles, and 1 other like this.
  4. 4
    Hi there,
    Congratulations on becoming a hospice nurse! I have worked with hospice for 2 years now, and before that I worked in a nursing home. I just started a job as a care manager for a home based hospice a month ago. The biggest thing I can tell you now is not to get too involved or too overwhelmed. It can get pretty crazy when you have 15 or more patients to case manage, especially if one or two of them have symptoms that are out of control and they are needing your attention most of the time. I find this job one in which not everything will ever be done (thanks to medicare) and you just have to realize that and not fret. I am a bit of a perfectionist, so it is hard for me to "leave" work at work at 5pm everyday, when I know that not everything got done.
    The second best piece of advice I can give is to find some support. If you are working in the home setting you will be working by yourself for the most part, and until you get to know your co-workers it can be tough to talk to anyone about what you are going through. Death is an intense subject and unless someone has experienced it personally, in my experience, they don't like to talk about it. And it's not all bad either. Sometimes I just want to burst out crying for all the good I have done, but trying to explain how I helped this patient die to someone who doesn't understand, well it can come across the wrong way.
    Hospice has been the most rewarding thing I have done in my life, I hope you enjoy it just as much! And feel free to message me if you need to talk!
    elprup, makua girl, Itshamrtym, and 1 other like this.
  5. 2
    Let's see...I've been a hospice nurse for 2.5 years now, and I love it. I think the most important thing is to find a mentor and don't be afraid to ask any and all questions, no matter how 'silly' you may think they sound. Also, don't be afraid of the drugs we use....morphine is your friend and ally! I've given people ungodly amounts of morphine that would have knocked over a herd of horses, but the patient was still up, talking and clear as a bell. Every patient is different. Be willing to think outside the box, too. For example, Vaseline balls DO work for constipation.....never had heard of THAT one before I did hospice.

    I guess it's important to remember that we are not going to 'cure' the patient. That was hard for me to wrap my head around when I first started hospice. We are all about giving the patient the tools he or she needs to have a good quality of life during the time left, and helping to prepare for death (if they will let us, but that's another story). Very rewarding work, but the hardest job I've ever had. Take care of yourself, too.
    DaisyGrlRN and Werblessed like this.
  6. 8
    First, give yourself TIME...you won't learn it all in a month but you'll have a much better foot-hold after a year. Tid-bit time!! (NOTE: Must obtain Physician's consent for any orders. You must check pt for any contraindications/allergies which might prohibit this plan of care. The following is just my own typical request/protocol.) Constipation is a constant concern in hospice (due to opiods, decreased fluid intake, body systems slowing down, etc). Here's a recipe that I typed up and carry around with me as I hand it out soooo frequently and it works most of the time. Brown Cow Drink - 1/2 cup WARMED prune juice (the warmed part is soooo important as helps dilate the gi area) and stir in 2 tablespoons (30ml) Milk of Mag. Drink and should produce large b/m within 24 hours. Can use if no b/m for more than 2+ days and/or PRN. The most common mistake I see new hospice nurses make is that they do not automatically add a laxative (Senna-S is most popular) as a routine medication when pts are taking opiods. Opiods slow down motility through GI so it can and WILL cause constipation for most folks. Anticipate and plan ahead. If you're starting an opiod for a patient (or are increasing the dosage), get an order for Senna-S as well (can do 1 tab PO QD or BID depending and titrate up or down for pt need) but get comfortable with handing out brown cow drink in event they do NOT stool for several days. I can't tell you how many calls we get on after hours of patient/family reporting, "It's been 8 days since she's had a b/m" ....plan ahead and you will save yourself and your team lots of time and will help ensure your patient is optimally comfortable.
  7. 4
    Even after 10 years in hospice nursing, I keep a sing up in my office that says...
    "Being a hospice nurse is....waking up each day knowing your schedule is going to change!" Versitility and flexibility are two of the most important traits of a good hospice nurse. Good Luck!!
    Last edit by rnboysmom on Sep 9, '09 : Reason: sp
    eternalsunshine, tewdles, Itshamrtym, and 1 other like this.
  8. 0
    Thank you, fellow hospice nurses! I treasure your advice, and, believe me, I will be back later to ask for more help at some point.!!!
  9. 0
    Quote from tencat
    Let's see...I've been a hospice nurse for 2.5 years now, and I love it. I think the most important thing is to find a mentor and don't be afraid to ask any and all questions, no matter how 'silly' you may think they sound. Also, don't be afraid of the drugs we use....morphine is your friend and ally! I've given people ungodly amounts of morphine that would have knocked over a herd of horses, but the patient was still up, talking and clear as a bell. Every patient is different. Be willing to think outside the box, too. For example, Vaseline balls DO work for constipation.....never had heard of THAT one before I did hospice.

    I guess it's important to remember that we are not going to 'cure' the patient. That was hard for me to wrap my head around when I first started hospice. We are all about giving the patient the tools he or she needs to have a good quality of life during the time left, and helping to prepare for death (if they will let us, but that's another story). Very rewarding work, but the hardest job I've ever had. Take care of yourself, too.
    OKay I give in, what is a vaseline ball?
  10. 2
    A vaseline ball is when you roll vaseline in a ball and freeze it, and it serves as a good cure for constipation, (given rectally).
    eternalsunshine and AtlantaRN like this.
  11. 1
    I love that we have to clarify that a vaseline ball should be administered rectally...lol

    Of course, I AM certain that if not specified some poor soul would most definitely try it po and then complain that it did not work...ewwwww.
    Hospice Nurse LPN likes this.


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