Im excited to be going back to bedside in the form of hospice home health. I did icy for 5 years and administrative stuff in between. I decided I want to go back to bedside and in the icu, I was sick of keeping very sick old people alive and in pain, but was taking comfort in bringing them comfortably into end of life care, so that's how I decided to go this way. Just by having a shadowing interview friday, I realized very sting assessment skills are required, a little different from icu assessment skills. While I am going to get a great orientation they tell me, I would love some tips or maybe if anyone knows of any books that can help with that form of assessment skills, that would be great!
Mar 18, '12
Welcome, although I can't help because I'm new myself (inpatient hospice).
I'm looking forward to the answers from experienced hospice nurses.
Mar 18, '12
Strong assessment skills are a good base, but the difference is WHAT you do with the assessment. In ICU you treat, treat, treat to look for a cure, or at least to improve to the point of transferring or discharging. In hospice we assess to apply comfort. Patient has pain? What is the best pain relief for the type of pain he is having? Nausea? Anxiety? Spiritual distress? Hospice "treats" these symptoms with many different modalities. Pain is treated from everything from Morphine to massage therapy. Nausea? And traditional meds are not helping? Did you know that Haldol is effective for severe, intractable nausea? Or is anxiety causing nausea (or pain), treat the anxiety with everything from Valium to visits with the Chaplin. You need to be able to really think and reason "outside the box" (no matter how much I hate that phrase, it fits here). Your patient can not tolerate oral meds? Hospice Pharmacia (a nation wide pharmacy that a lot of hospices use) can provide a lot of comfort medications in a topical, gel/lotion form that is rubbed in the inside of the wrist and can be as effective as oral meds.
I have seen that most hospital/ICU nurses (and I know quite a few who have the same feelings as you about the amount of "treatment" we force on our elderly) have difficulty not jumping in with technology...but they soon learn that low tech methods are very effective in controlling symptoms and comfort care is very low tech...and very rewarding.
Good luck with your new job. But be forewarned. You have the vision and skills you need. What will be hard is changing the way you think. It will come, but it will be hard at first. I had worked in long term care and sub-acute rehab for 22 years before I went to hospice, which I felt was the logical next step. But I found that it took me a good year to really be able to take a patient from admission to death without needing to do some research or ask another seasoned hospice nurse how to do things. But when that point came, it was great. Not to say I don't still do research or ask questions, it is just that it took that long to actually not have to think through each and every step before I did it.
Mar 19, '12
Thank you! What intrigued me and impressed me the most when I interviewed, shadowed and spoke with the director was their creative approaches to keeping the patients comfortable. The gels and lotions and my very, very very favorite of all was the Haldol Gummy Bears! Genius!! I was warned to never eat a green gummy bear if offered
The nurse realized that no amount of morphine was taking care of a patients pain in her side. She figured it was a localized nerve pain from when she had a chest tube and asked the pharmacy if they could make up this spray so they didn't have to rub because they couldn't tough her of 3 compounds you would not think to combine. The pharmacy could do it, the nurse got the order and it worked! I loved it.
Yes, critical thinking is completely different in hospice than ICU. I am excited to really learn this field.
Mar 20, '12
Welcome to the most awesome and gratifying nusing that you will ever do. Think "palliative not curative", were no longer seeking a cure but comfort. There are multiple jobs within hospice; crisis care, home care, admissions, after hr call team to name a few. I would reccomend that u work different positions if you can. I started inpt moved to admissions, worked home case managing and came full circle working inpt again. I learned so much from each and able to apply that edu each day. Again welcome
Mar 20, '12
Hey MomRn,check out a book called "gone from our sight" you can obtain a copy online for like 2.50 at the gone from our site web site.My advice is CARE...LISTEN ... and ...CARE some more.I've work as a CHPNA for 5 yrs and loves helping the patients.Trust me when I say this; Family members can see right through you when it comes to the ginuwine caring of their family members .So many nurses go into Hospice care cause they feel it's easier setting up their own,more flexable times being out in the field.In most cases because your prob applying for a Case Mgr slot remember your part of a TEAM.everyone is equal,only scopes of practice changes.I have so much admiration for a RN that will help turn, change, clean a pt(when time allows) than those who leave their dirty latex gloves on the pt's bed and exspect your to clean it up.With that said charish the information your Lvn, and HHA's give you, they will work harder for you and you will be valued above all.
ps....Remember to give out hugs like water!It will help you and the families!
Mar 21, '12
Wow thanks, i am so excited. It is a home care position, considered RN care manager. We go to people's homes and facilities.
In the ICU I was assigned to patients who were termination of life support/end of life care when we had them. It's because I do care. Nursing isn't a "task oriented" profession for me.
There are 2 team meeting a week, and I was lucy enough to be able to participate in one on the day I shadowed. It's the nursing director (who is very hands on and very caring), the medical director, social worker and chaplain. They discussions are mainly the psycho social aspects, how the patient is coping, how the family is, what discussion need to be had, what kind of support and resources are needed. One patient felt "ugly" and wanted no visitors. So a volunteer was arranged to come to the house and do her hair and make-up and pick out a nice outfit for her. It was so impressed with the level of caring and intervention and the team approach.
It is encouraged to attend funerals and there is 13 months of bereavement follow-up.
I am rambling here, but it has been sometime I have been so excited for a job. My time in administration has been unfufilling for me.
While the hours are good and flexible for me as a single mom, I did take quite a pay cut, but I think it will be worth it just to enjoy going to work everyday, making a difference the way I best now how.
Mar 30, '12
I thought I had it all figured out - palliative v. curative care - when I had to give huge doses of narcotics to an inpt in intractable pain. My charge nurse didn't say a word when I asked her if we had standing orders for Narcan - but I'm sure she realized it's a hard transition
Most hospice nurses I have encountered so far, my coworkers, are very nice. But not all, unfortunately - I guess you get old burned out bullies in every setting, and sadly I imagine they don't treat their patients any better than they do new hires. I'll try to ignore it, won't let one bad apple spoil the bunch.
Other than that, I'm very glad I'm finally where I belong
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