Newer Nurse trying to follow heart

[kota110]

I graduated with my BSN in May 2013. I had a very successful sales career for over 20 years but wanted to make a difference. I have always wanted to do hospice nursing.

My first job out of school, I didn't have the confidence nor clinical skills that they expected to handle over 6 patients and lost that job. I work in a LTC/Rehab facility on a casual basis. Unfortunately, I think my sales skills are so good that I was able to get a job on a med/surg floor that was in a rural area where you would be the CNA, HUC and RN most of the time for up to 6 patients. I found that I was overwhelmed doing all that and couldn't do my patients justice trying to do it all based on my limited experience. Plus, there were nurses that were my preceptors that were making up rumors about me (administering too much morphine and needing narcan to get the patient out of it!), that I found it hard to trust anyone.

Now I stand as a casual nurse in the LTC/Rehab with two failures behind me. I was one of the standouts in school, on many extracurriculars and a single mother. I have a huge heart and have been repeatedly commended on my people skills and attention to detail. I have found I love the geriatric patients. My patients love me. I just don't like med/surg and feel that I really want to be a hospice nurse.

I have found myself second guessing my decision to go back to school and giving up a secure, lucrative career. It seems that the only jobs open to a new grad is med/surg or LTC. I also volunteer in hospice nursing where I visit patients and support them and their families. I love it and know in my heart, this is what I was meant for.

I guess my questions are:

1. If I go into LTC/rehab, can I get hospice down the line? It seems it's more of med dispensing to over 20+ patients and never get to spend more than 1 minute per patient.

2. I have tried for hospice jobs and they say they want med/surg experience, is that the only way?

3. Are there other nursing specialities that would utilize my strengths but not require that med/surg be the only past experience?

4. Would additional education be helpful, such as masters in geriatrics or case management or even certification in hospice?

I would appreciate any help you could give.

[areensee]

No med-surg isn't the only way to get into hospice, but it is the best. I would not recommend getting into hospice without a good year of med-surg or related experience. The demands of the job require that you be able to work well independently, have excellent assessment skills and a broad understanding of pathophysiology. These are things that you can't learn in books exclusively, you need the experience. Your LTC/rehab work can be useful if you make it useful. Do you look up the drugs you are giving? Do you read the medical history of your patients? Do you talk even a minute or two with your patients (I know this is very hard in your setting). All of these things will go a long way in preparing you for a hospice position. The other thing I would recommend is that you find a mentor who can help you understand why things didn't go so well previously. Often times, even if we are not completely to blame for failure, there are things we can learn about ourselves and change.

[toomuchbaloney]

I agree that field hospice is a very difficult place for a new grad and most nurses hired into those positions should have a year of experience under their belt. I don't agree that the experience must be medical-surgical in nature.

I think that what hospices are looking for in that work time and experience is a development of the critical thought processes that are necessary for success in hospice field nursing. The work is very autonomous and very demanding. It is helpful if the nurse has experience which helps them to problem solve independently and encourages impeccable professional boundaries when in the homes of sad, sick, and dying people. It is also important for the nurse to be able to think clearly about the nuts and bolts of a situation, to summarize it into an SBAR type communication and to exact meaningful collaboration with a provider over the phone while the family is crying, the patient is moaning, and the family dog is trying to hump your left leg. We can develop those skills other than in an acute care med surg environment, in my view.

Good luck.

[areensee]

I agree that field hospice is a very difficult place for a new grad and most nurses hired into those positions should have a year of experience under their belt. I don't agree that the experience must be medical-surgical in nature.

Good luck.

I am prejudiced, I admit it. I worked in med-surg for 15 years and do feel it is the best preparation for hospice as well as most other specialties, however I agree it is not the only way to get the experience you need. I have been trying to recruit an LTC RN who definitely has the skills to be an excellent hospice nurse. When it comes right down to it, whether or not a nurse can do well in hospice has more to do with who they are and their ability to think critically, rather than what they have done in the past. This being said, I stand by my assessment that med-surg or related fields provides the best clinical background to develop these skills.