skills needed---help please?

Brush up on accessing PICC lines and implanted ports of all types. In hospice I have seen and taken care of all sorts of things one might not expect...chest tubes, NGs, rectal tubes, urinary diversions of ALL kinds, wounds of ALL kinds, stomas of all kinds, ventriculostomy tubes, continuous epidural infusions, continuous intrathecal infusions, continuous SQ infusions, paracentesis, etc etc etc.
I certainly have had to do some research to bring myself "up to snuff" on a particular subject or procedure before seeing the patient. That is part of what I love about this job. It is challenging in SOOO many ways. In hospice we have the advantage of knowing in advance what we might expect so that we can prepare ourselves before we visit. Makes us look smart!

Tewdles, totally agree with your posting. We see EVERYTHING and if you haven't had to do suctioning/trach care recently, I'd brush up on that one as well as I've been getting more and more ventilator pts over the last few years.

Best of luck in your new journey and WELCOME to hospice nursing!

Werblessed...are you familiar with Select Specialty Hospitals? I think (no data to back me up) that they are discharging more of their patients to hospice than they did a few years ago. So, yes, that is my experience as well. Long term vent patients going home to die. That means trachs in most cases.

Yeah, they have Select Specialty in Colorado as well. Most of our vent patients are being d/c'd from ICUs in main-stay hospital settings as Physicians are hearing patients/families stating they want to 'go home to die'. Thank heavens we have enough of a presence within our community of providers that they know who to call when patients make this request and we do whatever we have to do make it happen and NOW! Just had a 68 y/o lady in June dying of pulmonary fibrosis on ventilator and asking to go home as first grandchild was graduating from H.S. Was in ICU on Saturday and going downhill fast. Pt was able to communicate, barely, that wanted to be home for graduation party next day and knew she was going to die soon. Bing, Bam, BOOM - she's home, we staff Continuous Care to support pt. Grandson's party is at 1400, pt. PPS 20% but intermittently aware and comfortable - passed at 1620. THIS is why I love this work and feel blessed by this profession.