So what's the one piece of advice you wish someone told you...

Specialties Hospice

Published

Specializes in Hospice.

When you started out as a hospice nurse??

This evening, I feel like a new nurse - kind of the evening before the first day of school. I've carefully prepared my supplies - notebook, pens and highlighters. I've "picked out" my outfit (uniform) and it's all ready to go, wrinkle free.

Tomorrow I start clinical orientation as a hospice nurse. I chose to leave a management/ staff educator position to take a clinical position (and hopefully become educated). I will leave behind being the "go to person" in a LTC and be the "newbie" who has only book knowledge and limited experience caring for hospice patients. I got a position in a fantastic hospice that I am familiar with - they have a team atmosphere. I am so thankful for this opportunity and hope that I become an asset to them and the patient's I will serve.

It's exciting, humbling and terrifying at the same time:)

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Welcome to Hospice. I work on a 12 bed general inpatient unit. It is the most rewarding job I have ever had. Let me know how you like it.

Beth

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Welcome to this sacred, always humbling specialty! I've got two pieces of favorite advice: 1) place a patient high on their left side (perpendicular to the bed) for non-pharmacological secretion management, and 2) don't try to guess when a patient will pass though many people will ask you...there are too many variables! I've seen nurses really tick off family members who thought their loved one would be gone "in a day or less" and are still hanging on a week later....ugh

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I agree with you ShesanRN, on our inpatient unit I work night shift. Family members often ask if they think that it is okay for them to leave for the night or should they stay. I always tell them that if I see any change I will call them asap but things can happen suddenly. If the patient is not doing well I tell them if it is important for them to be there when their loved one passes they should consider staying. I explain that I cannot predict beyond something general like hours to days.

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Specializes in Hospice and Palliative Nurse.

Great advice from above. Here are my "tips"

1. I always take a moment to steady myself before I go in a room or home. I ask that I have the "right" words for this family at this time!

2. I ask the family if I have their permission to be totally "honest" with them at anytime. I have not had anyone say "no". It helps when you need to have that "serious talk". For example, the daughter from across the country flys into town and expects a feeding tube immediately because Mom is STARVING. No, honey, Mom is dying. This is what dying looks like.... and use the "D" word. Dying...not passing, not transitioning, not expiring (hate that one).

3. If the cat lays on the bed....they are not long for the world

4. If they are seeing people who have passed on, they are two to three days out

5. If they stop eating they are usually 10 days or so out

6. If they ask if they are dying...yes, they are. Let's talk about it....

7. Sometimes the patient will wait till the family leave the room to die. I think it is purposeful and meant to save the family the pain of watching them go. Death is a very private thing sometimes.

Remember, it is one area of nursing where it is ok to hug someone :)

Peace!

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Specializes in Emergency, outpatient.

Three weeks into orientation, I really appreciate tips like these. After over 25 years as a nurse, I feel like a newbie again. I am alternately challenged and overwhelmed. I find the case management part is quite overwhelming, but looking forward to getting it right. I'm learning the phraseology and the documentation is unparalleled in my experience. Newfound respect for those who can do all that AND provide tender care for the dying and their families.

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Case management was definitely the hardest part for me to get my arms around, especially because they seem to add new requirements daily. There are just SO many things you have to learn, I think that it took me over a year before I had most of the common scenarios down. We do have a special job, and yes it is ok to hug someone. One thing I often tell nurses that I am precepting is that they should let their "nursing common sense" take over when they can't remember anything specific. You can always figure out how to document later.

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Specializes in Critical Care; Cardiac; Professional Development.

How many of you work inpatient? I am being invited to apply to a brand new inpatient hospital unit, 24 beds. I have always loved end-of-life care and felt very sacred about what I am doing in those cases, but I feel nervous to pursue this, even though I have often felt palliative care/hospice is my calling. What is different being an inpatient hospice nurse versus a case manager that travels around?

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Specializes in critical care, LTC.

New to hospice myself. Terrified! Spent 30 years as a nurse mostly in critical care, the past few in LTC. Have taken care of patients at end of life many times. So much to learn, too old to learn it! The above tips are helpful!

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Specializes in Hospice. Worked ER, Med-Surg, ICU & ALF-Dementia.

I started out as an RN in a LTC so transitioning to hospice was easier in a way that what pts I had before are almost the same as what I have now.

Advice? Those trainings and orientations they give you in the office don't mean s#÷+, all there is to those classes/orientations are statistics you won't use when you are in the field on you own...ask as much as you can and learn as much as you can from shadowing a case manager when he/she visits pts. Hopefully, you have that in your training.

Goodluck and welcome to hospice!

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I would say the main thing to remember is to take ownership of the patient as case manager HOLISTICALLY. If you notice patient or family needing psychosocial support refer to sw asap, spiritual support refer to chaplain asap. Stay very organized, get a really cute small spiral to keep all pt notes in. Take notes during visit, don't think you will remember cause seeing 5-6 patients in one day will make you forget. Hopefully your agency will offer you a laptop so you can do bedside charting, that is best way, even though it may seem like your visit is longer you have your note in and out the way.. you don't want to bombard yourself with charting when you're actually off at night.. don't get into that habit because it will seem like you're working all the time. If the patient needs refills on meds go all head and call them in while you're there. If patient needs something that requires MD approval go ahead and call or text doctor while you're there. Don't put too many things off until after the visit. You have to stay organized.

Keep you a couple of admission packs and continuous care packs in your car. You never know when your agency will be calling you to do an eval and don't want to be running to the office to get those. Also keep extra supplies in your trunk ie wipes, chux etc..wound care supplies. Keep your own soap and paper towels in trunk.. sanitizer wipes to clean vital sign equipment between patients ... that's all I can think of for now :)

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