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tewdles 24,796 Views

Joined Jul 10, '09. Posts: 4,880 (60% Liked) Likes: 8,287

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  • Jun 17

    Quote from CJsGirlRN
    After working in Med surg for 4 years on two very difficult units, I have been offered a job as a home hospice nurse. No more working every other weekend, no more working holidays. On call requires only 2 days a month. And i'm hoping for once i will be in a position where my nursing skills will be much more appreciated. I am so excited to be working with families to help them through their difficult times and to make the patient comfortable in their last days of their life. I am a little nervous, but excited at the same time, for a big change. Any advice to a new hospice nurse out there? Any good tips that you wish someone had told you when you started? Thanks!
    Welcome to Hospice! This is what I wish someone had told me...

    Be aware that all hospices are not nice places to work, so pay close attention to the management style and agenda in your new work place. If this employer does not acknowledge or honor good and reasonable personal/professional boundaries set by their professional staff - begin to look for another job immediately. If the tone of the work place is not upbeat and positive, begin to look. Lots of hospices are hiring so you do not have to work in an unhappy or abusive environment. Hospice is a very emotionally demanding job and your employer should not add to the burden recklessly.

    As many posters have stated previously...on call expectations can vary wildly and can be vastly different from the pitch one may get during the interview/hiring phase. On call can be a huge issue for full time case managers. If "excessive" it is exhausting at best and dangerous at worst. You will hear of case nurses who work 50 hours/wk managing large case loads and also provide as many as 150 hr/mo of on call coverage (mandated). If your management team seems disinterested or insensitive to how on call adversely affects the staff (you), I would suggest you be very cautious. Self care is very important in hospice and self care is difficult when you are overworked and exhausted.

    I imagine that you possess some reasonably fierce bedside skills...so the technical skill part of field case management should present no significant challenge. We do see some pretty complicated wounds, drains and tubes of all sorts...the obvious things like foley's and ports. Your technical skills will be appreciated by your team. Many hospice nurses I have known over the years are not comfortable with intravenous skills...not starting, not drawing, not infusing...IV therapy has a very small role in hospice care overall. So your comfort/skill with that will be helpful. The challenge for you will be learning bag technique and developing your own style of working effectively and efficiently in the living space of other people. Mostly it requires a learned and stubborn foundation in fundamental skills of asepsis, etc with a huge dose of creative flexibility.

    Focus on the nursing process...what can you do for these people, as a nurse, that can help them along this pathway. Remember that you have a team. While you can offer guidance and prayer you do not have to be the chaplain or the social worker...in fact, you shouldn't be.

    Embrace the notion of "point of service" documentation now...it is NOT going to go away.

    I hope you love Hospice, I do...it is rewarding work in so many ways. Good luck.

    If you

  • May 23

    I am dismayed that the nurse who had a legal medical marijuana card was not hired because of it...
    Would that also have been true if the nurse had tested postive for ativan or some other med for which he/she had an RX?
    Like the other medications included on the drug screens, marijuana actually has proven medical benefit for some people in some circumstances, often with fewer side effects than other more "traditional" medications.

    so sad...

  • May 17

    The hospice I currently work for has standing orders for Atropine 1%, 4 gtts Q4 hr SL prn secretions...another hospice allowed same #gtts Q2 hr prn. we also have standing orders for either scopolamine transdermal or levsin if the atropine is not working well. I agree that position is helpful in controlling this troubling symptom. Make sure that you educate the family as well as possible as the noise is often more distressing for them than the symptom may be for the patient.
    Standing orders for managing these common symptoms of the dying process should be in place for your hospice, if they are not you can get some support from your national and regional hospice and palliative care orgs to help your agency come in line with the standards of care.

  • Apr 30

    I am dismayed that the nurse who had a legal medical marijuana card was not hired because of it...
    Would that also have been true if the nurse had tested postive for ativan or some other med for which he/she had an RX?
    Like the other medications included on the drug screens, marijuana actually has proven medical benefit for some people in some circumstances, often with fewer side effects than other more "traditional" medications.

    so sad...

  • Apr 2

    Our agency encourages the nurses (and other disciplines) to attend the visitations. One of the things that is troubling to families is the fact that their loved one dies and at the same time they lose all contact with the team that they bonded with. Visitation attendance helps both the family and the staff to experience "closure" of that relationship with less time requirement and social pressure for the hospice professionals.

  • Mar 24

    I think I still look quite a bit like my image there on the brochure...LOL

  • Mar 19

    I think I still look quite a bit like my image there on the brochure...LOL

  • Feb 7

    Our agency encourages the nurses (and other disciplines) to attend the visitations. One of the things that is troubling to families is the fact that their loved one dies and at the same time they lose all contact with the team that they bonded with. Visitation attendance helps both the family and the staff to experience "closure" of that relationship with less time requirement and social pressure for the hospice professionals.

  • Jan 31

    Unfortunately, not all of the family members have good social or coping skills...stress increases the likelihood that people will behave badly...

  • Jan 26

    I am dismayed that the nurse who had a legal medical marijuana card was not hired because of it...
    Would that also have been true if the nurse had tested postive for ativan or some other med for which he/she had an RX?
    Like the other medications included on the drug screens, marijuana actually has proven medical benefit for some people in some circumstances, often with fewer side effects than other more "traditional" medications.

    so sad...

  • Jan 24

    Quote from stephanie.
    No. I'm an idiot. I had no idea.

    And your argument is for the HR dept who withdrew their offer to the nurse, not me.
    Of course you understand that there are nurses undergoing chemotherapy who may be using marijuana to treat their side effects...and they may still be working.

    I fear that you are assuming that nurses who use marijuana do so for only recreational purposes. Obviously my post offended you, I am sorry.

    There is a great deal of ignorance about marijuana in the public, including health professionals.

  • Jan 20

    I was told when I moved to Fairbanks that Fairbanksans don't want their community to get too big. So I am supposed to tell everyone that it is too dark, too cold, and there is too much snow so they should stay in the lower 48.

    Other than that, I would highly recommend it. AK is a beautiful state and has lots of opportunity. AK has not been as troubled by the recession as the lower 48 have been. There are no dumb people in AK, they freeze along the road in the winter.

    Okay, that last comment was a bad joke, I will admit...and there is the matter of their recent Governor that would beg argument on the point anyway.

  • Jan 2

    Thank you for breaking a stupid rule...

  • Nov 29 '16

    I wonder...

    I love being a Christian..
    I love being a wife.
    I love being a mother.
    I love being a nurse.

    All of those things exist in my life simultaneously. All of those things impact my practice and expression of each of those other things. My job is to keep the proper balances in my life where those things rub together.

  • Nov 29 '16

    In my experience it has more to do with how you decline their offer of employment than other issues.


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