Advice before I start shadowing?

[MissIt]

I have been so fortunate to be volunteering at a wonderful inpatient hospice and I really feel like I've found a good match for me! I haven't done any inpatient nursing in many years. The nurse manager said that I can do a shadowing experience and follow a nurse around for a few shifts. Before I do that, I'd like to refresh my knowledge on the most common medications, procedures and skills I will use in this setting. I'd like this shadowing to be more of a "putting it all together" type experience than a "start at the beginning" type experience. Hopefully, by the time I'm done, I'll know if hospice is where I want to work. I suspect it is, but I have found in past jobs that there is a big difference between feeling good about a place when you're touring around and the reality of working there in "real life."

What things do you think are essential for me to review to have a basic knowledge of what I will see in an inpatient hospice setting?

So far, my medications to review list includes: Morphine, Hydromorphone, Haldol, Versed, Ativan, Scopolamine, Albuterol

Are there any that you would recommend I add to my list?

The procedures/skills I know I need to review include: Tracheostomy care/suctioning, inserting foleys, subcutaneous injection, use of oxygen and suction, central lines (dressings, medication administration), wound care.

What am I missing?

As you can see, I am starting from the very beginning! I feel comfortable with ADLs, positioning, etc. because I do those as a volunteer.

Thank you so much for your help! I am really excited about this. :):)

[leslie :-D]

it's hard to talk about meds, when pts come to us for acute yet varied symptomology.

we typically see:

severe resp distress, unrelieved anxiety/panic/terminal agitation, unrelenting pain, seizing, severe n/v and bleeds, fluid shifts require para/thoracentesis, surgical shunts, and some not so common events.

if you're being hired there, ensure an adequate orientation...much will come back to you, and your confidence level will be where it should.

my facility is like an icu for the dying...requiring aggressive intervention so they could die more peacefully.

let us know how it goes.:)

leslie

[ErinS, BSN, RN]

Reviewing symptoms of death and dying can be helpful. Honestly, I think many hospice have varied standards of practice (for example, some hospice use lots of fentanyl, some use lots of methadone). Our hospice has an orientation book with lists of common meds, procedures, skills, and symptom management. Ask the nurse you follow for recommendations. I appreciate nurses who are willing to take some initiative.

[Trixie's mom]

I don't know if you all remember me. I was on here about 2 yrs ago as IrishPooh. Well, I shadowed a nurse and then took the RN refresher course to get state endorsement. I shadowed again for the clinical part then was encouraged by the hospice nurses to apply. Took a while before there was an opening and I got hired! Last week was orientation and now they are training me. We don't have an inpatient but the nurses are very supportive of one another and with the phone I am told that I'm never to feel alone out there. I will get at least 3 mos of orientation (which I'll need!). Want to do the best job that I can and I believe that I am teachable. If you have a heart for hospice then go for it! I learned soooo much on this allnurses hospice forum and cannot thank you "seasoned" nurses (esp you, Leslie and some of the others I don't see much of on here anymore like Aimeee) enough for all your shared knowledge and encouragement. Maybe some day I'll be able to help other "newbies" like myself. Thank you, again, for all your help allnurses hospice nurses!! (ps...Trixie is the dog we got after losing Scruffy two yrs ago)

[MissIt]

I don't know if you all remember me. I was on here about 2 yrs ago as IrishPooh. Well I shadowed a nurse and then took the RN refresher course to get state endorsement. I shadowed again for the clinical part then was encouraged by the hospice nurses to apply. Took a while before there was an opening and I got hired! Last week was orientation and now they are training me. We don't have an inpatient but the nurses are very supportive of one another and with the phone I am told that I'm never to feel alone out there. I will get at least 3 mos of orientation (which I'll need!). Want to do the best job that I can and I believe that I am teachable. If you have a heart for hospice then go for it! I learned soooo much on this allnurses hospice forum and cannot thank you "seasoned" nurses (esp you, Leslie and some of the others I don't see much of on here anymore like Aimeee) enough for all your shared knowledge and encouragement. Maybe some day I'll be able to help other "newbies" like myself. Thank you, again, for all your help allnurses hospice nurses!! (ps...Trixie is the dog we got after losing Scruffy two yrs ago)[/quote']

I find your success story very encouraging!

Thank you all for your ideas. I will ask the nurse manager if they have an orientation book and I'll ask tons of questions!

[Trixie's mom]

I think you will do well, MissIt! Keep asking those questions, that is what I'm doing. And if you haven't already I'd go back through all the old threads on this hospice site and read up on some of the troubleshooting the "seasoned" hospice nurses have been doing since this forum got started. And another thing I've done is tried to do a lot of online CE classes pertaining to end-of-life...anything to bone up on hospice. Keep us posted on how things are going! Colleen

[evolvingrn, BSN, RN]

Shadowing is just really to get a 'feel' of the environment, you will get plenty of time to do those skills during orientation and even if you don't there is always someone else on the unit that can help. the one skills that i have only seen in inpatient hospice facilities (although im sure they are used elsewhere) is subcutaneous ports. they are great so that your not giving repeated injections. the thing i struggle with is iv's we do a lot of ivs but the veins on end of life pts are less than ideal. my goal is to improve in that area. then of course there is accessing port a caths , sterile dressing changes ect......there are lots of skills you will get to do :)

At our facility we do get trachs and g-tubes, and pluerx drains but not all that often.....

just like any acute care facility we get a little of everything and we learn as we go, don't feel like you have to know it all.

Good luck!!! i hope its a great fit

[netglow, ASN, RN]

i will give you this as a big picture. good for passing on to staff you might work with who are freightened or just never understood too. i'm editing to say if you go out to home/ltc and have to ride rough with mds or rns or cnas or family who need knowledge.

the last hours of living: practical advice for clinicians cme/ce

sign up at medscape.com, it's free, and a good ce. i suggest printing it.

[MissIt]

I read that one last weekend and then went into volunteer and had a patient with terminal delirium. It was a really good read. Thank you for suggesting it.

One thing I can do is central lines. My background is oncology, so I'm good there. :)

We don't seem to have very many IVs. There is a lot of subQ medication delivery, but I have yet to see an IV. I'm sure they are there and I just haven't been there long enough.

Thanks you guys. I appreciate this support sooooo much!

[MissIt]

One other thing. (Although, probably not the last thing. LOL). I am really nervous about taking care of kids, especially infants. Any advice about that? So far, the youngest person they've had while I was there was a teenager, so that was okay. But, how does the hospice care of a child differ from that of an adult?

[evolvingrn, BSN, RN]

It doesn't , because medicaid laws are changing we will probably start to see more and more kids on hospice because now they don't have to give up curative care to join hospice. we don't have a lot of kids.........but it very hard when they are there.