Brand new to Hospice Inpatient Unit

[countrygonecity]

Hi everyone! Just wanted to say I just got a job a week ago for an in house Hospice unit. I am excited but nervous at the same time. I am in orientation. From my understanding I have to do orientation for 6 weeks, which is good. I am glad of the orientation!!!! And, so far this week I have met with most all of the department heads and they are going over things with me but I feel that some things are being rushed. I said something about that, and the reply I got was that they don't have no more time to go over some things with me. So, I have learn as I go.

One of those is the computer system. We got about 1 1/2 hours orientation time on their system. It went so fast and they gave instruction and we did return demonstration. Don't get me wrong the person doing the orientation really knows her stuff. But it went by so fast and the instructor told us that they know we won't know it all when we get on the floor. But I still worry cause I worry a lot anyway! LOL! Okay, so they also gave us instructional sheet on how do a few basic things on that system. I am still confused. But I guess I will get it once I actually get to the floor.

One thing I have a question about is what is a Hospice medication formulary? Is that like their protocol for like if patient has anxiety or pain or no BM or can't sleep? And what is a an equivalency in meds???? Also I have never worked a PCA pump. I have seen different versions, but never worked one. Are there instructions on those some place online?

What about skills videos and the like? Just in case I need to brush up on something. I have worked a little bit of Med Surg, and some years at a LTC facility. I know quite a bit, but some things I still have not ever got to practice. One of those is lots of drains.

And also the PCA pumps. Right now I am going as ride a long with nurses and staff, which has been great so far. And what I am gathering is they do assessments when they first see the patient and ask patient and/or caregivers questions related to the sleep, mood, nutrition, pain, etc. They then do vital signs and any other pertinent assessments. They also do wounds. I have noticed that they do what is ordered for a wound even though it is palliative care. So basically what I am gathering is that the nurse does what ever is ordered and whatever is needed for the patient even up to and after patients passing. So am I gathering info right? Let me know and give me some tips on what to study up on and what I might need to brush up on,etc.

I have done many types of wounds before. I have done suctioning, I have done trachs care, I have done g-tubes. I have never inserted a nasogastric tube but i have accessed them before. I have done foleys. I have done rectal tubes. I have done multiple injections and taken care of plenty of diabetics and decubitus ulcers too. I have taken care of persons before during and after their passing in the LTC setting. I am not that great with IV's but I have inserted IV's some with success, others not. I have done neb treatments as well. I have helped with aides to do care.

So what is left for me to study up on? I am not that great with calculations. So I have been studying assessments, and pediatrics too, PCA pumps, calculations, drains. What else do you think would help me??? Please let me know thanks!!! I want to do a good job and I want to try to stick with this job. I have to do what it takes to make it.

[NRSKarenRN, BSN, RN]

Best wishes with this position... hope a hospice nurse will stop by soon to answer your questions.

[Pondmud]

Oh gosh. This post was from a year ago. I bet you can answer all your questions now :) If not, I might be able to fill in some blanks?

[Pondmud]

Actually no wait - my brain just farted. You've now been on the job for 2 weeks - congrats!!

There is all that. There are standard-ish orders for pain, nausea, agitation, congestion, constipation and etc., and I can tell you what ours are, but each facility is going to be a little different. All the mechanical skills like PCA and inserting tubes you will develop over time, and that's reasonable to be patient about.

Your eyes and hands-on assessment skills are going to be key. What do you see when you look at your patient, and what do you see 30 minutes after you give a PRN, to evaluate its effectiveness? This will help you discern over time which prn to give, since there will be lots of instances where you can give 2-5 different things for the same problem. I would put assessment skills as number two.

Number one should probably be narcotic safety. This will keep you out of hot water. Know your facility's p/p for that stuff. Waste properly, document correctly, have witnesses as needed. You're working with formularies that can terrify an ICU nurse. This is especially true of those PCA pumps. Take your time. Check your pockets. Keep your practice clean.

[Sessa RN]

Hey, all. Hospice RN here. I noticed your list was missing one skill crucial to hospice nursing: communication. You HAVE to be able to talk to patients and their families about their disease process & what may likely happen. Esophageal varicies, for instance, carries a significant risk for a very bloody death. Tumors in the brain or meninges? Seizures. Etc., etc. Prepare your families and patients with compassion and tact. Many have no idea what is physically happening to their loved one. Also listen to what your preceptors tell families. What do they say when they get the common "how much time do we have" question. When do they know to call a family to the bedside? What do you do when there is no family?

These are "soft skills," but they are just as important as your assessment. These families will remember you and what you said for the rest of their lives. Master this and you will be well on your way.

[FrancineRyan]

Hello, I will also become a new Hospice nurse as soon as I graduate, so possible you can teach me a thing or two. I read the post about knowing the conditions to talk with the families, and that sounds like a really good idea to know about the condition. So, how is it so far? How are you doing? Are they nice to work for?