CC RN moving into home hospice

QuiltDog · Apr 8, 2015

that is a big change! I went from a short stint in ER (6 months) and have been in hospice now for over 10 years. it is a wonderful specialty. I think you have a good knowledge base, but I would spend some time reviewing different types of cancers and the varied comfort meds/opioids we use in hospice. Prepare to feel out of your element for a while - I have always told new hospice nurses to give themselves a year to get comfortable. Also, utilize your teammates - you cannot do this job alone.

Good luck to you :)

hopefulinTN, BSN · Apr 8, 2015

Thanks! I have felt passionate about the end of life cases I've had in the ICU, which led me to make this leap! I've had many nurses tell me that I'll never be able to get another good hospital job, truth is that if I love hospice as much as I think I will....it won't matter. Any suggestions on good books? I got a pain mgmt one with various pain types and pain meds....

SeaH20RN, BSN · Apr 8, 2015

Im not a hospice nurse but enjoyed Home Health nursing. I did read a good book "One Foot in Heaven" by Heidi Telpner RN. It was an interesting story of her life as a Hospice Nurse. Good Luck on your journey!

nursecathi · Apr 15, 2015

I worked critical care for 22 years before going to LTC for 5. Now I'm in hospice (newbie of 4 months) and LOVE it. Going from critical care to LTC was totally different. Hospice wasn't that big of a stretch but still different. Very rewarding to take care of people at the end of life and keep them and their families comfort. I work in an in-patient unit.

Jensmom7, BSN, RN · Apr 27, 2015

I've been an RN for 35 years, and a Hospice Nurse for 5. It's quite a mind flip to go from Acute Care to Hospice. One thing you really need to remember is that Hospice is all about choices. The patient (or their POA) are in charge, unlike a hospital unit or home care situation.

Sometimes we see so clearly what the best interventions are for our patients, and it's difficult when patients and families don't "fall in line". Hospice teaches you patience; I never give orders, I make suggestions and recommendations based on what has worked for past patients. I also pick my battles; if they insist that Mom still needs her blood sugar checked 4x a day, so be it. I just make sure they understand that since Mom's appetite isn't what it used to be, and the only thing she will take in is ice cream and milk shakes, those blood sugars might be a little wonky. After awhile, they start doing it twice a day, then once, and comes the day they tell you they aren't bothering any more. Then, they get really brave, and let Mom have desert before dinner-a red letter day is when she gets desert INSTEAD of dinner lol.

Always remember, Hospice is truly a team concept-you don't have to do everything yourself (I always tell patients and families " I can give you the basics of what the Social Worker and Chaplain do, but when they make their eval visit, you'll find out much more"). Hospice can be draining if you don't learn to rely on your team (and that includes the CNAs as well-they are vital for providing some down time for the caregivers, which can help avoid CG burnout).

Remember, too, some caregivers will push back when it comes to letting the tasks fall away. Sometimes their entire sense of worth is wrapped up in how well they keep Mom on that stupid low fat, low cholesterol, low sugar, low Sodium diet, or how many times a day they take Dad's BP and titrate his meds. They may need your permission to not do all those tasks anymore. With practice, you will learn how to support them in their decision, and they will have the strength to allow their family member to die in their time. It's an honor to be able to be there as people travel down the road of their final journey.

MunoRN, RN · Apr 27, 2015

I've been an RN for 35 years, and a Hospice Nurse for 5. It's quite a mind flip to go from Acute Care to Hospice. One thing you really need to remember is that Hospice is all about choices. The patient (or their POA) are in charge, unlike a hospital unit or home care situation.
Sometimes we see so clearly what the best interventions are for our patients, and it's difficult when patients and families don't "fall in line". Hospice teaches you patience; I never give orders, I make suggestions and recommendations based on what has worked for past patients...

Patient's aren't in charge in hospital or home care situations?

toomuchbaloney · Apr 29, 2015

Patient's aren't in charge in hospital or home care situations?

Sadly, no they often are not in charge.

Too often the patient is getting exactly the care that the physician wants them to get, or the care that the insurance company will pay for, but not what they actually want.

Jensmom7, BSN, RN · May 10, 2015

Patient's aren't in charge in hospital or home care situations?

Nope, not really. Lip service is paid to the "you have the right to refuse medications, treatments, etc. etc." part of the Patient Bill of Rights, but in reality, if the patient declines a new med because to afford it they would have to take out a second mortgage (seriously, do physicians EVER bother to find out just how much the latest meds cost?), or actually have the nerve to ask why they need labs done 4 times a day or yet another scan, they are labeled "non-compliant". In Home Care that's a reason for discharge. I honestly don't think I could work in an acute care setting anymore. I love my Hospice patients, they have taught me so much about life and death, and choices.

DLS_PMHNP, MSN, RN, NP · May 10, 2015

Good luck in your new position. You will find a wealth of information at the Hospice and Palliative Nurses Association (HPNA) website. Keep us posted!