Could this be my specialty??

[heathert_kc]

First off I want to say that I have tremendous respect for what Youu guys do.

I have worked as an LPN for 2 years in LTC, did some home health as both a nurse and a CNA. Needless to say I have seen my fair share of death and met some really terrific hospice nurses. I am nearing the end of my RN bridge and starting to think about what area (other than ltc) that I might want to work in. I love my current position and want to remain there at least part time as they have been so great working with me on my schedule while in school, plus it is just a great company. Anyway, I feel the need to branch out a bit and I was wondering if perhaps hospice is something I might want to do. I don't much care for the hospital environment, I perfer to connect with people on a more personal level, which I don't see happening much in most acute environments. But on the other hand ought I try to do acute care just for the sake of experience?

I have a few reservations... How do I know that this is something that I can handle emotionally? Is it different when you have a young patient (child-middle aged)?? I ask that because I think that would be hard for me. I mean terminal illness is sad in anyone; my great-grandmother died a few weeks ago and I adored her so on a personal level I was sad but she was well into her 90s and led a full life, had temendous faith in god, lived to see her grand kids, great-grandkids, and even a few great-greats... how could I be too mad/sad about that?? But if she had been a 40 y/o mother of school aged children that was terminal like a woman that I assisted as a home health CNA:crying2:, well that's another story.

Hospice is not something that I thought I would do, but feel myself sort of gravitating toward it more. I only see hospice nurses come in for a visit or near the end of life: what is day to day work like?? how do you know if its for you? What do you like/dislike about your job?

Any advice/guidence that you guys could offer would be greatly appreciated.

[tewdles, RN]

Day to day you get to know your patients/families better and better. Both on a nursing level and on a personal level. The longer they live the more you know.

Your knowledge helps you to build an interdisciplinary plan of care directed at achieving the goals and outcomes identified by the patient/family and the IDT.

You may well have adequate experience to do field hospice work...perhaps as an on call nurse per diem while you are still in your current job? You would fit well into an in-patient hospice setting, no question. Do they teach anything about management of patient care in bridge programs?

[ErinS, BSN, RN]

It can be devastating to care for someone who is young, or children. But I think a lot of people who work in hospice and do it for a long time are very good at being dedicated, knowledgeable resources while remaining somewhat emotionally distant. The boundaries you set with pts can make or break your hospice career. Like I tell people- it is sad when someone dies, but it is a lot different when it is not your family member.

That being said, I have had lots of pts that I was very close to, almost another member of the family. I cried and grieved, and still do sometimes, but I moved on and know I made a difference in their life (and death).

[heathert_kc]

Thank you for your input. Yes we have done a fair amount of care planning and covering management of various aspects of patient care. Though I know that no matter what is gone over in class it will still be new to me when I work with it in the field and actually do it. It's all a learning process.

[jackster]

I am a new nurse, working on a very busy med/surg floor in acute care, but I did my "immersion" experience my last semester of BSN program in hospice. I knew from that experience that I loved the opportunity to build relationships with hospice patients and families. I, unfortunately, followed the institutional advice about getting acute care experience and am now finding that my original instincts were correct. I asked my hospice preceptor about working in hospice as a new grad and she replied that skills can be taught, but a nurse either has a "hospice heart" or not. I definitely have the heart and am so sorry that I am unable to use those skills much in acute care. As others have said, see if you can find an opportunity to observe and above all, trust your instincts. If you feel that you are well suited or not well suited to an area, you are probably right. Good luck to you!

[westieluv]

I was never a case manager, so I didn't get to know the patients well, or even at all, before I met them or their families when I would get called out on a death call or symptom management call as an on-call after hours hospice nurse. In some ways that made it easier, and in some ways it made it seem kind of impersonal sometimes, especially if the patient and their family had had time to build a strong relationship with their case manager and then she was off for the weekend and I went instead. The worst calls were, of course, kids and people in the prime of their lives. What I discovered, though, after going on a death call for an eight year old, was that even though it was terribly sad, I was doing something wonderful for her parents and extended family and helping them to get through the worst time of their lives. That's a really amazing feeling, knowing that you were able to help someone through something this awful. Few people get to do something this meaningful in their line of work.

I agree that hospice is a calling. I am returning to hospice nursing in a couple of weeks after working inpatient Med/Surg in a hospital. When I tell my co-workers, probably 80-90% of them say something like, "Eww. I couldn't do that job! I would hate dealing with death all day long." I guess the difference is that I see death as just another chapter in life and that needs have to be met during a death, same as in any other chapter in life. I find hospice nursing so much more rewarding than inpatient nursing.

[SuesquatchRN, BSN, RN]

No reason not. I do feel "called" to do this work.