Follow the hospice calling or stay put?

[NCtoRN12]

I am a new RN, licensed in September. This is a second career for me after retiring from the military, so although I am a new nurse, I do have a fair amount of life experience. While in nursing school, I worked as a CNA in an inpatient hospice facility and believe without a doubt that hospice is my calling. My last term of school, I completed my preceptorship with a local hospice making home visits. Upon passing boards, I didn't even consider applying to this agency because they have a requirement of 2 years nursing experience. Instead, I obtained a position on med/surg in a smaller local hospital. I like my job as a med/surg nurse and feel that I am gaining tons of valuable experience; however, I don't see myself in this position long term. Well, a couple weeks ago, my preceptor from hospice called me and told me there was a position open and encouraged me to apply. She said the manager was interested in speaking to me if I was interested in the position. I called and spoke with the manager who told me they were interested in me based on my preceptorship and they wanted me to apply even though I didn't have the minimum 2 years. So I applied and had my interview last week. I am feeling pretty confident that an offer is coming. My questions are 1) Am I doing myself and my patients a disservice by not obtaining more med/surg experience? 2) What resources/reading materials do you recommend for a new hospice nurse? Thank you all for your time and insight.

[Psychcns]

I am a new RN licensed in September. This is a second career for me after retiring from the military, so although I am a new nurse, I do have a fair amount of life experience. While in nursing school, I worked as a CNA in an inpatient hospice facility and believe without a doubt that hospice is my calling. My last term of school, I completed my preceptorship with a local hospice making home visits. Upon passing boards, I didn't even consider applying to this agency because they have a requirement of 2 years nursing experience. Instead, I obtained a position on med/surg in a smaller local hospital. I like my job as a med/surg nurse and feel that I am gaining tons of valuable experience; however, I don't see myself in this position long term. Well, a couple weeks ago, my preceptor from hospice called me and told me there was a position open and encouraged me to apply. She said the manager was interested in speaking to me if I was interested in the position. I called and spoke with the manager who told me they were interested in me based on my preceptorship and they wanted me to apply even though I didn't have the minimum 2 years. So I applied and had my interview last week. I am feeling pretty confident that an offer is coming. My questions are 1) Am I doing myself and my patients a disservice by not obtaining more med/surg experience? 2) What resources/reading materials do you recommend for a new hospice nurse? Thank you all for your time and insight.[/quote']

What would you hope to learn doing more med surg and could you learn it in hospice? If you chose to go to hospice you could do per diem at the hospital.

[NCtoRN12]

What would you hope to learn doing more med surg and could you learn it in hospice? If you chose to go to hospice you could do per diem at the hospital.

I guess my biggest concern is adequately managing symptoms and making the right recommendations to the physicians for dosage changes, etc. I feel fairly confident in my assessment skills and time management skills. I know I have the compassion and communication skills to work with hospice patients and families. However, there is a difference between being the CNA and recognizing the patient is in pain, needs pain meds and saying "I will get the nurse" than being that nurse and realizing that the dose of morphine the patient has been getting isn't adequate but that increasing the dose may not necessarily be the right answer. So I guess it comes down to critical thinking. Will the critical thinking gained in med/surg make a huge difference or does that learning curve apply even to seasoned nurses just starting in hospice?

[heron, ASN, RN]

from NCtoRN12

Will the critical thinking gained in med/surg make a huge difference or does that learning curve apply even to seasoned nurses just starting in hospice?

Yes and yes.

The symptoms you'll be controlling are the end-stages of the disease processes you're trying to stop, slow down or reverse in med-surg. The more you know about the disease process over time, the better prepared you are to understand what you're seeing in people who are dying because those processes are running their respective courses.

For more seasoned nurses, the learning curve starts with letting go of the obligation to stop, slow down or reverse those processes. You're not there to keep somebody alive no matter what. When the dying person decides it's time, you will eventually have to let go and focus solely on alleviating suffering in whatever way you can.

It's a lot more complicated than it seems ... you will not be flitting around holding hands and being radiantly spiritual. The work will, at times, become harsh, ugly and draining ... it's the nature of the thing.

When it comes to hospice, we all start out as beginners.

[heron, ASN, RN]

I want to add ... you are the only person who can decide if moving to hospice is right for you. It certainly seems like the universe is trying to get a message through.

The problem is that changing from any specialty to another is a crapshoot. There's no way to predict how you will respond to the demands of the new specialty ... being a beginner plain sucks and it's perfectly possible that you'll find out that hospice isn't for you. Always a good idea to have an exit strategy in mind.

Ultimately, it boils down to whether you're willing to take an honest leap of faith in your own ability to adapt and learn.

[leslie :-D]

if it was me, i'd listen to how the universe is beckoning you and definitely take the position.

it is an inpatient facility, not home health.

because of that, you will readily have access to all the help and resources you'll need.

the hiring mgr seems to have faith in you, and obviously s/he is not worried about you failing your pts.

and finally, because your heart's desire is so strong, i am from the camp that it should be your guide...

as our human intellects are much more fallible (often being driven by ego) and i have found that your heart cannot steer you wrongly.

negotiate for x amt orientation;

never be afraid to ask questions;

and do not afraid to say "no" when/if asked to do something that goes against 'your heart'...

for your heart is where truth resides.

best of everything, from a positively "spiritually radiant" nurse. :)

(although heron is spot on - hospice is soooo NOT about wiping brows and holding hands...hell no.)

leslie

[swimmer_mom_nurse]

I recently accepted a hospice position because my heart told me to do so. If you follow your heart, you won't go wrong.