Hospice admitting nurse

hospiRN · Apr 19, 2014

Oh How I would LOVE if we had an admissions nurse!!! I love hospice! Hospice admissions are quite time consuming, but give you an awesome opportunity to understand and get to know pts and families. It involves a lot such as Full Assessment and determining if they are hospice appropriate or not. I have gone to do an admission at times and the family is actually quite let down when they find out their family member is not appropriate, simply because they need the help...but we have an awesome social worker who can help with other options if they are not appropriate. So..after the assessment and deeming appropriate we would find out what the family/pt knows about their diagnosis/prognosis...this usually involves a LOT of education. We educate on hospice philosphy and go through what we can provide (24/7 support, RNS, CNAS, SW, Chaplain, DME, covered medications, levels of care, etc). If the pt/family is on board and would like our services, we start signing paperwork. We go through medications and determine what we will cover and what we wont (this is getting sticky with Medicare Part D changes going around as we speak)--This is also a time we like to educate on medications that are not medically neccessary at this point and see about discontinuing them (I have mainly dementia patients so we discuss things such as Aricept, Namenda, Exelon, etc). If pt needs DME (oxygen, hospital bed, supplies, etc) we order those. We notify pharmacy of pt being on hospice and provide a Rx card for the meds we will cover. We find out if there is an immediate need for social worker, chaplain (Is the pt actively dying? Difficult family dynamics, hardships, caregiver role strain?) We find out what family needs as far as CNA services, does the RN need to come out 1 or 2 times per week, etc. If you are going to be the admissions nurse it would be of utmost importance to cover all the bases and make sure pt is fully educated and that you have all neccessary information for the pt case manager. Then you chart the admission, which for us, usually takes about 2 hours. I hope I didn't miss anything...

Like I said..one of the hardest things is to find a pt inappropriate that would really like services, but it would be medicare fraud to admit an inappropriate pt...you would think people would be relieved that they are not hospice approriate, but like I also said, we offer a wealth of services...and some families/pts really need help, but there are other options.

I love hospice! I hope you will too!

toomuchbaloney · Apr 23, 2014

Admissions nurses are the first nursing contact with a patient. They sometimes work with an MSW who explains the legals and obtains appropriate permissions. The RN is responsible to assess the patient, the physical location of care, the ability of the caregiver, and the safety of the home for medications. At the same time, the MSW will provide an assessment of the emotional and psychological status of the patient and family members, discover their attitudes and plans (if any) for end of life rituals or bucket lists. Exploring what constitutes quality of life is an important aspect of the interview.

The admission nurse gives the patient a good "once over", undresses, examines and redresses all wounds". The nurse assesses the medication POC currently in place and notifies the physician managing the hospice POC with recommendations to improve the list. Often that mean DCing a list of drugs. The hospice nurse discusses that refined medication POC with the patient and family who have choices, and the plan will reflect those. The admission nurse determines the need for DME and other supplies and staff for ADLs and orders those things. The full POC is fleshed out in one visit by the adm RN.

When all of the assessment is complete and as much of the documentation is complete as the family will allow in the home, the nurse exits (stage left) and generally never sees the patient or family again.

Lather, rinse, repeat...

areensee · Apr 30, 2014

My recommendation is that you should have case management experience first, before working as an admission nurse. The admissions nurse is the first contact and the way you set things up will either make the case manger's job easier, or more difficult. Understanding the role of the CM is very important.

toomuchbaloney · May 3, 2014

My recommendation is that you should have case management experience first, before working as an admission nurse. The admissions nurse is the first contact and the way you set things up will either make the case manger's job easier, or more difficult. Understanding the role of the CM is very important.

Case managers never like it when the admission nurse makes promises that cannot be kept.

It does require a very close working relationship but I am not certain that they need to have that experience beyond shadowing with them for a couple weeks to get a feel. Good professional team work with interactive management can make for a good relationship between admissions and case management. IMHO

MCRNCHPN · May 8, 2014

I am an admissions nurse for our inpatient care center. I work very closely with our medical director and ARNP- in fact, we share an office. Together we review the patients labs, rad reports, patho reports, etc to determine hospice eligibility. A good number of our patients come from the hospital in which we are located. We are fortunate in that we have hospital liaisons who first meet with the family and obtained the appropriate paperwork.

I love my job but there are some challenges. It entails a lot of charting. It also requires good assessment skills. In addition, the admission nurss usually knows more clinical info (because we write the initial HPI) and I am asked to speak to families and explain their loved ones disease process quite often. In the setting I work in, I also perform chart audits on the patients that are on our floor.

I enjoy my job but I have heard from nurses who have filled in for me on a day off that they hate the job. To each his own.

Leesha · May 26, 2014

I need advice. I work part-time as an RN in a nursing home. I love my residents, but the pay is bottom of the barrel ($22 an hour, but I do get a whopping 50 cents more an hour on weekends!). I need to find another job. I am interested in working as a hospice admission nurse. Is there anyone who can give advice, what the duties are, etc. I am an older nurse and need a change. Thanks in advance for any responses.

I also worked in a nursing home on the rehab side for a year and a half. I was also getting bottom of the barrel pay the same as you. I just recently started at a hospice facility. I am still in orientation but I can tell you that it seems less stressful and the pay is certainly better! Good luck!

Leesha-RN