hospice nurse job duties

kat7464 · Feb 2, 2013

My typical shift...(I work in a Hospice House)...count the narcs, get report, assess comfort n safety of my patients, plan my shift. We still do some wound care, have foleys, ports, G and J tubes, and the occasional IV or CADD pump patient. And there are the scheduled meds. My HHA are there alone for up to six pts. It may not sound like much, but all nurses know things can go south quickly and frequently. Also, family dynamics to deal with....lots of emotions all around with dying - including the staff! We really get attached to our patients. Oh...did I mention we do the cooking for those pts still eating? We are generally running most of the time. We are sent a lot of pts in crisis, poorly managed in the realm of death and comfort. One pt can tie you up for hours, while you chase their symptoms, the docs, the paperwork, family....but I love my job and wouldn't trade it for anything. Sorry to ramble. Hope it helps.

Bringonthenight · Feb 2, 2013

That's crazy!

tewdles, RN · Feb 2, 2013

My typical shift...(I work in a Hospice House)...count the narcs, get report, assess comfort n safety of my patients, plan my shift. We still do some wound care, have foleys, ports, G and J tubes, and the occasional IV or CADD pump patient. And there are the scheduled meds. My HHA are there alone for up to six pts. It may not sound like much, but all nurses know things can go south quickly and frequently. Also, family dynamics to deal with....lots of emotions all around with dying - including the staff! We really get attached to our patients. Oh...did I mention we do the cooking for those pts still eating? We are generally running most of the time. We are sent a lot of pts in crisis, poorly managed in the realm of death and comfort. One pt can tie you up for hours, while you chase their symptoms, the docs, the paperwork, family....but I love my job and wouldn't trade it for anything. Sorry to ramble. Hope it helps.

Hospice is a very demanding environment.

There can be huge rewards.

How large is the House?

kat7464 · Feb 3, 2013

Six pt bed facility. When we are full, it can be very demanding depending on acuity. When not so full, there is talk of closing, yet we meet such a huge need in our community of predominant elders.

tewdles, RN · Feb 3, 2013

Is there one RN for 6 patients?

kat7464 · Feb 4, 2013

Yes, when we are a full house, which is the goal! :-)

MBAWkg2bNP · Feb 5, 2013

Wow great insight as I have wondered this myself, I really commend those working in this field as I think it would be particularly emotionally taxing.

tewdles, RN · Feb 5, 2013

To the OP, most hospice nurses work in the field rather than in a hospice facility.

More than 75% of all hospice care takes place in the patient/family home.

malenursega · Feb 6, 2013

In the home setting, the CM is responsible in implementation of the total plan of care, this can vary according to state and policy guideline if working with a LPN or alone, generally you have some sort of support at least we do, but always start with on-call report, listen for your pt's names or pt in your general service area, Make F/U visit or phone call to all problem pt's (saves me time). the CM is responsible for docuenting any decline, changes to POC, meds, maintaining contact with SW regarding any psychosocial issues including family fatigue anxiety etc. He she would generally also set up CNA scheduling, IDT notes or changes, routine visits with pt's and meetings with facilities to discuss POC, admission, revocations, and D/C's, also pronouncement of death, LPN usually deal with above except changes to POC, (a least in Ga), + all the non job duties such as emotional support funeral visitations etc... pretty much everything you can think of that would be involved with managing a pt's care... hope this helps

jlynn2303 · Feb 14, 2013

My day varies depending on what happens! We have to give our schedule for the week to the office. At 8am everyone is on the phone or in the office for morning call, where we hear what happened the previous night on call, about any new assessments or admissions that need done, any funerals, etc. How many visits we have varies per day. If it is a facility patient, I check the chart, look for new orders, nurses notes, wts, new labs, etc. I visit with the patient, get vitals, assessment, etc. I talk to the staff about how the patient is doing. Every other week we fill out a 3 page assessment form, the other weeks, we fill out a seven page assessment form. Every other week, we fill out the IDG form for the mandatory IDG meeting held with nurses, psych/soc, doc's, etc where every patient is discussed. If a person becomes active, we sit vigil with our own patients until at least fivepm, then we set up vigil with the vigil team for after hours. If the patient lives through the night, the case manager is responsible for vigil starting at 8am, plus still being responsible for our other patients. We take turns being on call, usually one night a week, plus back up on call one night a week and one weekend per month. If you are on call, all calls go to go between 5pm and 8am. If you are the on call nurse that day, it means you are also the admission nurse, and are responsible for assessing patients to see if they are appropriate for hospice, and for doing the first admissio. If there is a second admission, the back up nurse gets the second admit primary nurse gets the third, etc. I can be out til midnight putting meds in place etc on an after hours admit. We are also responsible for recertification paperwork, dealing pharmacy, family, etc. We have a mix of home and facility patients.

TootieCutie · Feb 25, 2013

jlynn2303, How many pts do you case manage, on top of having to sit vigil? You don't have a a continuous care LPN or team that can do that?