Books for a New Hospice RN

nutella, MSN, RN · Aug 12, 2017

Congratulations!

Are you going to work in the community?

Consider a membership in the :

http://hpna.advancingexpertcare.org/

Essential books - which I have used and continue to use:

HPNA

978

KYRNCA, BSN · Aug 13, 2017

Hi there... I have made notes and downloaded all the suggested apps. I'm excited and understandably nervous since this is all new to me so THANK YOU so much for your reply and all the helpful tips!

nutella, MSN, RN · Aug 13, 2017

Hi there... I have made notes and downloaded all the suggested apps. I'm excited and understandably nervous since this is all new to me so THANK YOU so much for your reply and all the helpful tips!

Hi - I think it is normal to be nervous - home hospice or hospice in the community is so different from most other nursing!!

I really liked that we had standing orders for all our patients, which gives the hospice nurse some discretion on what to order and recommend and also for the family who is being taught to take care of their loved once.

Generally speaking, I think that it is much easier to keep a patient comfortable at home with hospice as opposed to acute care with comfort measures only because even though the goals are the same, acute care is the worst setting for that to happen. Nurses and physicians and everything else is set up and geared towards extending life and the lack of experience with CMO /hospice care makes it much harder to get good symptom control...

I used so many skills in home hospice including accessing VADs, inserting foleys, wound care, teaching to patients and families about primary care and medications, and I also have done a fair amount of nursing care hands on when this was needed. Hopefully, the organization has a good orientation program and you will feel supported and like home hospice!!

One word about the documentation:

There is a huge amount of documentation nowadays for hospice - all on the computer. Admissions can easily take up to 4 hours with everything including the initial paperwork, assessment, teaching, documentation. The documentation to satisfy Medicare is interesting because it consists of a lot of checkboxes but I found that to actually help other team members understand what is going on and what my plan is, I needed to write a narrative in addition. The downfall of home care and home hospice is when nurses do not document right away or right after the visit at point of care and hope that they will have time later. This hardly ever happens I found because there is always the call you get from the family or the office to do an extra visit or to pronounce a patient etc..

First I was not too eager to use the laptop in the home or facility, but that changed once I figured out that documenting at point of care was really to my advantage. To make my life easier and my documenting faster, I got myself a computer mouse that I liked and a small mouse pad and would use the computer in the homes as much as possible to enter data right away. Between visits, I typically finished the documentation and narrative in the car before driving to the next visit. Once I stuck with this routine, I was able to finish all my documentation and visits within the normal work time - the problem is that many hospices hire you salaried knowing that most nurses struggle with the documentation piece and always end up working from home for several hours. Admissions I found difficult to complete in the home and on the road because of the sheer amount of work to do but lets say I would admit somebody to hospice and have to do acute symptom control as well and teaching - I would usually stay there for a while until patient is comfortable. In those cases, I found out that setting up shop next to the patient with my laptop was really helpful in getting the documentation process started.

KYRNCA, BSN · Aug 15, 2017

Hello again :) ... I was hired as an hourly employee so based on what you said its a good thing. Unfortunately they do not pay anything per mile so I hope I don't end up driving all over the place.

As far as nursing skills... Most of my background is either working at the well baby nursery or at an outpatient clinic treating plagiocephaly (no nursing skills used there) so I haven't started a IV, done a foley or accessed a VAD since college (2009). That scares me the most. I have tried finding a refresher course around me with no luck. My only hope is that the nurse training me is patient and willing to help me re-learn.

The company that hired me is super new so I'm not really sure what to expect of the training.

How much time do they allow you for each visit?

Once again thank you so much for your insight! :)

vampiregirl, BSN, RN · Aug 20, 2017

I can't say enough good about the HPNA - that membership is invaluable.

The Primer of Palliative Care from the AAHPM is also a tool I use routinely. One of the features I use the most is an equianalgesic table which is very helpful.

This website has a great online opioid converter - registration required, but it is free: Hopkins Opioid Program: Home

Good luck! Hospice is a fantastic area of nursing!