Hospice Nurses...please read my thread

  1. I'm a RN who has worked in hospitals and acute-care settings for years. It was always too many patients, not enough help/support. I began to feel anxious about going in each evening feeling that the license for which I worked so hard to achieve was on the line. I would leave in the a.m. (usually well after my shift end time to catch up on all of the charting, reporting, etc) and feel that I did what I could but it did not meet my goals for optimal patient comfort - actually it barely met my minimum. My prayer used to be simply that I did nothing unknowingly to hurt anyone during my shift and that no one would die on 'my watch'. Although I was well liked and my reviews strong, I still felt that I was being held back as a nurse and as a person wanting to give my loving care to others and not being given the possibility of doing so. The acuity of the patients gaining admission to hospitals was higher - much higher - and the staffing was unsafe and unrealistic. I went into nursing so I could make a difference and this did not feel like making a difference...it felt like shift-to-shift survival.

    As I was losing my 'sparkle' as a nurse, friends and family began to notice. One of my friends was a nurse working in a completely different field than hospital nursing...it was Hospice/Palliative Care. I had some exposure to this field during a clinical orientation 10 years or so previously. I remembered that experience as being one of the most loving nursing environments I had ever witnessed. When my friend told me about a position with a Palliative Care, I thought I'd look into it. What I found amazed me and disintegrated all of the hospice 'myths' that I'd heard. Hospice was not about giving up hope - it was about regaining hope for a better quality of life for however long that was. It was not about speeding the dying process along...in fact, we 'graduate' patients from hospice when they do not meet the requirements for this specialized level of care (and most times it is due to our skilled interventions and PT/OT, Registered Dietician interventions). Hospice is not a place, it is a philosophy of care. Hospice and Palliative care teams go to hospital ICUs, SNFs, ALRs, and most times to our patient's homes.

    Once I glimpsed the difference of how nurses were viewed in this discipline I was ready to begin my journey. I was given extensive orientation to this field while working on the Inpatient Care Center (kind of like the ICU in a hospital. Available for high level/acute issues until effectively managed). The Medical Director was one of the finest and most patient instructors I've ever had. He appreciated my strong clinical skills, explained to me how to approach specific symptoms and educated me on the pathophysiology of many disease processes. He championed all nurses in our organization to be honest with our patients in our assessments, to be prepared to consult with the Physicians as an equal member of our team and to always advocate for our patients who many times could not advocate for themselves. I was blown-away! I had time to sit with a distressed patient and really assess what was going on but not just from a physical standpoint...from an emotional, spiritual, and relationship point of view as well. I had Counselors, Chaplains, C.N.A.s, dieticians, PT/OTs/RTs - all which were available to me and my patients around the clock and which were just as involved in the care of the patient and familiy. It was a loving, caring, compassionate embrace of the care team, by the care team (which includes MD, RN, MSW, Chaplain, C.N.A., Volunteers and ancillary staff i.e., pharmacy, DME supplier, dietician, massage therapy, etc). I worked on the Care Center for a while and loved it. Then I decided to move to having my own patient load in Home Care settings and I really loved it! My kids got busier as they got closer to their teens and I went to After Hours (Nights).

    Our family moved a few years ago and I asked my Nursing Educator which was the best hospice to work for (there were about 18 small and larger hospices at the time). Without missing a beat, she told me that XXX Hospice was strongest in their care commitment and support of patients and employees as she had worked with them on several hospice-improvement projects. I visited their website and filled out an application. Within a few weeks, I was hired on as an After Hours RN. Even with a fair amount of hospice nurse experience under my belt, XXX Hospice provided me with more than ample orientation (it was really the paperwork/processes I needed a leg-up on and by the beginning of month TWO of orientation, I was antsy to get out on my own...never had THAT experience in the hospitals when orienting to a new unit, I'll tell you!). I've been working at there for over 2 years and I've never been happier in my nursing career. I am treated very well, with benefits and compensation that are well above anything the hospitals could offer. But most importantly, I am supported. Everyone looks out for one another. I know that sounds corny, but it is true and it makes my heart sing. I know now that death is not failure, that it is a part of life part and a journey each of us will eventually make. I know that relationships define us and are all that matter when life is winding down. And I've learned that it's OK to care about patients and their families and sometimes that's the price of being human and being a nurse and that I'm willing to pay that price in exchange for the uncountable blessings I receive each day I work in this field.

    Thank you for reading my thread. I hope to hear from those who felt a tug at their own nurse-heart strings.

    Truly blessed in this work,
    Last edit by sirI on Sep 4, '09
  2. Visit Werblessed profile page

    About Werblessed

    Joined: Sep '09; Posts: 43; Likes: 71
    Hospice Crisis RN; from US
    Specialty: 12 year(s) of experience in Hospice/Palliative, PACU, OR, Med/Surg


  3. by   mpmlpn
    This is inspiring, thanks for posting. The contrast in your experience is so vivid, it's fantastic that someone who cares as much as you do found a suitable place to work- we need nurses like you! Hospice is the reason I went back to school and became a nurse; I don't have work yet but that's my field. I'm so happy for you!
  4. by   tencat
    Take care of yourself, too. Just important to remember that. It is a rewarding field, but oh so hard on our emotional well-being. I do love it, though. Hospice myths, especially when spouted off by medical people, really burn my posterior. Glad you found out how rewarding hospice can be.
  5. by   missninaRN
    I just finished reading this and have tears in my eyes.

    I've been an RN for 16 months and have spent that time on a Med Surg floor much like the one you described. Many of patients have been total care, but they are only one of the seven I was required to care for on a given shift. Factor in the rapid turnaround on our floor, and I could be charting on 12 patients in a 12 hour period. That leaves precious little time for patient care; I have often left the floor feeling like a terrible nurse because the actual patients got so little of my time.

    My last day on that floor was earlier this week. I'm starting as a hopsice RN later this month. Despite the relief I have just in knowing that I won't be on the floor any more, it is rather frightening to leave the only nursing job I've ever known for something so dramatically different. Your post helped to serve as confirmation that I've made the right choice.
  6. by   Werblessed
    Catherine, I'm so excited for you as you start your own journey as a Hospice nurse. In the hospital it's Physician directed care plan. In hospice, it's patient-directed care plan...what a blessed difference! Your time on the hospital units won't have been for naught! All of those amazing clinical skills you got along with the stress will come in handy as you provide teaching and education to your patients/families. And it will also help you get the medications/interventions that your patient needs by being able to eloquently and skillfully paint an accurate clinical picture from the bedside to an Atteding Physician on the other end of the phone. Everything in your life has led you to this place at this time. Gosh, I'm so happy for you! I hope you love it and embrace it as much as I do!! Amazing philosophy of care and compassion.
  7. by   Mudwoman
    Mary, I needed this message so much. I have been nursing for 15 years. I was a LVN, then LPN, and earned my RN in May 07. I have worked a heavy med-surg floor in a hospital for most all those years. I'm burned out and have lost that loving feeling especially with patients that have drug addiction problems or those that just want to be sick and on disability.

    I was asked the other day if I was a hospice nurse by one of the family members of a patient. When I told him I wasn't, he told me I should be. I have never taken care of a dying patient that the family did not tell me I made all the difference in the world for them and their loved one.

    So, besides just putting in a lot of applications, what is the best way to break into this field. There are few ads for hospice nurses in our rural area, but the ones I see are wanting experience in hospice. Do you have any suggestions. I have seen where some of the online colleges have 1 yr certificate programs, but they are expensive and I would hate to spend money if not needed in this employment environment.

    I can't thank you enough for your post. I'm sitting here with tears-----you put into words what I have known in my heart for a long time.

  8. by   Werblessed
    Charlee, I am a BIG believer in being where you are meant to be, right now. I was meant to write that blog and you were meant to read it. Where to start to get into Hospice nursing? Find a non-profit hospice (I've worked for both and I will ONLY work for non-profit hospices going forward), preferably one that has its own inpatient care center (think ICU-level care for terminally ill/hospice patients). Many times you will not see an advertisement for hospice nurses though they are in heavy demand most of the time. Most of our nurses come knocking on our doors -either because they've worked with us while caring for patients in hospitals or SNFs or because they had someone they loved in hospice care and got an up-close look at what we do. It is perfectly fine to come into hospice care without having worked in hospice previously. I'll tell you what we look for...a nurse with strong clinical skills who can effectively paint the picture of what they are seeing at the patient's bedside; a nurse who has confidence in his/her own assessment skills and is not afraid to advocate for what the patient/family states are their goals for comfort and being able to communicate that goal and collaborate with Physicians to help meet it; a nurse who understands that we might see things that are a bit unexpected at times but is able to look into the eyes of the person you are treating and understand this could be your mother, your father, your child...yourself; a nurse who understands the fragile population whom we serve and who is OK holding the hands of the pt/family to help them understand what is happening and what we can do to help. I wear a button from the hospice I work at in Denver that says, "Actually, there is something more we can do". We know we're not on the curative side anymore but we have tremendous hope for a better quality of life (whatever that looks like to your patient) for however long that life continues. Go in and speak with the HR department of a hospice near you and tell them that your heart is telling you that this is where you belong. It won't be taken as sappy or smooth-talking...it will be understood from your hospice nurses' heart to ours. You are the nurse we want to join our hospice family of providers. And, yes, we do have special certification to demonstrate our expertise in this field but typically we encourage hospice nurses to work in this field for a few years before they begin down this road. Many hospices provide cash awards for obtaining this certification (ours offers $1250 award) as it is to our credit to be able to say that 85% of our RNs have been certified as experts in the field of Hospice & Palliative Care. So many wonderful experiences are ahead of you and you sound as ready as I was for a change. Someone is spiritually tapping you on the shoulder, my dear. It's been my experience to listen to that gentle advice and everything will fall into place around you.
  9. by   Itshamrtym
    Thank you so much for the fabulous post... Very lovely. Glad that you took the time to let us know how you feel and what you do.... God bless and take care..
  10. by   Heogog53
    Thank you for your thread.
    I've been a hospital nurse since 1982. I worked in CCU and now in the OR. While I love the OR, I'm burnt out in many ways, and since receiving a back injury three years ago, have been looking for alternatives jobs in nursing. For whatever reason, hospice keeps attracting my attention. I feel that I have a lot to offer to those who are in end of life situations.
    I have no idea how to find out which hospice services in my area are good, bad or indifferent. I'm not even sure what kind of hours I want to work, and what exactly would be expected of me as an in-hospice nurse vs a traveling around hospice nursing.
    I'd like y'alls opinions on my calling up the various agencies/services and ask to shadow the nurses for a day or so, just to pick up what the routines, the duties, the involvement that each group requires of their nurses. Is that a good idea? Do you think that I'd be welcomed as a "lookie-loo"?

    Thanks so much for your fabulous essay. I felt uplifted and happy to read of your experiences.
  11. by   Werblessed
    Heogog53...my recommendation would be for you to go and speak with the nursing manager of a local non-profit hospice and ask if you could 'orient' for a weekend or a few weekdays to get a feel for if this is the type of nursing in which you are interested. I think that's a legitimate request and if you can see what we do and how we approach situations you might be hooked...or not! But it's one of those 'live and learn' situations and I'm always open to those. You have a wonderful amount of nursing experience and this type of nursing benefits from strong clinical skills and working a bit more independently than we do in the hospitals. Go and check it out at a local hospice (one that has it's own Care Center is probably the best bet) and then listen to what your heart whispers.
  12. by   Heogog53
    Thank you for the advice. I'm torn between Hospice and, believe it or not, Infection Control. Both are natural outgrowths of my job, so far. There are several Hospices in this area, so I think I'll start calling on Monday.
    Thanks much,
  13. by   Mudwoman

    After receiving your reply to my reply, I went online and found that the Dept of Health in the state I live in has a full time opening for a hospice nurse in the county I live in. I have applied for that position and I am now waiting and hoping. Thanks again for your wonderful post.

  14. by   tewdles
    Yup...for many hospice nursing is a calling as much as it is a career or job. It is that way for me. I was inspired by the hospice nurses who cared for my young friend as she said goodbye to her family. I fell in love with the families and patients who are so grateful for the care that we provide. I am challenged by the autonomy, maintaining the balance between my Nurse Practice Act/scope of practice and rapid delivery of effective care for symptomatic patients. THIS is how I will spend my remaining years in nursing, and ultimately I hope, the remaining months of my life...in hospice.