IV certification / wound vacs / PCAs common?

homeboss1 · Jun 10, 2012

Hi all,
I am a med-surg RN trying to transition out of the hospital into a new venue. I've interviewed for two hospice positions and have a few questions about skill set. I passed on the first job after finding that I wouldn't have much orientation for the on-call position; I don't expect anyone to hold my hand but do hope to have resources and training as I acclimate. They felt that I would 'learn as I go', never something I want to hear when trying to move into a new area with patients and families depending on me! Onwards and upwards - the second position sounds better - getting my feet wet doing visits and admissions with another nurse before moving to an on-call position in 3-6 months.
My question: this agency told me they were primarily interested in me because of my recent years in med-surg. They said IV certification, wound care, familiarity with PICCs / PAC / PCA / wound vacs would be very important skills for their patient population. Of course, I would be comfortable with that but am a bit surprised to hear it is so common. Do you guys regularly use these skills? Are they appropriate for the home environment in many cases? Any issues you've run across?
Thank you in advance for any replies. I enjoy lurking here and learning from you all!
Best,
amarilla

Hospices are different... I got thrown into an on-call position years ago with 2 years of med-surg and we didn't do IV's etc. Where I work now, we meet the family "where they are" and sometimes this does mean IV's, flushing ports and ocassionally chest tubes. Haven't had to deal with wound vacs. And that's when I call on a nurse with more recent hospital experience. The main thing is if it is on-call, the idea is to take care of a particular problem and then the case manager follows up in the morning. Sometimes all you may need to do is change a IV pump setting at most. Usually foleys and disimpaction are the major skill need. And compassion-- most of all. Welcome to hospice!

Deb

tewdles, RN · Jun 12, 2012

wound vacs are more the territory of home care...too expensive as a general rule for hospice...and our focus is more on stabilizing and comfort

otherwise, hospice patients can be complicated train wrecks with drains and tubes and ghastly wounds. and yes, we use all sort of venous access devices.

jeannepaul, BSN · Jun 12, 2012

I've been in hospice for 10 years and worked at 3 different companies, one being a large hospice company. I don't know if it is regional but I'm in South Texas and only on occ. have we ever have patients on IV's, when we did, they went to the IPU. No wound vac's, no PCA's. We don't use Picc lines and we usually ask hospitals to take them out. I don't even remember using the medi port for anything. Heck, we don't do many injections (IM) either, usually when they come on to hospice, they are tired of being poked so we try to avoid it, but we have done Rocephin injections for infection when the patient could not swallow. We do oral/sublingual, rectal, or topical and we can make the patient comfortable using these routes.

The big O company didn't even do many blood draws for anything. I work at a small company now and we do more, but usually just for recertification. We have had a few trach's, but not many. Some drains we will maintain, but I haven't had any chest tubes.

It seems to mostly be about teaching. I can spend 15min with the patient and over an hour with the family. We have to deal with all sorts of families and sometimes it is a challenge.

When I first started in Hospice, my biggest fear was saying the wrong thing to the families. I was thrown to the wolves, but it does get easier as you go. I don't think I could go to a hospital to work anymore, not that I would want to.

Good luck!

sailornurse · Jun 15, 2012

The hospice I am at, we do not use any needles, no piccs/ports/ IVs, No injections.No PCAs, No wound vacs. Even in the in patient unit. It depends on the dx, we have had bipap,. Pegs/tube feeds depend on dx/reason for hospice admit. Peritoneal drains are sometimes used.

AtlantaRN, RN · Jun 16, 2012

It depends on the company. Some hospices sell hospice as an "extention of home health," which is wrong because hospice is end of life care. NO pcas, no wound vacs. mostly oral meds and wound care would consist of duoderms or wet to dry dressings. Maybe they are encouraged by your med surg experience because with that training, you can think on your feet.

Frankly, i wouldn't even think of accepting an on call position without working as a case manager in the field first. Or at least having a 2-3 month orientation to on call. You get all sorts of calls and you have to know what to do. Ive done on call for the last 3 yrs and i've been an rn since 1996, and STILL some things will stump me.

We do have some ivf, and accessing ports just to flush and heparinize q30 days.

TinkerBelle_81 · Jun 20, 2012

It all depends on the company you work for. I work for 2 different hospice companies. The bigger company (400 patients) have more complex patients. They do IVs (for few days), IV antibiotics, PCAs (via SQ, PICC, port-a-cath, IV), once in a while they would have someone with chest tube that needs to be drained prn, they had 1 or 2 patients on TPN (yes TPN, for a few days), and once they had a patient on a vent. I believe they used those more as marketing strategies which i do not agree with. I only do admissions for them. Having no hospital experience with poor nursing skills, I don't think I would want to do case management for a company with complicated patients.

The smaller company I work for (50+patients) have 95% board and care patients. In my experience those patients are much more easier, mostly just wound care plus you don't have to deal with very anxious family members who do not know what to do and panic a lot. For some reason, for most board and care patients, their families are more accepting about their situations and do not ask for IVs or any of those.

momof2guys · Jun 23, 2012

I work a a very busy IPU. We take pts w/ chest, nephrostomies and NG tubes. We acess mediports, PICC, sub q and insert IV lines, to use PCSs. We transfuse blood, send pts to have paracentsis and maintain TPN during pts stay. At times the staff has issues with the " medsurg feel" but we know that we're working on that pts symptoms.....oh yeah we usually receive at least 2 or 3 admissions.