Hospice oriented staff position

[JBMmom, MSN, NP]

I've been in my LTC facility a bit over two years now. In my current Master's program we're supposed to propose a new staff position for our unit and explore the feasibility/ benefits etc. I've chosen to create a position focused on getting residents hospice care at a time that will maximize the benefit to the residents, their family and the staff. In the time I've worked there I've found that sometimes family is resistant to the idea of hospice because they have a fear that hospice means we're "killing" their family member. Floor nurses don't always feel they have the authority to talk to families about it if the family isn't immediately receptive- they also don't have the time. I think it would be beneficial to have a staff member that is involved with families and residents throughout the process, from admission through care planning, to regularly assess residents for those that may be headed towards end of life and most importantly keep the communication going. It's been very sad to see some residents don't have hospice on board until the last few weeks, or even worse, days- before they pass. Even the staff benefits from hospice because I know many nurses that want to spend more time with residents that are nearing end of life, to provide extra comfort- but they don't have the time. Knowing that hospice is focusing on some needs that cannot be met within normal staffing helps alleviate some stress for staff as well. If anyone knows of any related position in a facility, I'd love to hear more about how it was integrated. Or, if you have any ideas or feedback I'd appreciate any time and input.

[CapeCodMermaid, RN]

It sounds like you're proposing a case management position which could be done by a nurse or social worker. If you don't have enough staff to support residents at the end of life, more staff should be hired. This would benefit ALL the residents not just those at the end of life. I'm a big supporter of hospice and never hesitate to suggest it to family members. Maybe it's the attitude in my facility, but my staff don't hesitate to advocate for it either. If someone told me I could create an FTE, I would hire an additional staff nurse.

[lifelearningrn, BSN, RN]

I really, really love this idea! Good luck to you.

[bethann27]

This would be so very helpful! Soo many people (including doctors, nurses & social workers) do not understand what hospice means.

[JBMmom, MSN, NP]

Thanks for the feedback everyone. Capecodmermaid, I agree that a staff nurse position would always be the first choice for improving care. However, for academic reasons I need to make a new position, and I also think that some of my co-workers are not as comfortable approaching the subject with family. Not because they don't want to advocate for the residents, but because we have had some really challenging families and not everyone can take that direct approach. I think maybe an expansion of social work's involvement would be feasible, we do have a particularly fantastic social worker that I know is involved in the process of getting families in with hospice.

[CoffeeRTC, BSN, RN]

I think anything that encourages talking about the subject would be good! Along those lines...palliative care too. Why is is so hard to wrap our heads around good pain management? Why do we always judge our patients so much? We all do it in one form or another. Yes, I've have quite a few of patients that are true addicts with pain meds.

[4boysmama]

Like Michelle126, I think I'd suggest a palliative care case manager - it would encompass the hospice-oriented discussions you detailed, but would also benefit other pts/residents that aren't necessarily hospice-ready but could really benefit from palliative care to manage disease symptoms. I would love to see palliative care happen more often in my facility!

[Nashvillejeanne]

OK...ya'll take this with a grain of "nurse humor"....as a hospice nurse of 15 years, I will tell you that when families or staff let on that they are convinced hospice means killing the patient. I gently remind them that hospices can only bill for each day the patient is ALIVE....nuff said :)

[HeyNurse2014, ASN, RN]

OP, what is the name of your masters degree?

[JBMmom, MSN, NP]

I'm in the MSN Patient Care Services Administration through Sacred Heart's on-line RN-MSN program.

[TeaMaria]

I love this idea...I'm working on my Hospice Palliative nursing and have envisioned the potential for changes in our PCH if we had a few Palliative beds and staff to collaborate, educate and support the resident and family during this difficult time.. I am currently the go to person, but it's usually in the last week of life. I think these discussions need to happen sooner so family won't be so shocked.