Hospice Private Duty?

[50kn]

What are your primary skills you use when you work with hospice patient? I was asked from my agency if I want to work for a hospice patient (private duty night shift). When I asked to my agency if I can have a brief orientation (to see the patient before I accept the case), they said "no, no orientation." And they don't give me the patient's information unless I accept the case.

So, you give pain meds to make a patient comfortable,,, ,, but is there anything else that is very different when you do a private duty for a hospice patient from the patient who is not a hospice patient? Or just the same, not so different--depends on a kind of treatment and medications that a patient has,,, ? I have never done a private duty for a hospice patient.

[merlee]

This is nonsense - of course they can give you more info, it isn't reasonable to take a case without knowing what it is.

And plenty of agencies give some orientation.

Move on.

[VMN2012]

I am a Hospice nurse with 4 years of expirence. Can I use this in a private duty arena?

[sfmedic100]

It is actually considered "Continuous Care Hospice" Nursing in most states. This means there is a change in the patient's condition that warrants 24/7 nursing care for a period of 72 hours. A physician can extend this period if needed. The change could be a need for pain management, the patient may be near death, or the patient's family may need further monitoring.

The majority of your work would be pain management with common medications being Morphine, ABH Cream, and Ativan to name a few. The focus is on "comfort" rather than "saving the patient." Generally, you would arrive at a patient's home, take report from the off-going nurse (a great resource if you have never done it before-they can show you around), perform your initial assessment/interact with family, and then monitor the patient. A LOT of the job is being there for the family and listening to their needs. Most people have accepted the patient is going to die, but some may be angry towards you. In reality, they are not angry at you, so please do not take it personally. On night shift, you will spend a lot of time just monitoring the patient for changes/signs of upcoming death. Most families will ask "When will they pass?" A lot of nurses out there will try to pretend they know the answer to this and say "a few hours" or "tomorrow." Please do not fall into this trap of "knowing" when a patient will pass on. There are signs of death that can tell you when a patient may pass, but some patients last for months.

I would search online for signs of death and stages of dying. I would also check with a local Hospice company to get some training as it sounds like your company is a "staffing" agency and you would be lucky to get any orientation from them. I am speaking from experience on this matter. I wish you the best of luck as it is a good field to get in to.

[Maria Diane McDonald]

Hospice nursing goes much beyond medicating patients. It is a specialty and it is not for everyone. I have been a Hospice RN in various capacities and EOL Doula for 30 years. There must be good knowledge of Medicare Regs, Symptom Management, Medication Management, Documentation and legality at the time of death. Not to mention a host of emotions. Your agency most likely does not want to delve in at that level, but it is the reality of working in the capacity of a Hospice Nurse. I don't want to seem harsh but a Hospice Nurse is educated in the art of dying well and not hastening death.