hospice-right for me?

leslie :-D · Jun 29, 2005

hi shercor,

can you identify specifically what it is you don't think you could handle?

personally for me, i started my nsg career in hospice and was literally magnetized to this specialty, therefore felt very comfortable in anything that had to be learned. but that's just me. if you can share w/me what your specific concerns are, perhaps i can help you better.

leslie

shercor · Jun 29, 2005

hi shercor,
can you identify specifically what it is you don't think you could handle?
personally for me, i started my nsg career in hospice and was literally magnetized to this specialty, therefore felt very comfortable in anything that had to be learned. but that's just me. if you can share w/me what your specific concerns are, perhaps i can help you better.
leslie

Leslie--thank you for your response, if I could orient with you I know I'd be a great hospice nurse (just from reading your other posts!!) My concerns when I say "Could I handle it?" are not physical care related. That I feel very confident with. It's the sadness of a husband loosing a wife, a young child loosing a parent, the intensity of emotion----yet--I know that hospice is a support for families. It helps them interact with the dying patient in ways that are meaningful when they would otherwise be flailing--not knowing what to do. Another concern that I have is pain management. Is pain well controlled in most cases? I think it would be VERY tough to have a patient in excruciating pain and feel helpless--or--can most pain be managed for patients so that you can TRULY promise them that they will be comfortable as their disease progresses. Thank you for your input. I would be embarrassed to ask these questions at an interview--

nursejoey05 · Jun 29, 2005

I agree with this poster about orienting with you, Leslie. Can you write a book? :bowingpur

leslie :-D · Jun 29, 2005

Leslie--thank you for your response, if I could orient with you I know I'd be a great hospice nurse (just from reading your other posts!!) My concerns when I say "Could I handle it?" are not physical care related. That I feel very confident with. It's the sadness of a husband loosing a wife, a young child loosing a parent, the intensity of emotion----yet--I know that hospice is a support for families. It helps them interact with the dying patient in ways that are meaningful when they would otherwise be flailing--not knowing what to do. Another concern that I have is pain management. Is pain well controlled in most cases? I think it would be VERY tough to have a patient in excruciating pain and feel helpless--or--can most pain be managed for patients so that you can TRULY promise them that they will be comfortable as their disease progresses. Thank you for your input. I would be embarrassed to ask these questions at an interview--

first and foremost to you shercor and nursejoey, i've been truly humbled and extend my heartfelt thanks. hospice will probably be a lifelong passion of mine,and often, has been to a fault. in that i mean that i've gotten into some ferocious fights with reluctant md's over pain mgmt issues. and the last time i tried to get a pt the care she needed, it ended up costing me my job. would i have changed anything? absolutely not. but the kind of care this woman needed was costly and the facility was unwilling to pay for anything, as the facility was for profit.

ok. shercor- in terms of dealing with anticipatory grief, it has been my VERY strong sense of spirituality that helps me in dealing w/the patients dying. yes, there have been families (esp those w/kids) that have been especially rough, particularly children that understand the permanency of death, such as 9 and up. i've never cried in front of a child;have cried w/ family members on occasion.....but you get through it. in my 9 yrs of hospice nsg, there have been a few that i'll never forget. and those were the ones that no matter how much pain meds were given, nothing worked.and there screams would be echoing down the hallways. that's when i asked the md for conscious/semi-conscious sedation. it's a last resort but is effective most times.

so can you handle it? how spiritual are you? most times, death will be peaceful as it should be. one time i cared for a 33 yo pedophile and i cared for him as i did all my patients. his physical pain wasn't the issue but his mental anguish was, as he feared he was going to hell. i told him i didn't know where he was going but asking for forgiveness would be a start,and that i would try and minimize his suffering to extent possible. he had aids-don't know if he passed it on to his victims. but he had major respiratory and skin infections and really suffered. he ended up being on iv valium 10mg q 2-4 hrs prn for major anxiety. that helped alot. and before he died, he really thought i was an angel (hallucinations)

just keep in mind that not all deaths are peaceful, but most are.

if you believe in an afterlife or have a close relationship with God, then death isn't scary at all- to me it's a natural continuum from here to there. and no matter who the patient is, everyone deserves a 'good death'.

just follow your heart, be good to yourself (esp important) and be innovative/resourceful- experiment with meds and different interventions w/ea patient, as ea is unique. don't be afraid to get to know them.respect their autonomy, and their anger,frustration,grief,helplessness. and don't take any of it personally. it's not about you at all. and most important, always,ALWAYS advocate for them-you're the only one they really have.

as for pain mgmt., there will be doctors who are quite stingy.you need to fight for that pt. tell the md that you intend to document your request, his/her response, pt's response to being undermedicated. every single time i've told a doctor that, they end up (pissed off) asking what it is i want. so have a plan in mind when you do speak with the doctor. you should familiarize yourself with all the different narcs and anxiolytics, antiemetics, colonics. but please, do not shy away from those bullying md's. you're fighting for your patient, and you need to do what it takes to get what they need.

also, on interviews, no question is stupid. if anything, any question you ask just shows them your interest in this specialty. even when you're working as a nurse, if you don't know something, always ask ask ask.

shercor, you'll do beautifully. don't doubt yourself for one moment. go and shadow a nurse for a few days-get a feel for it. i am confident you will flourish.

peacefully,

leslie

shercor · Jun 30, 2005

first and foremost to you shercor and nursejoey, i've been truly humbled and extend my heartfelt thanks. hospice will probably be a lifelong passion of mine,and often, has been to a fault. in that i mean that i've gotten into some ferocious fights with reluctant md's over pain mgmt issues. and the last time i tried to get a pt the care she needed, it ended up costing me my job. would i have changed anything? absolutely not. but the kind of care this woman needed was costly and the facility was unwilling to pay for anything, as the facility was for profit.
ok. shercor- in terms of dealing with anticipatory grief, it has been my VERY strong sense of spirituality that helps me in dealing w/the patients dying. yes, there have been families (esp those w/kids) that have been especially rough, particularly children that understand the permanency of death, such as 9 and up. i've never cried in front of a child;have cried w/ family members on occasion.....but you get through it. in my 9 yrs of hospice nsg, there have been a few that i'll never forget. and those were the ones that no matter how much pain meds were given, nothing worked.and there screams would be echoing down the hallways. that's when i asked the md for conscious/semi-conscious sedation. it's a last resort but is effective most times.
so can you handle it? how spiritual are you? most times, death will be peaceful as it should be. one time i cared for a 33 yo pedophile and i cared for him as i did all my patients. his physical pain wasn't the issue but his mental anguish was, as he feared he was going to hell. i told him i didn't know where he was going but asking for forgiveness would be a start,and that i would try and minimize his suffering to extent possible. he had aids-don't know if he passed it on to his victims. but he had major respiratory and skin infections and really suffered. he ended up being on iv valium 10mg q 2-4 hrs prn for major anxiety. that helped alot. and before he died, he really thought i was an angel (hallucinations)
just keep in mind that not all deaths are peaceful, but most are.
if you believe in an afterlife or have a close relationship with God, then death isn't scary at all- to me it's a natural continuum from here to there. and no matter who the patient is, everyone deserves a 'good death'.
just follow your heart, be good to yourself (esp important) and be innovative/resourceful- experiment with meds and different interventions w/ea patient, as ea is unique. don't be afraid to get to know them.respect their autonomy, and their anger,frustration,grief,helplessness. and don't take any of it personally. it's not about you at all. and most important, always,ALWAYS advocate for them-you're the only one they really have.
as for pain mgmt., there will be doctors who are quite stingy.you need to fight for that pt. tell the md that you intend to document your request, his/her response, pt's response to being undermedicated. every single time i've told a doctor that, they end up (pissed off) asking what it is i want. so have a plan in mind when you do speak with the doctor. you should familiarize yourself with all the different narcs and anxiolytics, antiemetics, colonics. but please, do not shy away from those bullying md's. you're fighting for your patient, and you need to do what it takes to get what they need.
also, on interviews, no question is stupid. if anything, any question you ask just shows them your interest in this specialty. even when you're working as a nurse, if you don't know something, always ask ask ask.
shercor, you'll do beautifully. don't doubt yourself for one moment. go and shadow a nurse for a few days-get a feel for it. i am confident you will flourish.
peacefully,
leslie

Leslie-Thank you-Thank you-I will take all your advice to heart-really appreciate the time you took to write to me--Sincerely, Shercor :nurse:

Wren · Jun 30, 2005

Shercor, if you feel drawn to Hospice then I suspect that it is the right choice for you. I think Hospice tends to draw to it those folks who are most likely to do it well and succeed. It tends to be a "love it" or "hate it" situation with not much middle ground :roll

I knew in nursing school that I wanted to be a hospice nurse and while I didn't go straight there, it didn't take me long to make the move! Since then I've worked for hospice for a number of years but have been employed since then as a hospice RN on and off, primarily because of where I lived and the options available (or not available in my case). But I am starting back with Hospice again in 2 weeks and as my husband pointed out to me, it's the only job I've ever LOVED. I have been succesful in other areas of nursing and somewhat satisfied, but nothing is like hospice. :redbeathe

Like Leslie, I've had very few patients whose pain couldn't be managed well and I agree that some situations are extraordinarily sad and you can't help but be affected by that. That is true in many areas of nursing though...you won't avoid death and tragedy easily. My daughter who is a labor and delivery nurse sees her share of unexpected death and loss.

So...go for it! Hospice needs as many dedicated and devoted nurses as it can get and you sound like you will love it. Good luck.

shercor · Jul 1, 2005

Shercor, if you feel drawn to Hospice then I suspect that it is the right choice for you. I think Hospice tends to draw to it those folks who are most likely to do it well and succeed. It tends to be a "love it" or "hate it" situation with not much middle ground :roll
I knew in nursing school that I wanted to be a hospice nurse and while I didn't go straight there, it didn't take me long to make the move! Since then I've worked for hospice for a number of years but have been employed since then as a hospice RN on and off, primarily because of where I lived and the options available (or not available in my case). But I am starting back with Hospice again in 2 weeks and as my husband pointed out to me, it's the only job I've ever LOVED. I have been succesful in other areas of nursing and somewhat satisfied, but nothing is like hospice. :redbeathe
Like Leslie, I've had very few patients whose pain couldn't be managed well and I agree that some situations are extraordinarily sad and you can't help but be affected by that. That is true in many areas of nursing though...you won't avoid death and tragedy easily. My daughter who is a labor and delivery nurse sees her share of unexpected death and loss.
So...go for it! Hospice needs as many dedicated and devoted nurses as it can get and you sound like you will love it. Good luck.

Dear Wren- Thank you for taking the time to write me. And -good luck with your return to hospice. YOur points are well taken and the encouragement appreciated! shercor :thankya: