Hospital career after hospice nursing

[mharden]

I am a new R.N. (got my license 4 months ago) and have been working in a long-term care facility. My true preference is the hospital, but it is very difficult to get a hospital job in my community at the moment. Long-term care is not at all what I thought nursing would be; 30 patients at a time, pushing meds non-stop and very little time for interaction with patients. I also have few chances to practice skills such as starting IVs. I have an opportunity to work as a Hospice nurse. I'm conflicted; It would be very rewarding to spend more time with patients and to make a difference to them and their families. However, my concern is that I won't be able to transition to a hospital if I decide later that I want to. What kind of technical skills are used during hospice nursing? Any advice is much appreciated!

[MissIt]

It depends a bit on whether you're doing home care, long term care, or inpatient hospice. I do inpatient hospice and it is acute care. We do all the skills you would use on a med/surg type floor-- IV starts, subQ site starts, trachs, foleys, gtubes, wound care, central lines, pleurivacs and chest tubes at times. We take care of patients with epidurals sometimes. There is a lot of variety. In home care, I know you'll do some of these things too-- taking blood, putting in foleys, wound care. I do think you tend to do more "skills" in inpatient because you'll have more different patients; the length of stay is shorter. The main thing is, though, I don't think a lot of nurse managers know anything about what we do in hospice. Many people think we give pain meds and hold hands... period. So, you'll have to sell yourself! Or you might find that you adore hospice nursing and can't imagine going to the hospital after you start. :)

[ErinS, BSN, RN]

I work in home hospice in a busy metro area and we have lots of young pt's. I have learned more working in this setting about medical procedures, meds, and disease process than I did in 2 years of acute care in the hospital. However, my hospice is very different from lots of other hospices that have lots of little old ladies.

[tgrosz]

mharden, suggest you keep trying to get with hospital which

is your first choice. although you may gain some technical

experience with hospice, it's would be more feel experience.

hospice would be more of a career ending than a beginning.

best wishes!

[tewdles, RN]

I know several nurses who have worked their entire careers in hospice. One in particular started as an aide, completed nursing school and obtained her BSN while working as a field nurse, She worked for a short spell in the inpatient unit, worked in field management and is now a department director.

Clearly, hospice can be a long term career choice.

As for which skills you may use in hospice, it depends ENTIRELY upon the hospice agency, the medical community, and the end of life philosophy of the region you serve.

My hospice operates in the area of a world reknown University hospital and medical school. A fair number of our patients are reasonably complicated in their care by the time they elect their hospice benefit.

[leslie :-D]

i wish the public understood how aggressive and complex hospice tx can get.

even without lifesaving interventions, it can get very challenging in achieving comfort with multi-organ system failure...

or secondary complications from the disease process.

aids and advanced mets, are a couple of examples that can get hairy.

it's true, we do not just give meds, hold hands and mop brows.

the times that we can, it's a true privilege.

but keep in mind,. hospice has a high turnover.

nurses burn out quickly.

i believe hospice is ideal for new grads, and am not understanding why it'd be preferable towards the end of one's nsg career.

it's not an ideal way to 'slow down'...

unless you live in a remote area with few pts.

leslie

[tewdles, RN]

While I appreciate leslie's sentiments, I prefer to think that new grads should come to hospice in an inpatient setting first. I think that the field practice can easily overwhelm them with a sense of being "alone" when they are faced with a very symptomatic patient, a distraught family, while the new nurse is still learning to fully utilize his/her nursing process to evaluate and intervene.

And, as leslie said, turnover in hospice can be problematic in part because it is such an emotionally demanding job. I hate to contribute to that turnover by putting inexperienced nurses in very stressful situations. Of course, that is the manager in me talking.

[leslie :-D]

While I appreciate leslie's sentiments, I prefer to think that new grads should come to hospice in an inpatient setting first. I think that the field practice can easily overwhelm them with a sense of being "alone" when they are faced with a very symptomatic patient, a distraught family, while the new nurse is still learning to fully utilize his/her nursing process to evaluate and intervene.

you're absolutely right, tewdles.

since inpatient is where my experience is, i was speaking about a new grad in inpatient hospice.

i would never recommend a new grad going out on their own.

leslie

[SoCalRN1970]

I love it when I see a new grad wanting to jump into hospice. But this is really not the case. It's a case of desparation to get into a middle zone while a position might be offered downe the road at an acute hospital if I read it right.

Hospice is truly a calling. It is really not a transitional speciality.

New grads can be trained in hospice but the work itself is autonomous. Nurses especially RN's are meant to be independent on their feet thinkers and often new grads do not have this developed early on, and if they do, it's because they were perhaps an LVN or LPN previously... Its rare.

Saying that, I'd truly think this poster should stick to what her heart is set on.