How Do I Know If I Can Handle Hospice?

RNfromMN, BSN, RN · Apr 18, 2007

I might be talking out of my, uh.."rear" here, since I don't have any hospice experience, but here's what a teacher of mine told us:

When it was time to pick our preceptorship sites, she told us that some of us might have to go to hospice. Terrified looks from every student in the classroom (except, of course for the one who already worked in hospice) & this teacher told us that she's done Hospice Preceptorships in the past, nobody ever wants to volunteer for it, but every single student she's ever had has absolutely loved the experience (every single one!) & that many even switched their career plans afterwards to practice as hospice care nurses.

AtlantaRN, RN · Apr 18, 2007

Goal is comfort, not cure. We're all dying, from the moment we are born, it's just a part of life.

I comfort patients and help to keep them at home until they die. That is my goal, comfort. Of course, I cried my eyes out today at a patients funeral--but I wasn't crying for my patient because there is no cancer in heaven--I was crying for the husband who is mourning her death, and the sister also who is mourning...

As for me, i tend to get real "domestic" when i'm sad; so there is a prn nurse doing visits today, and this afternoon i'm cooking a roast. As a nurse, I feel we all have things we have to deal with, whether it is in the hospital, home health, or hospice setting. I wouldn't trade one minute in hospice for any experience in the hospital setting--I get much more out of hospice--I get to know my patients and families...in the hospital in the last few yrs it's been "treat em then street em...as quickly as possible." I didn't enjoy the last few yrs.

linda

jr4jc · Apr 19, 2007

my .02 you do not have enough experience, you will see lots of different Dz's and quite often multiple Dz's and your alone [if in a home setting]ie no one down the hall to ask, what is this contraption and how does it work OR what do you think is going on....

HOSPICE when you work it either is a fit or NOT.

you are welcome to try it and see if it fits, but i think you will find your over your head.

jwelhwel · Apr 19, 2007

You won't know until you try it! As a hospice nurse of 20+ years, I can tell you it is one of the most rewarding types of nursing that you can do. None of us by ourselves is emotionally or spiritually strong enough to do hospice work but that is why hospice works on a team concept so that you will have the support and affirmation that is necessary to do this work.

tencat · Apr 19, 2007

Thanks for all your input. I don't know if I'll get the job, but I've been upfront with them about the fact that there will be times when I will need guidance because I am a relatively new nurse. They said there is clinical support available for questions and issues. They also said there is orientation to the position. We'll see what happens.

doodlemom · Apr 20, 2007

my .02 you do not have enough experience, you will see lots of different Dz's and quite often multiple Dz's and your alone [if in a home setting]ie no one down the hall to ask, what is this contraption and how does it work OR what do you think is going on....
HOSPICE when you work it either is a fit or NOT.
you are welcome to try it and see if it fits, but i think you will find your over your head.

I totally disagree. 8 months might be plenty enough experience - depending on your life experience. If you're 22 years old and just 8 months out of nursing school - you may need more experience with nursing and life in general. I started working in hospice after having only 1 year of experience as a nurse 12 years ago but I was in my 30's and had quite a bit of life experience. Depending on where you are working and how much precepting you have - and how much support you have from the main office...

Hospice Nurse LPN, BSN, RN · Apr 20, 2007

Our agency requires min 2 yrs experience for RN or LPN field position. However, we're always quizzing each other and you'll never stop learning. As stated above, hospice is more of a calling than a career choice. I'm beginning my 8th yr in hospice and I cannot imagine doing anything else.

KSELRN · Apr 21, 2007

You've gotten some great replies so far. I started out in hospice with only 1 yr. experience as an RN. I didn't expect to like it as much as I do! I do mostly hospice admissions, which tends to be a little different than what the case managers do on a daily basis. I think you'll do fine. Even though you're kind of "on your own" out in the field, there's usually a nurse on call, or a supervisor that you can call with questions. Good luck!

wonderbee, BSN, RN · Apr 21, 2007

I started hospice with only a year's experience. I'm new in hospice with only 3 months. It's much different than my critical care job. I think every new job has it's honeymoon period. Mine is over and I still love the core concept of what I do. My time spent with patients is time well spent.

I thought I'd give you some thoughts from the perspective of being new in hospice and young in nursing. What we do is an art more than a science. You have to learn to trust your inner voices. Just because Nurse XYZ thinks a patient in her last hours should be turned and repositioned regularly doesn't mean that it's the "right" thing to do because you may think that if the patient appears comfortable, just leave her be. That too is the "right" thing to do. I'm getting used to being more autonomous with the use of PO and SL meds that I'm more accustomed to giving IV in different doses. I've also learned that most attendings pretty much "rubber stamp" whatever orders I propose so the autonomy factor is very real.

There's also another layer. Case management isn't like hospital nursing in that you're not done when you've finished charting. You've got other disciplines that need to be kept in the loop and so you have to know what their job is too, and when to contact them.

I'm still getting a big education about medicare rules and what is covered and what is not. Just because something is ordered doesn't mean it's covered under the hospice benefit. And the paperwork... oh my! There's a paper for everything.

And of course, being salaried, the day doesn't end at 5pm. There's always more phone calls and paperwork. You need to have a little office at home... could be just a little corner for your computer, your printer/copier/faxer (you will need all) and your forms.

This is not a specialty for people who like to do their job and go home and forget about it. Life experience is an asset here too.

Hope this helps.

tencat · Apr 21, 2007

Thank you for the advice guys! You guys are always so great. I really am attracted to the autonomy that hospice will provide. I also feel drawn to it for some reason. I guess it's because I've seen so many 'ugly' deaths in the hospital and I feel that there has to be a better way to transition out of this life than hooked up to ten different drips and fifty machines (exaggerating, I know )

prostreetrig · Apr 23, 2007

Hello there. I have been a Hospice nurse going over a year now. The day I dropped off my application I was questioning what I was doing. The problem is Hospice brings about terrifying emotions. Dead people, cancer, dying, pain, etc. Hospice is so far from that in so many ways. There is a huge lack of knowledge in palliative care and Hospice. As far as knowing if you can handle it emotionally I would say try it. For instance, my first death I witnessed was a gentleman who requested to be terminally sedated. He had lung ca with mets to the bone. THis guy was in severe pain with no help from Fentanyl, methadone, Roxanol, ativan, etc. I watched this man go from being a kind dying man who was enjoying life as best he could to a mad man. His pain was so severe and he was so dehydrated he began getting violent. The day I walked in his room he looked at me with glazed over eyes and said get out of my room. I told him I was his nurse and he said "you're supposed to be my nurse" He thought all of his family and Hospice was there to take his soul. Poor guy, anywho, long story short, he finally died after he was sedated for about a day. I actually handled it well. I knew he was in a better place without the pain, the cancer, etc. Hope this helps some. Good luck.

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