How Much Autonomy Do Hospice Nurses Have?

[jjnmrsmom]

I really like the idea of hospice nursing. My unit is a hodgepodge type unit where we care for every type and acuity of patients, including hospice. They have promised us that soon they will open a unit that is exclusively hospice, which I'm thrilled about. Currently we have the same docs caring for all our patients and are treating the hospice pts like every other pt on the floor. It's like pulling teeth to get them to increase or change pain meds. They order labs and send them for unecessary treatments. The other day one of the docs wanted to order a blood transfusion because one of our hospice pts hem was low! I am hoping that once we open the hospice unit that they will give us nurses standing orders and allow us to use the brain God gave us so that we don't have to keep agruing with the docs for what we know our pts do and don't need. They are hiring a hospice doc for the unit... I'm hoping that will make a difference.

How much autonomy do hospice nurses typically have?

[marachne]

I can't speak specifically for in-patient hospice, as you are still going to be w/i whatever is the culture of the institution -- after all, ICU RNs have a lot more autonomy, than the average med/surg RN, but that is going to vary from hospital to hospital, as well as the relationships between physicians/NPs and RNs.

If she/he is a good one, having a certified hospice/palliative care physician will make a big difference, because the traning includes an emphasis on working cross- inter- disciplinary, and recognizing that that the folks that are at the bedside have the best picture of the current situation.

Ideally, the RNs who are going to be working w/the doc would get to be part of the hiring process, but that's probably asking a bit much.