Is this really what it's all about?

smurfynursey · Apr 23, 2012

i'm thinking about starting out in med/surg now so that i can utilize my skills and actually do "nursing" things.

i'm sorry to hear that your rotation is not what you had hoped for...

however...however....

just because you are not dealing with ivs, hardcore meds, blood, guts and gore does not mean you aren't doing "nursing" things.

have you disscussed your concerns with your preceptor? have you asked her to do an assesment, or do one with you, so you can hear what you want to (ls, hypoactive bs, ect)? i have worked with students before and i am willing to show them alot of stuff it they appeared interested. even if it is not what you want, there is always something to learn. hospice is a great place to learn what crappy lung sounds, poor bowel sounds, heart issues, and the s/sx of the dying process are if you are interested in learning it.

best of luck.

ErinS, BSN, RN · Apr 25, 2012

I believe your hospice experience can be variable depending on the acuity of clients a hospice takes, the diagnoses, and the nurse. Hospice is generally not a field heavy in 'nursing tasks' such as placing IVs, but very, very heavy in nursing process (also called care planning), assessment, and psychosocial support. That being said, I work in a hospice that has a very high acuity and lots of clients in the hospital. I do admissions, so I interact with nearly all our patients at their first visits. In a normal week, it is not uncommon for me to do the following:

Start a subQ infusion

Access a port

Place a foley

Drain an indwelling ascites drain

Draw labs

Give a bed bath

Do wound care

So I would say that I feel fairly competent in my ability to perform 'nursing tasks', but working with students I recognize it is often difficult for students to recognize everything I am really doing in a visit. For example, I go into a visit and sit down and chat with my client. During this time I am assessing for mood, affect, skin color, dyspnea, signs of pain, and signs of weight loss. I then do VS, listen to heart, lungs, and BS, and check feet and legs. While I do these things I continue to chat with client about bowel movements, appetite, fatigue, pain.

One thing to remember about hospice is we are focused on symptom management. For example, I may hear crackles or wheezing in a client's lungs, but if they are not having symptoms (coughing, dyspnea, fevers, LE edema), I just keep watching. As a student, I encourage you to tell your preceptor you would like to do the assessment and care planning for a client by yourself and run by her the things you think should be priorities and why. You may also, unfortunately, just be with a nurse who does not much love her job anymore. It happens. Good luck!

tewdles, RN · Apr 25, 2012

I don't believe that field hospice nursing is a good place for a new grad RN with no nursing experience.

You should, however, express your concerns about this particular experience with your preceptor up the chain of command...prolly your instructor who will communicate to the hospice manager. Your preceptor should be providing you with a MUCH better picture of what a case manager does.

MomRN0913 · Apr 25, 2012

Actually, that is what Hospice nursing is. It's not really performing technical skills.

We don't give the meds, we teach how to give the meds so the patients can be managed at home.

We evaluate for symptoms and creative ways to manage them and keep them comfortable. We teach caregivers how to keep their loved ones from getting bed sores. How to feed them. We do wound care and teach wound care. In cases of acute pain we teach them what meds to give and evaluate the patient to see what interventions we can put in place so the patient does not have to experience pain.

it really is heavy on assessment and teaching. But not much doing. And support and managing a case as a whole. providing resources and conferring with a team. I'm in my 3rd week of orientation and we do see 3-4 patients a day and it is alot of paperwork.

These are all "nursing things."

I say, sure, go to med/surg if you want to perform technical tasks. That's the place to be. I've been in med/surg and ICU prior to this. And I can tell you in med surg I did a lot of tasks. I was so busy and overloaded I never got to know a patient on a supportive level. Full head to toe assessments on every patient was almost impossible. But it's what you like.

I'm lucky to work with a very caring bunch in hospice where everyone on the team knows the patients and families inside out and does whatever they can for them.

I was assessing my patients from day one in hospice. SO just ask if you can.

Good luck!

Dragonfly949697 · Apr 26, 2012

As a hospice nurse of three and 1/2 years if feel that I use every morsel of nursing education. I agree with the above that the nursing process is crucial (obviously for all nursing) but heavily crucial in hospice. Yes...we have technical skills, however it is through the nursing process that we assess and evaluate our patients and re-eval based on outcomes. It is good to think outside of the box and get into why we came into nursing in the first place. Every pt is a psych-social, physical, and spiritual. In a nutshell hospice nursing is very much a hollistic practice meaning we treat the pt as whole and in entirity....not just one specific problem or disease process. We do deal with heavy meds (morphine, dilaudid, ativan......(list goes on) for sx relief (sob, nausea, pain, anxiety/agitation....etc), through all routes including picc's, mediports, sub-q, and injection. We also have pts with trachs, drains....etc. I would recommend a year of med-surg to really have an instinctual grasp on the nursing process and critical thinking. I feel hospice nursing for me is the ultimate reward and I always feel full and blessed to make the best in the rest of quality of life a pt has, relief of pt suffering, and family support. Good luck:)

tewdles, RN · Apr 26, 2012

I absolutely agree that our hospice nursing practice "looks" much different to the student. That is why it is important for the hospice preceptor to explain the process to the student. To talk with them about the POC, how it was developed, how you work with it, and how you document, etc.

Without proper precepting a nursing student would simply follow a hospice nurse and compare that scenario to the hospital based acute care nurse. There is no doubt that anyone would initially think that the hospice nurse was slacking. Just like Dragonfly so aptly stated, hospice is not a task oriented nursing practice.

Yeah, that preceptor didn't earn her money that day...sorry for the student.

MissIt · Apr 26, 2012

It might be useful for you to see if there is an inpatient acute care hospice unit around you. Maybe you could do a few days of your rotation there or at least shadow a nurse and see what that side of things is all about. If you want to do hospice and still do a lot of hands on acute care-type nursing work, that might be a good match.