Learning Curve for Being an On-Call Hospice Nurse

[westieluv]

I recently began working at an inpatient hospice facility after years of working hospital inpatient Med/Surg nursing. Now I am accepting a position with the same company as an on-call field nurse. I am really excited about trying something other than bedside nursing for the first time, but I am also feeling a bit overwhelmed by the type of autonomy and authority that this position provides. As a hospital nurse, I am used to taking my orders directly from physicians or charge nurses, but when I'm out in the field I have to rely upon my own knowledge and I feel inadequate much of the time. My question is, based on your experiences, will I feel comfortable in time in this new role, and how long did it take you to get into the groove of it? I went out on my first solo visit last week and even though I put on a confident face, I honestly felt a little intimidated and not as knowledgable as the nurses that I have been shadowing for the past few weeks. I had to call the triage nurse for advice three times, and that made me feel really stupid. I have been an RN for over twenty years and I have years of experience, so do you think that my main problem is lack of confidence in my ability to take on this new role? Do you have any advice for me?

Thanks!

[Hospicetex]

Like you I have been a RN for many years but that first weekend on call I called my back up more times than I would like to admit. She was great and I really appreciated her but it was very overwhelming.

I think with a couple of weekends under your belt you will more comfortable. I occasionally call my PCC on the weekend but only with an issue I haven't addressed before. It takes a couple of times to get the hang of it and our PCC's are available if we need them.

Good luck!

[AtlantaRN, RN]

It just takes time. some weekends will be better than others. remember to call the field nurses---you are taking care of their patients on the weekend....that is how i feel as the weekend nurse. Frequently, I call them for their take on a situation. I've been doing this for a full year now with 3 yrs as a field nurse, and 10 yrs in the hospital setting. I have a hospice pharmacia book that i had from my last position at a different hospice-they have algorhythms for problems and list each symptom in order.......you will learn that steroids are great for bone pain, as is choline magnesium tricylicilate......... I have a backup nurse for when i have a rough weekend or several middle of the night calls.....i always keep my clinical nurse manager or branch director in the loop (whomever is backup administrator on call) with text messaging to update them on what is going on.

it is autonomous, but liberating. there is pride in a job well done. remember to keep everything you think you need and then some in your car (they call my scion xb "the piniata..." because i have EVERYTHING in it.....

There is never a dumb question, always use your backup nurse and field nurses as a resource.

linda

[westieluv]

Thanks for your replies. They really made me feel better. :)

[patsysparksrnchpn]

Maybe it is a bit late to post a reply, but I feel inclined to comment. I have been a nurse for 19 years, worked hospice for 6 years and been on call nurse for over 5 of those years, yet there are still occasions when I get a call and on the drive to the patient's house I am thinking 'what am I going to find and what will I do about it!!' So far, I have always been able to assess and provide the needed interventions. I guess what I am saying is that sometimes you do feel 'out there', but on the whole, I love the autonomy and have good support in my Medical Director and the case managers. I really love my job.

[AtlantaRN, RN]

We have a new m-th on call nurse. Pretty much on the call, people will tell you what they need......although sometimes you get the "she doesn't look good and i want to call 911 or she has to go back to that facility (ipu unit). My next question is "is her chest rising and falling, breathing normally?" If family say yes, then I tell them i am on my way to visit and call me if there are any changes....If family said no, she is short of breath, i would instruct to give 5mg of roxanol under the tongue, and i'd call every 15 minutes to check on them and patient, instructing to give another 5mg each call....(up to 20mg in an hour)....I usually get there within 45 minutes.

every case is different....sometimes family members just need to talk. I had a call last weekend at 915am with family saying they were "concerned with patients condition," I called dtr right back....she went on about brother feeding patient the night before without checking her glucose, and now it's 225, and she is sluggish..." I educated i'd rather have her sugar a bit high than low....patient is known to sleepuntil noon and it was a particularly cold morning.....dtr turned conversation to her own medical issues and how brother stresses her out over their mother....((she sent brother to the grocery store because he was producing so much anxiety for her))....after all was said and done, daughter didn't even want a VISIT---SHE JUST NEEDED TO TALK FOR 30 MINUTES, which is fine.....

another night 1am, mother calls about 40 yr old son with es cardiac, he pulled out his foley, i get there and he had pulled out a #12 foley with a 5-10ml balloon....nurse had used last one on friday, so there were no more in the home, all had were the 16"s & 18's.....i educated #12 is not a standard size (pt is a downs syndrome patient and member is approx 5mm circumference....putting a 16 or greater would have injured him i am certain). she was not happy, but the best i could do was leave 2 packs of xxl briefs for her until monday (it was sunday morning 4am when i left the home).....you can only do what you can do, and move on.....

for the most part, people tell you what they need, and i do love my job.....anything weird happens, i text clinical manager and branch director.....

[AtlantaRN, RN]

westieluv-there are no stupid questions......i'm sure you will do fine....when in doubt, call your manager....

[westieluv]

Thanks, I can't believe how much different I feel since I posted this back in August. I feel soooo much more confident now, and so far I haven't gone into any situation that I couldn't either handle on my own or with the help of my on-call supervisor or the on-call physician. Doing this job has given me a new confidence that I never had before as a nurse working inpatient. It is so rewarding to see immediate results of your efforts and the patients and families are generally so appreciative and nice. I love what I'm doing, and that's honestly the first time I could say that with 100% truth since I've been a nurse.

Thanks again for all of your replies. :)

[GundeRN]

This is encouraging to read. I am new and can't sleep when I'm on call even if I don't get a call. I am anxious about the phone ringing. Even my personal phone makes me jump. Right not it is almost 2am I have only gotten one phone call tonight and didn't need to go out. I should sleep because I have a lot to do tomorrow but I just can't when I know that phone could ring. It's good to hear that this goes away.