LPN student in Hospice

webblarsk · Mar 8, 2005

You sound like a wonderful person to be working in Hospice. I think most hospices utilize LPN's. Check it out. Hospice's need people like you!

aimeee, BSN, RN · Mar 9, 2005

Check it out. It varies from hospice to hospice. We utilize LPN's for continuous care only, but some hospices utilize them for on call and for assisting the case managers.

CHPN1680 · Mar 10, 2005

Hello! I am a 46 year old LPN student currently working as a STNA for a home health care agency. I had taken several cases from this agency and found that I was working for a company that sent out just anyone to patients homes and the level of care given was horrible! I was about to separate from this agency and possibly home care altogether when I was asked to "bail them out" of a problem case. The problem I found was not with my patient, but with aides who went to her home and sat all day long, forged time slips and wouldnt even speak to her! When I arrived at......lets call her Jane.......Janes home, I found a wonderful 49 year old with stage 4 ovarian cancer. She has paraneoplastic cerebellar syndrome which has effected her speech among a host of other disabilities. She transfers by herself only by use of her arms and I feel communicates very well if one would just take the time to listen to her. I have never met anyone so determined to live one day at a time, and believe me, I have learned more from this woman about living and about dying than I could have imagined. As I was brand new to this field, I forgot about the risks of becoming too personally involved, and Jane and I have become good friends. Initially Jane was depressed and didnt speak much. Today we talk, laugh and joke and have made one day a week, "beauty" day where I wash and style her hair. She loves it and her family is so grateful! I can see the person Jane was before her illness and she still IS that person today, inside. What a difference the caregivers perception makes in the overall health in her patient!
Jane has recently decided to stop chemo as she wants to die "feeling good". I support her in this and would have in the event of any other decision she might have made. I dont believe I am anyone "special" but I do believe that I have been given a gift to assist the dying. Janes passing will be difficult for me. However I have never felt such a profound sense of "being there" for someone and I am so grateful that I have been able to help make her last days happy and peaceful. Its just the little things, like quietly listening when she wants to talk, massaging her feet, keeping her skin healthy and remembering to bring donuts every Sunday. Its allowing her quiet time also and being able to tell her that yes it really stinks that she wont ever see grandchildren.
Anyway......since being given the gift of sharing Janes last days, I am seriously considering a career in Hospice. Is there a need for LPN's in Hospice? As I am "older" I felt that starting as an LPN was the right choice for me. Is there special training? Any ideas or input is greatly appreciated. Thanks!

We have LPN's that help the case managers with routine visits and the also do continuous care. It really does vary from state to state and agency to agency. It sounds like you would be a welcome addition to hospice.

You must be mindful of boundary lines. You did indicate an awareness of this. There are always patients and families that you form closer attachments to than others. That's normal. Just make sure that you are mindful of your role and that you work as part of the team that is caring for the patient. Social Workers and Chaplains play a vital role and I often see nurses acting too much like social workers. It is just in our nature. :) Good Luck to you!

ChristinaV · Mar 10, 2005

We have LPN's that help the case managers with routine visits and the also do continuous care. It really does vary from state to state and agency to agency. It sounds like you would be a welcome addition to hospice.
You must be mindful of boundary lines. You did indicate an awareness of this. There are always patients and families that you form closer attachments to than others. That's normal. Just make sure that you are mindful of your role and that you work as part of the team that is caring for the patient. Social Workers and Chaplains play a vital role and I often see nurses acting too much like social workers. It is just in our nature. :) Good Luck to you!

Thank you all for the positive feedback and encouragement. Bob, I appreciate the reminder to watch my boundaries, and important issue for me! I was not prepared for this assignment and recieved no support from my provider agency, so I have been feeling quite alone out here. Initially it felt good to be so depended on, doing 7 days a week and taking charge. After 6 months I was drained and insisted on one day a week off. We would go months without seeing a nurse. Once I called my nursing supervisor to insist upon a nursing visit. Jane had an infected ingrown toe nail and felt pain in her foot that she has had no feeling in at all for 2 years. When the nurse came out she complained in front of the patient about being called out for a toenail! Later I called my supervisor to report that my patient felt bad "imposing" on this nurse. I suggested that Jane is a human being and not just a toenail! She was in pain, confused and afraid and needed some support from our nursing staff. As an aide, I am not qualified to treat nor diagnose any symptoms.We just got a new case manager and this nurse is awesome, so help has finally arrived and is taking over a great deal of the work I was doing alone. As an STNA, and not even being a nurse yet, I am not qualified to meet all of Janes needs. As a human being, I am not able to meet all of anyones needs! I realize how important it is to be part of a team like you mentioned. Jane will also benefit greatly becoming part of hospice, where she can get more of her needs met and a refreshed staff as well! Thanks again for the support and for listening to me vent!

mkc · Mar 20, 2005

Thank you all for the positive feedback and encouragement. Bob, I appreciate the reminder to watch my boundaries, and important issue for me! I was not prepared for this assignment and recieved no support from my provider agency, so I have been feeling quite alone out here. Initially it felt good to be so depended on, doing 7 days a week and taking charge. After 6 months I was drained and insisted on one day a week off. We would go months without seeing a nurse. Once I called my nursing supervisor to insist upon a nursing visit. Jane had an infected ingrown toe nail and felt pain in her foot that she has had no feeling in at all for 2 years. When the nurse came out she complained in front of the patient about being called out for a toenail! Later I called my supervisor to report that my patient felt bad "imposing" on this nurse. I suggested that Jane is a human being and not just a toenail! She was in pain, confused and afraid and needed some support from our nursing staff. As an aide, I am not qualified to treat nor diagnose any symptoms.We just got a new case manager and this nurse is awesome, so help has finally arrived and is taking over a great deal of the work I was doing alone. As an STNA, and not even being a nurse yet, I am not qualified to meet all of Janes needs. As a human being, I am not able to meet all of anyones needs! I realize how important it is to be part of a team like you mentioned. Jane will also benefit greatly becoming part of hospice, where she can get more of her needs met and a refreshed staff as well! Thanks again for the support and for listening to me vent!

Having been thru the gamant of nursing fields for 13 yrs,I was fortunate to find the job I was ment to have in hospice.Some skills I'm not allowed to use in my position (calling DR.,taking orders) but I prefer the hands on anyways. Usually need 1-2 yrs. HH. or ECF. experience before applying.Goodluck on your career!

Blackcat99 · Mar 21, 2005

I am an LPN who works in hospice and I love it. It seems to me that some hospice's hire LPN's and some don't. Best of luck to you. :)

mkc · Mar 26, 2005

Love to see hospice L.P.N.'s. A special quality of care only a dedicated L.P.N. can deliver. We know our scope of practice and get to deliver hands on without the headache of ALL that paperwork to satisfy JCAHO. We are now permitted to be certified! What took so long in learning that L.P.N.'s can play a vital role in providing end of life care? Just wish I wasn't so limited in utilizing skills I was trained to do. Who decides what we can or cannot do? At my organization, they are still trying to figure out what my limitations are, yet eager for me to use the skills I can. National? State? Local? Where is it in writing?(I'm a visual learner!) :nurse:

Katillac, RN · Mar 27, 2005

in the hospice where i am eployed, we utilize lpns as staff nurses in our residence and also in home care. but please remember that the medicare benefit, which drives a lot of the operation of hospices, does not allow for the kind of time you are spending with this patient unless there is a need for continuous care. our lpns see as many as six or eight patients a day. you sound like a terrific and compassionate person, but hospice nursing involves many areas of specialized skill and knowledge as well. check out:

http://www.nbchpn.org/pdf/nbchpn_handbook_2005.pdf

for some ideas about what is involved in certification as a specialist in the field, which lpns can do. note i am not saying you need certification to practice as a hospice nurse.

i am not raining on your parade here. i agree that we need more good hospice nurses, and you sound wonderful. i wouldn't want you to be disappointed, though, to find that the job involves responding to demands that are different from the ones that seem to bring you such satisfaction now. i work (along with three other roles!) as a staff rn at our hospice residence, and i definitely get time to "be there" for my patients, but sometimes not nearly as much as i would like as there is so much non-contact other stuff that goes with their care.

good luck to you!

ChristinaV · Mar 29, 2005

Thank you Katillac!! Thanks also for the awesome link. That provided much needed information. I knew going in to the LPN program that I would need further training. I look forward to joining the ranks of you wonderful Hospice nurses one day. I just hope I make it before its time to retire :chuckle

michw2 · Mar 29, 2005

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Just wanted to say thats what nursing is all about to me. You sound like you would be great in Hospice.