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need input, want to start Hospice Nursing

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Hi, I love reading posts here but this is my first post. I am a 53 yo new RN grad with 8 years expeience as an LPN, mostly in LTC/ALF and 3 years in home health. My current LTC position is a 'good' job with decent pay and benefits but im really feeling empty and unfulfilled. I mostly pass meds and chart. Ive been seriously researching hospice nursing for a while and have read books (I loved "one foot in heaven" by Heidi Telpner RN). Its a big decision and I want to be as sure as I can be before I move. Will some of you who have done this for a while talk about some of the down sides to it? I know driving will be extensive and there may be irregular hours (??) But what about the psycho-emotional side? Do you stay recharged or do you have times where you feel overwhelmed or drained? Is this worse in the beginning and get better, or vice versa? Other considerations? Of course I love hearing the positive too as im definately leaning towards this specialty, I am happiest when I really connect to a patient.

I have been in hospice for almost five years and I can honestly say that I have never felt overwhelmed or drained. I am very energized by being able to help people in this way and sometimes even feel euphoric after a good death. I think that hospice is really a calling, and people without the personality/resiliency needed to deal with it don't stay long or don't start at all. That said, I am not sure it is more difficult than other types of nursing where exposure to death is common, such as ICU or oncology. In fact, it may even be easier, since in those disciplines there is a lot more futility and feelings of being unable to affect the end result. I never feel that way in hospice.

Thank you for your insight. I hope I do have that resilience.

I really encourage you to apply and interview. You will learn a lot in the process and may even be able to shadow a nurse or spend one on one time with her. You'll know right away.

After 8 1/2 years in hospice, I can still say I have never felt emotionally depleted from dealing with the death and dying aspect of the patients. If I feel stressed or disheartened, it is invariably due to job expectations/not enough PRN staff to help/having to work OT or take call, etc. Occasionally, it is the push and pull of the families, especially when they have unrealistic expectations. It is our job to educate but this takes time as families are usually stressed and, depending on their personal histories, gaining their trust may take time. It is a joy to have time to recharge between patients while driving. I take a book with me to enjoy during lunch. The patients themselves have usually been through the wringer by the time they get a hospice referral and they are often more than ready to back off on the treatments and going to the doctors and are more at peace with the thought that EOL is near. If you are the case manager for patients in nursing homes, you will have to learn the "personality" and expectations of each nursing home. They are similar but never the same. There are pros and cons to having patients at a nursing home. Just remember that you are a guest in their facility and so make sure you are tactful with the staff. I have known nurses who go into nursing homes with an attitude and are rude to the staff. That is never acceptable. There are also pros/cons with home patients. The main thing is being flexible. You will learn the ins and outs over time, just remember to be patient with yourself as you learn and always ask questions when you are uncertain. If you are feeling a pull toward hospice, I believe you will do fine.

Thank you softbreeze and tammyg. I appreciate your honest replies, im going for it. I am drawn to the fulfillment and satisfaction of being there for the patient and families...that special feeling when a patient looks into your eyes looking for something and finding what they need in you! I feel blessed to be drawn to hospice nursing.

Excited, I have an interview with a hospice near me on the 20th!

DLS_PMHNP, MSN, RN, NP

Specializes in Psychiatry. Has 11 years experience.

Good luck with your interview!

QuiltDog

Specializes in Hospice Nursing.

Good luck with your interview. I have been a nurse for 28 years, the last 10 in hospice. It is the best job I have ever had! I cannot ever see returning to hospital nursing. That said, it isn't all rainbows and butterflies. I learned quickly that even when they have signed up for hospice, patients/families aren't necessarily accepting of the terminal nature of their illness. This type of crisis brings out the best and worst of families. Most of the time it is a beautiful process, but when it is bad, it can be extremely stressful!

Having a comprehensive, lengthy orientation is a good start. Having supportive management and team is critical for your ongoing happiness. It is a wonderful career - keep us posted on your interview :)

Good luck and let us know how it went today!

Well I feel my interview went well. He said he would let me know one way or the other around Tuesday. He said he was going to call my references so I must be a good candidate?? So now I'm so nervous. He said the case load is 12 to 16. Back up call is 5 to 8 times a month. the position is Rn case manager. I had to ask what the title was because I wasn't responding to a job posting, I just called him and wanted to ask some questions! oh, orientation is 3 weeks. Does this sound Ok?

I'd suggest volunteering to get your foot in the door and to see if hospice is something you'd like to try. That is what I did. I asked to volunteer in an area with a lot of patient contact so that I could see whether I could handle becoming attached to patients and then learning that they have died. I now work in a hospice in-patient unit, which is like a hospital for dying patients. We see a lot end-stage diseases and help patients manage their symptoms. Some patients go home and enjoy more time with their loved ones, others die at our facility. The downsides? Sometimes we get families who don't want their loved ones to have pain meds! Sometimes families just don't get hospice.... they wonder why we aren't trying curative treatments. Staffing can be rough.... all areas of in-patient healthcare seem to be skimping on staff and hospice is no different. I think hospice pay is a bit low. It is a high-burnout specialty. The hours (like in many areas of in-patient work) can be rough. A lot of people (even nurses!) seem to have a misunderstanding of hospice. We really do a lot and see a lot. My facility does blood transfusions and lab draws. We assist doctors with paracentesis. We administer TPN if the families want it. Sometimes we do tube feedings and of course trach care. I really do like working in hospice. I feel like I am helping patients and families get through a difficult time. That said, it is rough... hard on me and the hours are hard on the family. One of my patient families asked one time how hospice employees survive after seeing so much suffering. I was thrown back by that question, then told her that we just make the most of our off time to recharge the batteries... I hope I was more eloquent than that.... but maybe not. Good luck to you!

Another thought: would you have time to take a PRN hospice position to see if you like it, while maintaining your regular job for awhile, just in case you don't like it? A lot of hospice inpatient units have PRN positions... I don't know if there are field PRN jobs available, though..... I think the inpatient unit is a great way to get started in hospice because there are other nurses around if you have questions.... I came from an acute-care background and was AMAZED at the difference between curative and hospice treatment/medication. It is a different world.

Actually, there are field PRN positions. They orient for a few weeks with the FT field RNs. That's an excellent way to get a taste for hospice but it IS only a taste. The PCMs will not send their PRN staff into a difficult situation if they can help it. They will get the easy visits, usually (routine visits with the least drama- straight in and out). You really have to be with hospice about a year before you can experience the full range of situations you're likely to run into. The most important trait to have, imo, is being able to keep your equilibrium through various stressful situations. None of us can please everyone so being able to "brush it off" and move on to the next case is important. Also, don't take your work home with you and I mean that literally and figuratively. Don't fret over your patients when you are home- do the best you can for them on the job then set those concerns aside to the next work day. We all need that "me time" to recharge our batteries.

Hi I am an LPN and was lucky enough to get my first job on a 12 bed general inpatient unit. I love this work. I find it an honor to be able to take care of my patients and my families. I particularly enjoy inpatient setting because I have 3 other nurses to bounce things off of. I work nights and we work as a team. Now, I have found that some cases hit a bit too close to home. I took care of a woman my age (49) that ceased to breath. Very rewarding work. Good luck!

BerryhappyRN, MSN, RN

Specializes in Nursing Leadership.

YaY! Your interview sounds like it went well! If you got an interview basically off cold calling, and he is going to check your references, you are good! I am so excited for you! Just because you are so interested, that means you have heard "The Hospice Call". It is a blessing to be able to provide care and comfort to a patient in their most vulnerable moment. Welcome to our world!

Well, the assist administrator thought my lpn experience would suffice but the administrator wanted 2 years of Rn experience so I'm back to square A. Well I'm looking at options. My current employer is Ltc with 2 days a week on the rehab side. I'm just unhappy here. we don't have CMAs and 70% of my time is passing meds. Now I'm venting. I'll take my time and look for the right hospice job. I applied for the hospital hospice position, not sure if it's inpatient or home based, I believe they do both.