New Grad Straight to Hospice Nursing? Think Again ...

NurseDeltaInk, RN

Along the way, I've met many nursing students and new grads who have a "hospice heart.” They share their stories of witnessing a loved one die at home, having relevant experiences during this event and now feel that hospice is their calling as a nurse. Or, they work as a CNA in a skilled nursing facility and lose their favorite resident and now want to help others at the End-of-Life. I get that special feeling myself.

Attending the dying and death journey, for some of us, brings an almost indescribable heart-centered warmth even in the midst of loss. The inexperienced nurse then assumes THIS should be the job they apply for upon graduating.

The birth of a career passion is strong medicine, yet it is not enough to be the "wind beneath my wings" for a green nurse when it comes to practicing home health care hospice nursing. There is so much transferable knowledge yet to be learned in facility nursing at the beginning of any nursing career.

A new grad has little time spent in learning and prioritizing when it comes to med administration, wound care, pleural drains, foleys, and physical assessments (and more!), not to mention dealing with difficult family dynamics that require professional communication know-how.

Home health care hospice is an advanced practice role. You are alone in having to rely on your critical thinking skills based on your unique library of nursing experiences. Also, home environments are less than ideal at best and sometimes just plain awful to practice nursing in. Throw in all the dysfunction death brings up in some families and you have a recipe for failure as a new nurse. It takes creative ingenuity at times to problem solve and this comes with time and practice.

Additionally, the hospice medical director relies on keen nursing assessments in the field when the need to call them for changes in condition or upon admission arises. They aren't actually seeing what the hospice nurse is seeing in the moment so being able to give a detailed report as well as anticipating patient needs is crucial...and not so easy for a newbie nurse.

Facility settings provide greater support and mentoring opportunities when still wet behind the ears. There are always other nurses, doctors, PT, OT, ST, RT, etc. to grab for their input. Charge nurses can be spectacular for assisting with a difficult NG drop or IV line blockage. A new nurse will see a plethora of things in a facility over time that can be directly applied in the home setting.

Are you still considering the hospice nurse role? Here are 7 suggestions to prepare any student or new nurse in the meantime.

1️⃣ Volunteer At Local Hospice

Hospices receive Medicare/Medicaid reimbursement and, thus, are required to provide a certain number of volunteer hours to their patients/families. They are always happy to have volunteers! They furnish basic hospice training before seeing patients that will lay the groundwork for this nursing specialty.

2️⃣ Ask To Be Assigned To Preceptorship

This can give you critical experience in what a typical day is like for hospice nurses. It can be eye-opening.

3️⃣ CNA License? Find Job At In-Patient Unit

This is exactly what I did while I was in school. It was a 5-bed unit with just the nurse and me...talk about a paid preceptorship! I learned so much about comfort measures and had the privilege of holding the hands of the dying. I treasure that time as an aide when I truly made a difference and acquired hospice training at the same time.

4️⃣ Consider Position In Oncology, ICU, Palliative

Again, you will have loads of resources and assistance all around you to launch your nursing career and this knowledge can eventually lead to being successful in the hospice nursing role. And, don't disregard a solid med/surg position.

5️⃣ Hospital Certification Programs

Becoming a Certified Hospice and Palliative Care Nurse (CHPN) is a brilliant step toward a hospice nursing career. Yes, there's more studying ahead. However, you can get additional alphabet soup behind your name that equals mastery of a subject matter: in this case, hospice nursing philosophy and care. I took advantage of my hospital's program while I worked on Oncology. They paid for my testing fee and awarded a yearly bonus to boot for having this certification. Besides that, it looks great on a resume when you finally apply for your first hospice job. Win-win!

6️⃣ Long Term Care Positions

Contrary to nursing myths, LTC is NOT where old nurses necessarily go before they retire. (And what's wrong with that? They've seen and done it all! What a resource!) Geriatric nursing is a complex, demanding and rewarding specialty. You will see tons of end-stage disease trajectories, learn many of the treatments provided in hospice and make a difference in so many special lives.

And here's a little secret: you work in their home. And residents die there as well. The difference is that you'll have facility staff and a visiting hospice team to learn from and support you along the way. Make sure to ask the hospice team questions, get your gloved hands on dying patients, talk with bereaved families who visit and practice your bedside hospice manner. You'll see multiple deaths over time.

You can learn all the comfort measures that are needed in End-of-Life and can practice using your "gut" senses that will aid you when you are out in the field alone as a home care hospice nurse. For example, do you think Bill will die tonight...were you right? What clinical findings did you put together with your nursing intuition that lead you to be correct? What transpired if you were wrong by a day or three?

The nursing home IS the resident's home. And, you will get close to many of them. Ask yourself this: when they finally pass, did it wreck you to the point of deep sorrow and demonstrative crying? Or, were you able to have professional distancing and show up at the bedside to skillfully support both the resident and the family with a simple, compassionate tear in your eye? A hospice nurse must come with the ability to realize that they are there to facilitate a patient/family life event. In other words, you cannot be in hospice if you get overly attached and make it about you. This can take time to learn for many nurses.

7️⃣ Do Home Health Care After First Year

You may be chomping at the bit to try your nursing chops out in the field right now. Starting in a home health care position is a great segue to hospice nursing.

Home care has its own set of nursing challenges. All field nurses must eventually master quite a juggling act. You will see multiple patients a day in a variety of home environments that require all sorts of treatments, usually done in the hospital. Managing travel times, unforeseen events and trips to pick up meds at the pharmacy for your patients will be time-consuming and demanding. Are you able to keep up?

Then there are hours of computer charting you do at home that MUST be done in a timely fashion per organization policies and CMS regulations. You won't be pulling out your tablet/laptop at the bedside to chart, thinking you'll save time. You will be more effective, and patient safety will increase if you are fully present in the home when you are observing them and not on a screen. You'll get a crystal clear idea of the logistics of home hospice nursing if you first start in home care. Home care is different; you don't get to leave your job at the time clock at the end of the day. Work follows you home.

So, you know you have a heart for hospice. And, like me, if you know, you know. Try one or more of the above suggestions while you start to hone your basic nursing arts. Hospice will always be there, waiting for your special, experienced nursing savvy and compassionate nature.