new hospice job

ErinS, BSN, RN · Oct 29, 2010

You may want to look into the weekends and holidays thing. I still work an occasional Sunday and work many holidays. The best thing you can do is just relax. Don't let things your patients say or do get to you. The best thing about hospice is that I feel like because my patients are dying, it doesn't matter how obnoxious they are (although most of my patients are amazing people). Also, make sure you have boundaries. For example, I do not do work between 6pm and 8 am. I don't care who calls or if my manager is mad that I did not come home and chart for 2 hours. Good luck! It is a great field of medicine!

Hospice Nurse LPN, BSN, RN · Oct 31, 2010

Congrats! I love hospice nursing, but as posted by Erin, look into the "no holiday" thing. Sure we get to take the holiday off, but the pts must still be seen. Usually, you'll see those scheduled for the holiday the day before or the day after. Sometimes you'll be able to do a "visit omission" d/t the family requesting no SN visit that day, but if the pt is doing poorly SOMEONE will have to see them.

One thing that I always tell my caregivers from the get-go is DO NOT call me on my phone....call the office. I'm sorry, but when I'm off---I'M OFF! I actually say on my voice mail, "Hi this is Hospice Nurse LPN. Please do not leave me a message about a pt because I do not return calls. Please call the office at ###. It works about 95% of the time.

I don't chart or make calls from home (unless I'm on call). If I'm working, I'm going to be paid for it. Good luck and welcome to hospice!

leslie :-D · Oct 31, 2010

a pt's wishes, should always take priority over a family member's.

it amazes me how many don't get that.

leslie

CJsGirlRN · Nov 1, 2010

Well as for the weekends and holidays, they have nurses who do just on call and weekends, and they have enough people to rotate holidays so that i may have to work a major holiday once every few years. Of course I won't have all holidays off, but right now for my med surg job i have to work every other holiday and every other weekend. it will hopefully be a nice change of schedule.

AtlantaRN, RN · Nov 1, 2010

I completely agree with the "when i'm off-i'm off"....

Hospice nursing is demanding, and you HAVE to set boundaries---or you will burn out quickly.

Do your best for the patients and the families-any issues, i call my administrator-or text her a brief summary of potential problems.....

If you do something wrong, go ahead and write yourself up. Once put a foley in the lady parts of a dementia patient that was beating the crap out of me. ((family INISISTED on a foley, against my better judgement---if i had to do it over again i would have said no because pt hadn't been able to swallow for 2 days--but i was new at the time and the "customer is always right")) went back the next day, no urine in bag, and brief was soaked. One family member emailed corporate to complain.....the good thing was, right after the visit the second day, after profusely apologizing to family, I called my administrator and wrote myself up explaining the extenuating circumstances of getting bashed in the head by a demented patient......Id rather write myself up, than giving another the opportunity to do so.

tewdles, RN · Nov 3, 2010

After working in Med surg for 4 years on two very difficult units, I have been offered a job as a home hospice nurse. No more working every other weekend, no more working holidays. On call requires only 2 days a month. And i'm hoping for once i will be in a position where my nursing skills will be much more appreciated. I am so excited to be working with families to help them through their difficult times and to make the patient comfortable in their last days of their life. I am a little nervous, but excited at the same time, for a big change. Any advice to a new hospice nurse out there? Any good tips that you wish someone had told you when you started? Thanks!

Welcome to Hospice! This is what I wish someone had told me...

Be aware that all hospices are not nice places to work, so pay close attention to the management style and agenda in your new work place. If this employer does not acknowledge or honor good and reasonable personal/professional boundaries set by their professional staff - begin to look for another job immediately. If the tone of the work place is not upbeat and positive, begin to look. Lots of hospices are hiring so you do not have to work in an unhappy or abusive environment. Hospice is a very emotionally demanding job and your employer should not add to the burden recklessly.

As many posters have stated previously...on call expectations can vary wildly and can be vastly different from the pitch one may get during the interview/hiring phase. On call can be a huge issue for full time case managers. If "excessive" it is exhausting at best and dangerous at worst. You will hear of case nurses who work 50 hours/wk managing large case loads and also provide as many as 150 hr/mo of on call coverage (mandated). If your management team seems disinterested or insensitive to how on call adversely affects the staff (you), I would suggest you be very cautious. Self care is very important in hospice and self care is difficult when you are overworked and exhausted.

I imagine that you possess some reasonably fierce bedside skills...so the technical skill part of field case management should present no significant challenge. We do see some pretty complicated wounds, drains and tubes of all sorts...the obvious things like foley's and ports. Your technical skills will be appreciated by your team. Many hospice nurses I have known over the years are not comfortable with intravenous skills...not starting, not drawing, not infusing...IV therapy has a very small role in hospice care overall. So your comfort/skill with that will be helpful. The challenge for you will be learning bag technique and developing your own style of working effectively and efficiently in the living space of other people. Mostly it requires a learned and stubborn foundation in fundamental skills of asepsis, etc with a huge dose of creative flexibility.

Focus on the nursing process...what can you do for these people, as a nurse, that can help them along this pathway. Remember that you have a team. While you can offer guidance and prayer you do not have to be the chaplain or the social worker...in fact, you shouldn't be.

Embrace the notion of "point of service" documentation now...it is NOT going to go away.

I hope you love Hospice, I do...it is rewarding work in so many ways. Good luck.

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