New hospice nurse: Burned out!!!

CalArmy · Aug 11, 2016

I critically think EVERY day!!! We are alone in the field and have to think on our feet. Hospice is not just pain control. We manage and treat a lot of symptoms. We also manage family dynamics. All of which take critical thinking!!

MsPrettyHospiceRN · Aug 14, 2016

Exactly I have learned more in hospice and have done more critical thinking and have actually had the opportunity to apply it in hospice. I feel like if you have no helpful suggestions then please shut up. Thanks!!!

MsPrettyHospiceRN · Aug 14, 2016

Thank you all who had helpful suggestions. To those worried about my formatting if you have no helpful tips then beat it. I turned off my caps just for you.

Nascar nurse, ASN, RN · Aug 14, 2016

Thank you all who had helpful suggestions. To those worried about my formatting if you have no helpful tips then beat it. I turned off my caps just for you.

Yikes, you will find many highly talented and well seasoned nurses on this site that are always more than willing to offer a helpful suggestion or support. My helpful tip is to show respect and act like a professional. You received several replies with an honest desire to offer support but your OP is very difficult to read due to the formatting. If you honestly want help then fix it. If your trolling to pick a fight...beat it

MsPrettyHospiceRN · Aug 15, 2016

Oh im sorry was I referring to you. No I was not. If you could read you would know that my post was not answered in a nice respectful way by many. Including people trying to imply that critical thinking is not needed in hospice. I see that you have no problem with those who are rude with someone who was asking for assistance. Also if it is very difficult to read then type that do not try to be rude about it. When someone has asked for help and the first thing you see is someone being rude then you can talk to me. If I was trolling for a fight I promise you I would have probably said a lot more then beat it. So if you honestly can not read it then don't. Thanks and have a nice day.

NurseToOurVets · Aug 16, 2016

Hospice nurses are special and if you love doing it then keep on doing it. You will need to either go to the company and let them know how you feel or you may need to go to a different company. If you didn't have proper training you are putting your patients AND your license on the line. You worked WAY to hard to loose it because you did not get good training! Remind whoever does your training that you did not receive enough training to feel comfortable, you should not have to figure all these things on your own. I work at the VA hospital and when our Hospice unit was brand new so there were a lot of things that we all needed to learn but even through the "growing pains" of a new unit, we were always supported and given extra training if we needed it.

I worked with an RN that came from home care and she told all of us how much different it was. I can't imagine having 13 HOSPICE patients. I put in all caps because as you know, hospice pts are a different kind of patient to care for.

I get burned out too and sometimes sit in my car after work and cry like a baby because I lost a patient, or because I knew they would not be there when I got back the next day. You are human and it is all part of nursing. If there is a social worker or counselor on staff, maybe you could talk to them about how you are feeling. You deserve training and there is probably a policy that states how many hours a nurse is supposed to be oriented, I'd check that out. Don't risk your future by letting the company you are with get away with inadequate training! If the Co. does not want to provide it then I would move on. A good hospice nurse is hard to find and I am pretty confident after reading your post that you won't have any problems finding another job. Good Luck to you. If you have any other questions about hospice nursing I would be more than happy to help you out.

MsPrettyHospiceRN · Aug 17, 2016

Thank you so much for the advice. I appreciate it very much. I have never posted on a site like this but due to me loving my job immensely I was willing to try anything. My brother always tells me there are plenty of other hospice jobs out there and I know that is true but I have built such an excellent professional relationship with my patients and my co-worker that I have not wanted to leave my company. I sent an email to the director of my site and our director of clinical management regarding my concerns and my cries for help being ignored and me not receiving the same assistance as others. At the time of me voicing my concerns I had a total of 18 pts. I was a mess. She understood where I was coming from and agreed that I was ill prepared and I am now going through one on one training and being provided with a lot of assistance from coworkers who have been giving me valuable information. I did not know how gratifying hospice was until I started this job. Now I can not see me doing anything else. If you have any helpful tips about time management, which was a big problem for me that would be awesome. Also if you have any documentation tips that would save me some time and still be appropriate and paint the picture of the patient that would be great. As we both know documentation is everything in hospice and determines everything. I was writing an entire book for notes per my manager which is not realistic however I am very thorough with documentation and sometimes a bit wordy. Really any hospice tips would be greatly appreciated as this is new to me along with nursing in general. Once again thank you very much for your genuine concern and helpful advice.

Kittypower123, BSN, RN · Aug 17, 2016

Time management can be difficult. You can plan your week, but it won't turn out that way! One thing I do is front-load my week. I plan to get almost all of my visits done in the first three days of the week. I know it won't happen, but if I plan for 4 visits on Friday, I know I might end up with 8. As I plan my week, I try to cluster visits geographically. I also think about which visits should be pretty straightforward (patient is stable, not much in the way of education needs, etc) and which will likely take more time. I think about which visits can be moved to later in week if something comes up and which can't. Having this information in my mind helps me change plans as I go and still be sure patient needs are being met. I'm constantly reviewing my schedule to check my progress and any changes I've had to make. If I have a CC or GIP patient, I see them first. I know they can take more time and I want get them taken care of. Most of time, if something else comes up with them after the visit, I can handle it by phone. It's tough to get time managed well in hospice, it takes time and practice. Use the frustrations with time management to learn. It will get easier.

As for documentation, that takes practice too. Remember to document decline. For example, on admission patient ambulated with rolling walker, now confined to wheelchair. Also, you don't need to write a narrative for every system. Focus on what is an issue for that particular patient. For example, if you have a CHF patient, what is their b/p, hr, heart rhythm, do they have edema, is it better/worse/the same, are they on oxygen, are they compliant with meds, what education did they need, etc. For us, the assessment is mostly checking boxes and imputing certain stats like vital signs, last BM, Diet and % eaten, pain rating, that sort of thing. The narrative itself doesn't need to be long, just focus on the reason for the visit or the particular issues for that patient.

simbawicz · Aug 20, 2016

I'm trying to think of CRITICAL skills needed for hospice. Pain and anxiety management is all; patients are not being medically treated.

You are misinformed. We treat much more than anxiety, restlessness, dyspnea, nausea, and constipation. We still treat medically, just not toward a cure of their admitting diagnosis. We treat infections, wounds, and have to perform differential diagnoses when symptoms erupt, or are intractable, etc, and we educate patients and families in creative ways. Your post reminds me of something I heard from a L&D nurse who said hospice nurses don't even have to document like real nurses, "What's to say? 'Not dead yet.'"

To OP, yes, it is very hard. I am a hospice RN Case Manager, and I usually start reading after hours notes around 7:15 am while the coffee is brewing, then decide who gets seen when. It's a rare day that I'm completely done with visits, phone calls, documentation, team collaboration, etc by 8 pm. Five days a week. And yes, I am salaried. I'm in a rare company with no call, no weekends, few holidays. It is hard when you start. Patricia Benner reminds us that it takes a year to stop being a novice, around 5 to become an expert. Moving from one nursing specialty to another puts you back in the novice category. I'm sorry you are not getting what you need from management, but honestly, I can't immediately recall when that ever happened in my nursing career. But for me, this is the best kind of nursing there is. I hope you can find a mentor or two among your colleagues. In hospice, my coworkers provided the most education and support. Not management. But I have also realized that my managers were over their heads in work and were often suffering the same learning angst in their positions that I was. I hope you find the support you need.

Stacey01 · Aug 21, 2016

I've been a hospice nurse for what feels like forever ( I did leave for a short time a few years back...while I was a hospice nurse, my mom became a hospice patient and though my coworkers were wonderful -- not only in their assisting me with her care , but as friends...I was only able to continue for about a year after she died. I needed a break). Time management is crucial in any home based nursing, but especially hospice. As others have stated, you can plan your day but we know what they say about best laid plans . No one dies on a schedule, so you just never know how your day is actually going to play out. The poster that stated to front load your week was spot on. I do that every week in hopes of gaining some ground by midweek. I also rely very heavily in point of care documentation. I know many will say this is impossible, but I do it regularly. When my day is done, I do not want to spend hours charting at home . My folks are used to seeing that computer come out so I can document changes as I talk with them. I assess and then sit down and document as much as I can while chatting with them. I do not chart and ignore them, but it can be worked into your visit. Anything left over is often done sitting in my car before I head to the next house. I just had 6 folks die over the course of 10 days...but my case management census had been at 24 which is a boatload of folks. My days don't always end at 4:30 but the bulk, if not all, of my charting is done when I get home. You don't need to write a novel. Learn to be concise and to the point...it's about accuracy, not about the number of words. You are still early in your hospice career and will learn lots of new trick to help along the way. As discouraged as you sound, don't let this get the best of you. Hang in there. It sounds as though you certainly have a hospice heart..the rest will come. Best of luck.

nutella, MSN, RN · Aug 24, 2016

I'm trying to think of CRITICAL skills needed for hospice. Pain and anxiety management is all; patients are not being medically treated.

I am not sure you understand the work of a home hospice or hospice facility nurse - it is very complex and requires a lot of critical thinking. The skills needed to be successful are very specific.

OP: I left home hospice because the agency was burning out the staff. Since all agencies in the area are doing the same without consideration, it has led to a shortage of home hospice nurses in the area. Managers make promises of a certain amount of visits to perform per day but once oriented, try to force people to pick up "extra" or constantly call them for "extra" visits or "emergencies". In addition, some agencies require poorly paid on call.

It was important for me to stick with some basic boundaries while working hospice and not to give in to the pressure of always doing more as I do have a life besides work...

You can look around in your area and see what other agencies offer - make sure to ask about productivity and on call expectation. Because of the shortage I have seen some really good job offers lately including pensions (!), lots time off, and really great benefits! With some experience you can also see if you would qualify to sit for the CHPN cert, which would give you more leverage.

I now work in a hospital though I really liked working in the community.

TammyG · Aug 24, 2016

I agree with Nutella. Many hospice nurses burn out because their hospice is poorly run and poorly managed. I would definitely look for another agency, or consider part-time or on call (talk about using your critical thinking skills, you definitely will do that on call). If you love hospice, don't give up.