New job as a Hospice Nurse

nutella, MSN, RN · Dec 11, 2015

I found a membership in the Hospice and Palliative Nurses Association (HPNA) helpful , they also have a journal. The core curriculum is a great book and has helped me significantly.

Get familiar with the Medicare Hospice benefit and get a cheat sheet.

Get the FAST scale and other assessment tools you will need.

Those are really important items for me : car charger (especially in home hospice because you will be driving a lot as opposed to a hospice house), GPS or phone with GPS app, space in your trunk if you are doing home hospice for all the supplies you will need ....

Get organized and get one binder with protective sleeves for forms (pronouncement forms, standing orders, revocation, notice of non coverage, phone numbers for other nurses/team/MD, ....whatever forms are used in your work place .

Get one binder with information you won't need all the time but good to have especially when you are home hospice (CADD pump instructions, Hospice criteria , and so on).

I have apps on my phone that I think are useful like medication apps, narcotic apps and so on .

Black pen (for the pronouncement), sticky notes, small note book.

When I started I asked my preceptor what she had in her car and she gave me an idea what I would need on a day to day basis and helped me to get those things in the agency. In home hospice you need to be prepared to insert foleys, you may have to access ports, change central line dressings, drain pleurx , need extra syringes without needles for oral medication administration, at least one box of unsterile gloves, needle box, diapers and chucks, urinals and bedpans .... just ask the other nurses what they have in their trunks.

When you start program the phone numbers you will need most right into your phone and get a hands free device if you are driving as a home care hospice nurse - you want the hospice doctor, hospice manager, perhaps the educator and other nurses on your phone as well as the pharmacy, elder services, hospice social worker, hospice spiritual /chaplain, volunteer coordinator and so on.

Good luck !!

nurseontheway · Dec 11, 2015

Thank you very much!

Jensmom7, BSN, RN · Dec 11, 2015

One thing you do need to know, the test for HPNA and the membership itself are very expensive, as is the renewal fee.

You can get the core curriculum materials to use as a resource on their own.

Look at the informed consent form and also the patient handbook your agency uses. They both will spell out specifically what the Medicare Hospice benefit does and doesn't cover.

Your agency may provide copies of the PPS and FAST scale. If not, Google them.

Learn how to do a MAC (mid arm circumference). It's how you get measurable proof of weight/muscle mass loss on home patients who can't be weighed. You can find BMI apps to use with people who can be weighed. Both are important as evidence for continued Hospice eligibility.

I only use one binder. A 3 inch binder holds all I need.

All my patients are in a facility, so I keep very little in my trunk. We also don't deal with ports, central lines, we do have an occasional Pleurx drain. Since I occasionally see home patients when I'm on call, I keep a box of gloves, a bag of diapers, one Foley and an insertion set and basic dressing supplies in my trunk. It's up to the Case Manager to keep home patients supplies in order-and they hear about it if they don't.

Remember that we focus on comfort, not cure. You will still use your critical thinking skills, but you will be aiming to relieve or manage symptoms. Our patients often actually feel better in Hospice, but they are not getting better. Hospice is a 180 degree mind flip from acute care. It's also incredibly rewarding, and some of the best nursing experience I've ever had.

HeavenlyRN · Dec 13, 2015

Congratulations nurseontheway!!! I am a new hospice nurse too (about 3 months). I don't have a lot of advice yet, but just wanted to offer encouragement. I agree with the others about the binder and plastic sleeves for necessary forms. I also carry a folder in my binder for each pt that I keep a copy of the face sheet in. It is very convenient to have all of that pt information handy when I have to call the pharmacy, MD, family member etc. and I don't have my laptop out. Good luck and I hope you love it!

vampiregirl, BSN, RN · Dec 24, 2015

Welcome to Hospice!

The above posters offered great advice. I definitely agree with the recommendation to join HPNA, while the cost may seem a little expensive the information available is invaluable. For me, it's worth it.

A couple of additional recommendations to the above supplies that I keep in my vehicle: a container w/ bottled water and non-perishable snacks (for me), baby wipes, a sticky lint/ pet hair roller, and a bottle of downy fabric refresher spray (this is the lightest scent I've found so far, and use it sparingly when necessary - after visits at residences where smoking occurs in the residence).

BerryhappyRN, MSN, RN · Dec 24, 2015

Sounds dumb but keep a gallon size ziplock bag in your car for trash. I keep mine right between the drivers seat and middle console. All those little bits and pieces of trash that you will accumulate while driving and eating will fill up your ziplock bag quickly! I like the one with the zipper top just in case I eat something that could become stinky if it sits in the car too long.

nurseontheway · Dec 24, 2015

I really appreciate all of the feedback. All of the advice is important and really helps a newbie like me! I have found with hospice that we are still doing interventions but they are more comfort measures then 'healing' measures. We still try to relieve pain, anxiety, shortness of breath etc. I have already fallen in love with this specialty and can really see myself retiring in this field. I also love that it isn't just focused on the body- it is also spiritual and there is a huge support component to this role.

dkpfeil69 · Dec 27, 2015

I was in hospice for the last 10 years. I always eplainer to new staff a few self care things.

1. Don't give your phone number to families. If they get it from caller ID then don't answer them. Train them to call the office that way when you are off, you are really off.

2. Don't feel guilty if your favorite patient dies while you are off duty. This is their journey, not yours. Your job is to walk beside them, support them and their family, and to ensure that their comfort needs are met.

3. Get charting done daily so you aren't miserable trying to play catch up all the time because you will be expected to do it on your off time.

4. Give yourself at least 6 months to learn the job. This is s new field with a different mindset and you have to learn the flow and get into the groove.

Jensmom7, BSN, RN · Dec 27, 2015

I really appreciate all of the feedback. All of the advice is important and really helps a newbie like me! I have found with hospice that we are still doing interventions but they are more comfort measures then 'healing' measures. We still try to relieve pain, anxiety, shortness of breath etc. I have already fallen in love with this specialty and can really see myself retiring in this field. I also love that it isn't just focused on the body- it is also spiritual and there is a huge support component to this role.

Always remember, "DNR" does NOT mean "do not treat". It's just that what we treat are symptoms, not the conditions that cause them.

The example I give my patients and families is a UTI. The major symptoms in the elderly (our largest population, unless you're Peds Hospice) are sub normal temp, abdominal pain and AMS. We aren't going to cath for a culture, but starting an oral antibiotic is ok. Tylenol for pain (narcotic on board if really bad, but no reason to bring out the big guns unless necessary). Encourage fluids.

I'm on the downside of my career and honestly can't see myself doing any other kind of nursing.

GreatDaneAPRN · Dec 27, 2015

I completely agree. I have been an on-call RN for a Hospice agency for 3 years. GPS is very important. I cover a rural area and I have to go to areas that I am not familiar with. I learned very quickly that I needed to carry foleys, dressings, diapers, kitty litter (for disposing of medications), and plenty of forms. I also agree with the phone number. If the family has your number they WILL call you. Their loved one declines rapidly, they want to speak to you, so at 2am they may call you. It has happened at my office numerous times. As a result, I don't give my number out. I block my number. It will take a few months to learn the job. There is a lot of education for everyone involved. Good luck.