New RN going into hospice care

[Daisy Mac]

Hi all, I am a relatively new nurse and I am considering accepting an offer for a hospice case manager position with Suncrest Hospice. As a new nurse, I don't feel confident with many skills and simply don't know what to expect. I feel like hospice nursing is a special opportunity and would like to pursue it but I am just fearful of the unknown. Has anyone worked for this company before? What was your experience with them? Is going into hospice a good move or should I consider doing long term care or med surg to get more experience first? What can I do to prepare myself for this role? Any tips and advice would be much appreciated! Thank you all in advance

[NRSKarenRN, BSN, RN]

3 hours ago, Daisy Mac said:

As a new nurse, I don't feel confident with many skills and simply don't know what to expect.

Unless you are working inpatient Hospice where you will be supported, outpatient Home Hospice is not appropriate for a new RN grad, especiaily when you don't feel confident with your skills.

Hospice RN's are expected to function independently, have sharp assessment skills, thorough understanding of terminal illness, medication management, pain management and are able to educate family in the dying process, symptom management and medications to be used.

I worked in Hospice post 10 yrs experience, even then had a learning curve took 6 months to feel comfortable.

[NotMyProblem MSN, ASN, BSN, MSN, LPN, RN]

Definitely NOT a good idea, in my opinion. As a new RN, what would you do when the patient begins his or her final transition and the family decides at the LAST minute that they want EVERYTHING done to try to save their loved one? That happened with a newly-decided hospice patient on our med/surg unit a few years back just hours before they were to be transferred out for hospice care.

Let me tell you, it was not a pretty sight trying to round up the powers-that-be (physician, ethics representative, patient representative, house supervisor, risk management, and even a whispered call to the Code Team just in case) STAT, all while the family members stand there screaming DO SOMETHING.

WOW! The anxiety just revisiting this situation in words...geez! I had only been an RN for about a year and a half, but had been an LPN in Acute Care for many years when this happened and was completely dumbfounded at the situation.

On a side note, this sounds like a facility that may have had some challenges if they’re even considering hiring a brand new nurse into a case management position such as this. Just my 2 cents..

[Gft23]

My first nursing job was as a hospice RN but I had worked for the company as a CNA for a year before getting my ADN. Since you’re a new grad I’d recommend that it would be better for you to start in a hospital or a LTC facility because you don’t really use a lot of nursing skills in hospice care. Also as a case manager you will be out on your own assessing your patients and won’t have other RN’s there if you need help with something. You need to have great knowledge of all the medications and be an expert on the dying process in order to educate the family. If you work well in a high stress environment and don’t mind learning a lot of new stuff on your own, I think you’d be able to adjust to hospice well. Now I work as a hospice nurse on the side and work in LTC full time and I love it. It’s a good mix of everything.

[kbrn2002, ADN, RN]

My first though when I read the title was why not? Newer nurses are trained in on various specialties all the time.

Then I read the post and when I found out this was a case management position I definitely had second thoughts. I would think you would benefit from some experience as a Hospice nurse before you dive right into a case manager job. Frankly the fact that this employer is offering a case manager position to a newer nurse with zero Hospice experience and little to no relevant experience that you could bring to the job is a big waving red flag to me.

Now I am not saying run for the hills. But before you accept a job that will require a lot of independent practice in a field you know nothing about think long and hard about it. What kind of training is offered? Will you be paired with another case manager until you are able to work on your own?

I would think the goal is for you to become Hospice certified, probably sooner rather than later. Does this employer offer education towards that or will you be expected to take that on in your own time?

No matter what job you accept as a newer nurse you will have a pretty steep learning curve. If this job offers adequate training and is supportive enough to allow you the time to get comfortable in the role before you are completely on your own it might be a good fit if Hospice is an area of nursing you are interested in.

I've never heard of this particular company so I can't offer any opinions about how they operate or treat their employees. Of course if they are offering you a job they are only going to show their good side during the recruitment process so if anything during this time raises concerns expect the reality of the job to be worse.

I won't say turn it down but do go into it with eyes wide open. If you accept and find you are not getting the training you need to succeed don't feel obligated to stick it out hoping it will get better because it won't. On the other hand if you accept and find they are supporting you and feel they will continue to support you as you venture out on your own it might be a good experience for you.