Newer Nurse trying to follow heart

[kota110]

I graduated with my BSN in May 2013. I had a very successful sales career for over 20 years but wanted to make a difference. I have always wanted to do hospice nursing.

My first job out of school, I didn't have the confidence nor clinical skills that they expected to handle over 6 patients and lost that job. I work in a LTC/Rehab facility on a casual basis. Unfortunately, I think my sales skills are so good that I was able to get a job on a med/surg floor that was in a rural area where you would be the CNA, HUC and RN most of the time for up to 6 patients. I found that I was overwhelmed doing all that and couldn't do my patients justice trying to do it all based on my limited experience. Plus, there were nurses that were my preceptors that were making up rumors about me (administering too much morphine and needing narcan to get the patient out of it!), that I found it hard to trust anyone.

Now I stand as a casual nurse in the LTC/Rehab with two failures behind me. I was one of the standouts in school, on many extracurriculars and a single mother. I have a huge heart and have been repeatedly commended on my people skills and attention to detail. I have found I love the geriatric patients. My patients love me. I just don't like med/surg and feel that I really want to be a hospice nurse.

I have found myself second guessing my decision to go back to school and giving up a secure, lucrative career. It seems that the only jobs open to a new grad is med/surg or LTC. I also volunteer in hospice nursing where I visit patients and support them and their families. I love it and know in my heart, this is what I was meant for.

I guess my questions are:

1. If I go into LTC/rehab, can I get hospice down the line? It seems it's more of med dispensing to over 20+ patients and never get to spend more than 1 minute per patient.

2. I have tried for hospice jobs and they say they want med/surg experience, is that the only way?

3. Are there other nursing specialities that would utilize my strengths but not require that med/surg be the only past experience?

4. Would additional education be helpful, such as masters in geriatrics or case management or even certification in hospice?

I would appreciate any help you could give.

[JennNJ83]

What about an office position? If you do home hospice, good clinical judgement is important, because often times you are by yourself in the home. You'll drive yourself crazy second guessing all the little things that come up. If you're heart is in hospice then you should do it, but probably get some more experience before you do so that you could really enjoy it. How about something with a lower pt ratio like an ICU or stepdown, some do preceptorships where they train people with little to no experience

[maryjosephine]

I would suggest that if you have some med-surg experience along with your LTC that you would enjoy home health care. It allows you to utilize all your skills, autonomy, support from your peers, and after a number of years re-apply at hospice. You won't have to deal with the poor behavior of some nurses that you've had to experience which is very sad, you will be mostly on your own, giving one on one attention to your patients and it will satisfy that desire your describing. That experience will get you a hospice position.

good luck

[esperanzita]

I work for a large hospice company. After reading your post, I checked their current job postings. In some locations, they require only 1 year of experience as an RN, stating that med/surg or hospice experience is "preferred." (Read: not required.) When/where I was hired, they required 2 years of experience. My 2 years working in SNFs got me in--I never worked in med/surg. I don't know how things will be when you reach 1-2 years of experience, but it sounds promising for you. (No small tangent: if I had worked in med/surg, a lot more doors would be open to me.)

If it's any consolation, when I was passing meds to 20-40 patients, I didn't realize how much I was learning that would be useful in my work today. But yes, I hated it. One way I got out of it was working as a treatment nurse in the SNFs. That was also educational and enjoyable, with its own stressors.

Regarding additional education... I can relate to second-guessing the decision to go back to school, down this path. And to being discouraged by "failures" and negative experiences with coworkers. I decided to work for awhile, to decide if nursing is right for me, before advancing my education. So, that's what I think about that. For me.

Thank you for taking this leap, in order to make a difference in people's lives. Even as we struggle with this, we are helping others--that is one small miracle I've had the pleasure of seeing since I headed down this path.

[babyjRN]

I landed a hospice job with 3 years LTC and 2 years in-patient psych experience. I never worked a day in med surg. Both areas of experience have served me very well in hospice. Some of our nurses come from ER and ICU backgrounds and I watch them struggle a bit.

[kota110]

Thank you for all the responses. What do you find has been the single most important attribute or experience that has made you successful in hospice? Is it as rewarding as I think it will be?

[makeitwork, BSN, RN]

I too, left another career to become an RN and got my BSN. I worked in LTC facilities for a year, interviewed for a hospice RN job, got it and now I am a supervisor. I think the single most important experience for me was actually during my last few weeks of nursing school where I was finishing up in the ICU (where they wanted me to work after getting my license) and having my preceptor have me take the call from the mother of the pt I was caring for right after he died (he had AIDS and quite a few co-morbids/secondaries and was on comfort care). I felt I was a natural because the words just flowed and, most importantly, I found I knew when to listen--which is a huge aspect of being of a hospice nurse.

[TammyG]

I had similar experiences to Makeitwork when I was a floor nurse. I usually volunteered when we had a vent wean or when a family had to be called in the middle of the night. I just felt it was easier for me than some of the other girls did. I guess that is when I knew I wanted to be a hospice nurse.

So, I guess the lesson is . . . follow your heart. Lots of experiences go into making a good hospice nurse and they are not all technical. Take the next job that feels right to you.

[kota110]

TammyG, thank you your post means a lot to me.

[toomuchbaloney]

Would the hospice work be in a facility or in the field?

How comfortable will you be in a very autonomous role?

Do you have good professional boundaries?

[duskyjewel]

I work for one of the oldest, and currently the largest, nonprofit hospice company in the nation. I've watched them hire lots of new grads. Maybe it's just where you live. Have you looked into every hospice agency where you live? Some might have different hiring practices than others.

[grayduck]

kota110,

I was a hospice clinical director for nearly 9 years. I came from LTC, rather than a hospital background. I found that nurses I hired with LTC backgrounds had a much easier time adjusting to hospice. I hired hospital nurses with success as well, but we had more work to do together to change the mindset to a hospice setting. Hospital settings are much more authoritarian, even today. People, as educated as they are now, come into the hospital and give over control to the health care providers. Hospital nurses are used to "fixing," achieving improvement, and sending home. Most LTC nurses have performed functions of hospice, but just do not label it as such. Hospice is provided in both LTC and hospital settings, but more commonly in LTC, so that experience can help you understand, relate, and collaborate with your LTC partners more effectively. I truly believe that hospice nursing is a calling. People looking for a paycheck alone do not keep coming back. The job is too hard and demanding, but for those who are meant for it, the rewards are worth it. Much luck to you!!