Newly hired New to hospice

I was just hired as Rn case manager with a locally owned company. I'm so excited, I tried for 8 months to get it! I was an LPN for 8 years and now an RN for 1. I want to soak all the knowledge up I can and get up to par and productive as quickly as reasonably possible. My background is LTC and 3 years in home health. It's a great company, locally owned and very well respected! While I have read many recommended books listed here about nursing experiences, history and philosophy of hospice, etc. I am nervous about assessing for symptoms r/t specific terminal diseases. Not having hospital experience plays into that I'm sure. I wish I could find a book about nursing for end-stage disease processes with palliative care and assessment specifics. I know I will learn mostly from experience but am concerned for my first patients. I want to be able to anticipate complications for them. Any wisdom or advice would be greatly appreciated!

[toomuchbaloney]

Welcome to hospice!

Join the National Hospice and Palliative care org

www.nhpco.org

they will have wonderful resources for you.

[PghRN15]

Welcome to hospice. Hospice nursing is all I have ever done. 1st as a CNA, then LPN now RN. You will go through an orientation period and you will learn a lot from that. Join a national organization, I am a member of the HPNA. I also have a small book that is called Symptom Management Algorithms - A Handbook for Palliative Care. ISBN 978-1-888411-20-1. You can get it on Amazon for about $35. I gives you assessment tools by symptom, treatment options, non-pharm options and various information such as PPS scores, FACT scores, OME conversions (which is what I most use it for), quality of life index tables, karnofsky scores. I think it is a great tool to have in my bag.

Also, just something to remember, you are out in the field, one on one with your patient and family. You may feel alone, but you are not. You can always reach out to your co-workers, supervisors, physicians etc..

Best of luck. Keep us posted. Welcome!

[Nashvillejeanne]

Welcome!! Now, take a deep breath :) Remember it is all about symptom management. Try to anticipate your disease and dying process. Dying happens in stages, like a birth...all go through the same stages but at different rates and intensity. Some women have a baby easy as pie and some do not, but they ALL go through the three stages, right? So, dying is the same thing. There are markers to look for. Not eating is a marker, seeing people that we do not see, withdrawal from interaction, a good day (out of the blue, very alert and wanting to eat for example), mottling of extremities. Most people have a "knowing" they are passing and will give clues away, you just have to be open and see it. Good luck to you.

[elimayrn]

Thank you for your replys and excellent advise! Ill definately apply it. Im reading the Hospice Companion which is very good, teaches the responsibility of the IDT at each patient stage, documentation and symptom management. Its great to read your encouraging posts!

[pfeliks]

I agree. There is not much information to be found on what end stage will look like. I had a patient with neurofirbromatosis Type2. This was a new disease to me. I went to the internet to search for what to expect at the end of life with this disease. I found nothing! I just had to use my nursing knowledge and realize this patient had a progressive neuro disease. I think sometimes we nurses know more than we think we do.

[elimayrn]

Update on new job, day 4 of orientation and I love it. The company is super supportive, well staffed and Organized. My confidence is peeking out with hope!

[elimayrn]

Update: 2 years later. I've learned so much in 2 years working as a RN CM with hospice, many in-depth lessons about nursing in general and have gotten in closer touch with my family and myself! Unfortunately the reality is hospice is taking a huge toll on me physically, mentally and emotionally. I love my patients and families, even the feisty ones.. Love working autonomously and my IDT. The core problem is the hours and conditions. In short I feel taken advantage of for the profit of our agency. Therw are few

40 hour weeks and many are 50 to 60 hours. We are salary so get little compensation for weekly overtime. We are always short 1 or 2 case managers with too few LPNs to rescue us with visits. By the time the weekend comes I'm exhausted so catching up on home responsibilities leaves little time for me and my partner, grandkids or friends. I'm 57 years old and feel I'm drifting away from the things that matter MOST to me. I live in the KC, MO area and nearly every hospice agency in the area is advertising for case managers. I have worked for 2 agencies now. It's a crying shame. I know this is a lucrative business but it seems as though greed drives most agencies to hire the minimum number of nurses, provide the minimum benefits then drive them until we give out. I'm not sure what else I can do other then leave hospice and find another area of nursing where I can leave work at work at the end of the day and live my life.

[bryan_del, ADN, MSN]

Would you recommend hospice nursing per diem?

[NelleG]

"Unfortunately the reality is hospice is taking a huge toll on me physically, mentally and emotionally. I love my patients and families, even the feisty ones.. Love working autonomously and my IDT. The core problem is the hours and conditions"

this is what worries me about taking a position with Hospice. In the hospital setting I am pretty much guaranteed to leave on time. I should just look for a new postion within the hospital.

[sonicleese, ADN, BSN]

Hi ElimayRN,

I was just hired as a new RN Case manager. I live in Kansas City, but the company where I was hired is in Kansas.... Have things gotten better for you? Are you still in Hospice?

[pmabraham, BSN, RN]

"Symptom Management Algorithms - A Handbook for Palliative Care. ISBN 978-1-888411-20-1. You can get it on Amazon for about $35."

Recent price check, $135. Does anyone know where one can get it towards the $35 mark in 2018? Thank you.