Not doing what I was hired for

[MomRN0913]

Another vent again. I was hired as a hospice nurse into my company 5 months ago. I was told there would be " a little bit of palliative care". Well, its only me the supervisor and the director in the hospice division of our HH company because they can't keep. Uses ( one left after me being there for 3 weeks) and that can't find anyone. So I am stuck with all of the palliative care. I hate palliative care. I do hospice revisits, but my intention was to be a hospice nurse, as I was told, not the person to just pick up the crap no one else wants to do. Almost 6 mo ths and I haven't done a hospice admission or pronounced. My supervisor knowingly dumps the most awful patients on me that she opens up and announces " I hate this patient, you go see it". I am the dump job nurse, left busting my butt to see the patients no one else wants to see, not even what I was hired for. And my supervisor said " get ready, the palliatives are picking up and they are all yours"So, tomorrow is a progress meeting with the supervisor, director and educator. I have mentioned my desire to really the lean the hospice that I desire to do, they say " yes, we'll start doing it, and they never do. I want to say something again. I am at wits end at this Job, sick of working my butt off and charting all the time on my own time. My happiest times in this last few months I have worked here was in the last 3 weeks where I had 10 days off for a lap chole! It's the only time I have felt free and destresser. Not worrying about having to wake up at the crack of dawn to do paperwork or going to roach infested homes of dirty people who can't take care of themselves and no one else wants to see. My tolerance is gone. I feel like I'm gong to say everything I mean tomorrow and it won't be good.I'm a former icu nurse. Loved it there and had to leave because I couldn't do shift work with my family situation. It's been aMost 2 years since I've been gone and I'm friendly everyone there and they say all I have to do is ask if I want to come back. It's a great system. I wish I could figure out a way to do it. With all that ranting I lost sight of the question. Should I speak up tomorrow? I chose hospic for a reason. I did not want to be a palliative care nurse. I don't mind doing it when needed, I'm a team player, but I want to do what I was hired to do and have a passion for.

[dudette10, MSN, RN]

Your remark is rather condescending. There is very little difference between the two. I've looked it up, and discussed same with a clinical nurse specialist.

Agreed. There is so little difference between the two that I still don't get it, even when I looked it up.

Hospice does not mean DNR. Hospice does not mean no treatment at all. Hospice also doesn't necessarily mean no life-prolonging treatment.

From what I read, the main difference is terminal certification and insurance or Medicare eligibility for payment purposes. The source that I looked at qualifies statements with the phrase "most programs," from which I inferred that different programs have different criteria under broad guidelines.

[JMBnurse]

Hospice does not mean DNR. Hospice does not mean no treatment at all. Hospice also doesn't necessarily mean no life-prolonging treatment.

I don't know if it is everywhere, but where I live you do have to agree to a DNR status to be admitted into Hospice. I have also known of patients who were promptly discharged from their Hospice when they or their family changed their mind about the DNR status.

True, Hospice does not mean no treatment at all, but it is a type of care where everyone is supposed to have accepted that the patient is terminal and their will be no extraordinary measures in the plan. The plan is comfort. All comfort...all the time. If a patient is not ready for a DNR status, then they are not ready for Hospice.

This is my experience, anyway. Don't know if it's different in other areas.

[MomRN0913]

I don't know if it is everywhere, but where I live you do have to agree to a DNR status to be admitted into Hospice. I have also known of patients who were promptly discharged from their Hospice when they or their family changed their mind about the DNR status.

True, Hospice does not mean no treatment at all, but it is a type of care where everyone is supposed to have accepted that the patient is terminal and their will be no extraordinary measures in the plan. The plan is comfort. All comfort...all the time. If a patient is not ready for a DNR status, then they are not ready for Hospice.

This is my experience, anyway. Don't know if it's different in other areas.

yes, there must be a DNR. You revoke the hospice benefit if you enter the hospital for treatment other than symptoms and pain that cannot be controlled in the home. You still will intitially revoke your hospice benefits, but than can become General Inpatient through the hospice benefit.

You explained the difference very well, and those are that is my area of interest for personal emotional reasons, not because one is dirtier or cleaner than the other.

[MomRN0913]

I have work to do on my day off:), so check out this thread, maybe some of you who think anyone who has any not so holy thoughts about their patients shouldn't be nurses or are uncaring, check out this thread, maybe you should share those feelings with them too.

https://allnurses.com/nurse-colleague-patient/what-patients-behaviors-780639.html

[dudette10, MSN, RN]

I don't know if it is everywhere, but where I live you do have to agree to a DNR status to be admitted into Hospice. I have also known of patients who were promptly discharged from their Hospice when they or their family changed their mind about the DNR status.

True, Hospice does not mean no treatment at all, but it is a type of care where everyone is supposed to have accepted that the patient is terminal and their will be no extraordinary measures in the plan. The plan is comfort. All comfort...all the time. If a patient is not ready for a DNR status, then they are not ready for Hospice.

This is my experience, anyway. Don't know if it's different in other areas.

We had an inservice with the hospice coordinator of the hospice that is owned by the system I work in. She told us that a patient does not have to be DNR to be admitted to program. I think that's why the online resource I looked at qualified statements with "most programs."

[dudette10, MSN, RN]

This is why the difference between hospice and palliative is so confusing to working nurses, regardless of what was or was not taught in nursing school.

DNR Order, Question & Answer, Hospice Foundation of America, Ask the Expert, Community | AGIS

Hospices should make it clear to patients that hospice election means giving up aggressive treatments and accepting that death is approaching. But, there is no legal requirement to force this choice by signing a DNR before admission. In practice, many hospices choose not to be so blunt, and give patients and families time to adjust to the terminal illness and prognosis, even paying in some cases for life-extending treatment such as chemotherapy and radiation.

[BrandonLPN, LPN]

Well, I think being full code and hospice simultaneously is nonsensical. There's nothing 'hospicie-ish' about breaking someone's ribs or shoving a tube down their throat. Doesn't that violate the very principal of hospice theory??

[caroladybelle, BSN, RN]

Well, I think being full code and hospice simultaneously is nonsensical. There's nothing 'hospicie-ish' about breaking someone's ribs or shoving a tube down their throat. Doesn't that violate the very principal of hospice theory??

It has less to do with common sense and more to do with legalities. In some states, a hospice (as well as some other healthcare entities) cannot choose or decline patients based on their DNR/nonDNR status with violating certain pt rights. To do so, would bar reimbursement from some state/federal sources ...... Or so is my understanding.

Thus, it is a bureaucratic issue.

[angel337, MSN, RN]

I think many people here have said that they didn't know the distinction between hospice and palliative nurses and its good to know that there is a difference because it puts a different light (slightly) on the situation. I don't think any nurse proclaim to be perfect and sometimes people need a break from patient care so that they don't lose their mind and so that the patienst get what they deserve. My mother was a hospice patient so I do view this from a patient/family point of view.

that's fine, you are all entitled to your opinion.

Then only perfect nurses should be taking care of patients I guess. The nurse who says quietly to herself "OMG, he pooped again?" you wouldnt want that nurse either. or the one who says in their head "stop rining the call bell, I'm going crazy, wasn;t I just in here turning your TV channel?" Bet their family wouldn't want their nurses having those thoughts. guess they shouldn't be taking care of anyone either.

If you never had a negative thought about a patient, you are a liar, end of discussion!

Even my company sees palliative care as different from hospice patients. My director does too. When our homecare nurses help us out, they only help with palliatve, not our hospice patients, BECAUSE THEY ARE DIFFERENT.

Wasting my time here.

[jadelpn, LPN, EMT-B]

Hospice Vs. Palliative Care

This is a really good article on the differences between hospice and palliative care.

I can absolutely see the OP's point. Wtih reading this article, palliative care can be symptom control for a chronic illness....rather like a visiting nurse in a general sense, as opposed to a nurse who is caring for an actively dying patient on comfort measures. So between those two types of nursing can be a HUGE amount of a difference.

I apologize for getting caught up in the details of the original post, but I do tend to get a bit put off by venting comments in the heat of the moment. And when I said that I could sense your frustration, I meant that sincerely. But it was, in my opinion, a pretty harsh vent, and hate palliative care or not, it did come off as if you were disgusted by a number of your patients. Sometimes, it is in the art of the vent.

With that being said, after researching a bit on the differences, I can see that when one's expectations are that of a hospice care nurse and they become a general visiting nurse (which shout out to all of the extra-ordinary homecare nurses out there--you all ROCK) I can see that it would be frustrating. Palliative care is really quite different than hospice care.

In any event, I think that if, OP, you are able to actively pursue answers regarding a timeline and thoughts about hiring (and hiring specific to palliative care) then perhaps you could stick it out for the year. If they can not give you a specific timeline, and what they are doing to hire, then I would definetely look for a specific hospice postion (and perhaps NOT in a homecare agency setting)-- or a general home health position where you could have a variety of patients, and be clinically challenged similar to an ICU setting, but home care nursing is not for everyone either. A way that you may be able to do that is to specifically look for hospice care centers or floors within a hospital setting. Another choice is to find a hospice organization where perhaps you could work with families and patients within group sessions, talking about comfort care--as your years of experience in ICU could prove invaluable. If you are a single Mom with a child in daycare, then maybe a surgical day, doctor's office, or school nurse to completely switch it up a bit, and think about hospice care nursing when your child is older. Or, with your experience, an oncology chemo clinic to get certified in chemo, or even an oncologist's office.

[PMFB-RN, RN]

All hospice patients are, or should be DNR. Even when they are not officialy DNR they are DNR. Hospiced patients are expected

to die in the next 6 months or so. Like BrandonLPN said, there's nothing hospice like about the brutal process of coding a person. I would, and have refused to code a hospitrce patient. Unlike palliative patients who are usually full code and expected to leave the hospital to home or other living situation.

[netglow, ASN, RN]

Geez peeps it's not so hard. And no PM you don't get to decide. Resus hurts. It hurts if if you were a hospice patient or if you weren't. Either way you were about to die, so?

If that is what the patient wants that's what you do (running away is your choice, not the patient's choice). You have to live with the betrayal.

A patient said something to me long ago that should help some of you understand things:

"I want to live till I die of what's supposed to kill me (cancer) - I have an agreement with my body about that."