makeitwork

When studying for my CHPN exam I used the HPNA Core Curriculum book (ISBN-13: 978-1-4652-7728-2). I felt this book filled so many knowledge gaps related to hospice for me and still feel all hospice nurses should have this book as a hospice primer.

Prior to going into hospice, I simply browsed this category looking for topics that I wanted more information about on that particular day. I spent many days reading about this field of nursing because I was told, "You will know within six weeks of hospice nursing whether it is for you or not." Part of that is due to the emotional gains and drains which I find makes me grow as a person. I have been in hospice for over five years and cannot imagine myself anywhere else. Good luck with your decision.

I had a caseload of 20 only after we lost a couple of case managers to attrition and it was not for very long. In the past five years I have worked for two hospice agencies and both would do what they could to keep case loads in the 10-14 range. I can't imagine providing the desired care and follow-up with orders, etc. with a constant case load of 18-20.

I commonly say something like, "I feel this is where I am supposed to be" or "This was definitely a calling" or "You would be surprised how much good this job makes me feel by helping people at this time of their life." I then get the head nod and start talking about football.

To me this is a bit of a no-brainer. Go to where you are being led. We have to define "taking a step back." I see this as you stepping forward to where your heart is leading you. Stepping up is not always stepping forward. I stepped "down" from an supervisory position to allow me to have the direct patient care I got into nursing for in the first place. What is interesting is that I then "stepped out" to another employer, doing the same direct care job, and I am happier than I ever was and I am now making more money and have more family time than ever before. I would like to call that stepping forward.

I wish you all the best in your career! I hope the field that chooses you will be as rewarding as it has for me.

You are welcome...it is an honor to care for our patients. I am sorry for the loss of your family member. The field of hospice can always use more good nurses. May I recommend you give it a little time, say six months, until making a move? In fact, there are some hospice agencies that won't hire a nurse with a recent loss without some sort of waiting period.

I am in Washington State and have worked for two different hospice agencies. Each one tried to keep us at 12 cases or less, but, I have had as many as 20 for a very short time when we were understaffed. I hope that helps.

I am sorry I did not see your post sooner. How did the shadowing go?

What stands out for me is the fentanyl patch. If a patient is already taking one or more of the short-acting analgesics, a 24-hour morphine equivalent is calculated and then a fentanyl equianalgesic dose can be calculated allowing better initial pain management with the patch. The automatic 12mcg fentanyl patch may waste time getting ahead of the pain. As I think about it, I suppose the 12mcg patch may be better than nothing, but, I would want a more accurate dose initially on board. Just a thought...

Over the last four-plus years in hospice I have met several co-workers that worked in the ICU. The common thread was that they were tired of seeing patients whose families would not let their loved on go and they kept them on life support even if the patient did not want it. "Vegetable Row" was one term I heard. Some of these patients were there for months. These nurses felt it was cruel to the patients and a huge waste of resources--and they got tired of it. They mostly made the move to hospice because they felt it was the next natural step in their careers. To provide comfort to end of life patients is just one aspect of hospice nursing. Should you choose hospice, you will, or should, begin to look at the family/household as the patient. Hospice nursing is more encompassing than administering morphine and lorazepam. I will tell you that I commonly spend as much time, or more, with family members than with the actual patient. Oftentimes, comforting and educating family provides me with as much job satisfaction as successful symptom management--and I get a lot of job satisfaction in this field. We also coordinate care with the team which can include the chaplain, MSW, hospice aide, volunteer, comfort therapy, and, of course, the patients MD. After all that, I will ask you to feel if you have a calling toward hospice and that you are not just looking for a refuge. Follow your heart. You will chose hospice if you do find you have a hospice heart. I wish you the best.

"The majority of your visits will be 30-45 minutes." A short visit for me would be 45 minutes. We not only talk to the patient/family providing emotional support and education, but, we do the assessment, medication reconciliation, orders (as needed), calls to the pharmacy for med delivery, maybe fill a medi-set, wound care if needed, and any other treatment required. My visits are usually over an hour long. If I was just seeing patients in a facility where staff nurses are doing treatments and getting most orders then I would consider "5-6 visits/day" an easy day. It is good to keep things in perspective. I agree with HeavenlyRN.

I rarely attend memorials or funerals of my patients. I need that separation/work-life balance. When I have attended, I try to sit or stand in the back and learn more about the patient's life--these events certainly allow for that. I feel this is the family's time and I was there for just a small part of the patient's life. Interestingly, it always happens that when a family member sees me, they either grab me by the arm and make me sit in front and/or they introduce me to almost everyone in attendance...so much for being low key. It shows what an effect a hospice nurse can have.

I hope the nurse that charted is not the same one that documented the FAST of 7b. If so, and you see this often, it sounds like a training issue for this nurse and/or the nursing staff.

Way to go! Once some of the excitement levels out make sure you find work/life balance. I have found that I ended up getting to involved emotionally and my up and downs became very extreme.

I work in a rural area and seem to average around 80 miles per day. A buddy of mine has a couple of patients in the far reaches of the county and easily doubles my average two days a week. If you throw in on-call mileage to the "outer rim" of course we could be well over 200 miles in a day.

I have been a hospice nurse for over four years. At the last agency I worked for I was the only male RN Case Manager. Many times male patients are glad they have a male hospice nurse. To add to that, I am a veteran and I often am able to connect with patients because of it. I remember admitting a male patient that preferred a female nurse. His wife called me before I was out of their driveway and said, "You are his nurse, there is no way he is having a female nurse. He was just trying to see what he could get away with." Turns out, we had a great relationship throughout our time together. I have found older female patients to be kinda' funny with male nurses. Some do not want a male at all and many are glad to have the male attention. I have had times when they would not let go of my hand. They're great and I am glad to be there for them. I am now with another agency, a larger agency, and there is a much higher ratio of male-to-female nurses. It seems like it is just left to chance as to whether there are any male hospice nurses in your area.

Our agency's on-call policy is very similar to Grumpy's with the exception that Grumpy has a nicer supervisor--if no one volunteers our supervisor puts our names into a bowl and starts pickin'...

May I add that with 4-6 administrations of short-acting pain medicine you may want to considered a long-acting analgesic? By getting in front of the pain you can reduce the Roxanol administrations and, if related, reduce the mouth sores (along with making your patient more comfortable).

So true RK. I do case management and admissions. The biggest complaint we get is that families (or MD's, but, that's another topic) wait too long to get their loved one on service. If a patient/family is on the fence about hospice, I sometimes mention that fact to them. Many then ask friends or relatives that have had hospice in their lives about this and they confirm the need for sooner rather than later.

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.

I have to ask if the pt called the on-call nurse prior to going to the hospital. If they did not call us first, we did not have the opportunity to provide crisis care and, therefore, the pt is liable. As mentioned above, revocation would result in Medicare paying (outside of hospice). If we are called and our nurse is unable to provide symptom relief, we then take the responsibility for billing after sending the pt to the hospital. (I hope that made sense)

I live in WA state and took several of my prereqs online through the community college system--including chemistry. Perhaps where you live there are cc classes you can take online, which I find convenient.

Just_cause is correct. However, what happened is that we went to the hybrid class every other week for an hour or two and that still gave me plenty of time to also go to work. You can certainly "hit me up one day for advice" but please wait until the end of March--we are currently in the most difficult quarter of the program (I shouldn't even be on Allnurses but I needed a break from study).

You need to check with the state nursing quality assurance board (Dept. of Health). There is a list of approved colleges and Excelsior is not on it. If your heart is on Excelsior, go to a state that approves it, and has reciprocity with WA, get your license and then move back. I hope that helps.