Iluvhospice

Agree completely with tewdles... If they are not happy with the present hospice, there are generally several in any given area. The first step should be speaking to the present hospice about their perception regarding the hospice's stance on food/fluids at the end of life. At my agency, the patient and family are the primary decision makers on those types of issues with guidance by the hospice staff - not mandates.

You have what it takes to be a hospice nurse. After graduating from nursing school, I worked on an oncology floor for 10 months and then moved on to hospice. You may place foleys, access portacaths, drain PleurX drains - but rarely do IVs. Blood draws occasionally. Let the people that you interview with know that this is your calling. The nursing skills are important but so is a love for the work and a compassion for your patients. You need to be able to think on your feet, to remain calm when others aren't, and to be kind. Think you can handle it? Then you can! ! Best of luck to you!

Definitely get actively searching for a new job. I am in management and the only drawback I can see is that you will not have accrued paid time off for the maternity leave and will not have worked there long enough for FMLA to apply. But crying on the way to work is a clear sign that this is not a good fit. Home health is an option where the pace of work may be a little slower - but it has its own stressors and requirements. Good luck in your seach/choice and pregnancy!

Since I last posted in this thread, I have worked in hospice for more than 5 years. The increased tracheal secretions are simply the result of no longer being strong enough to swallow the saliva/secretions that you and I are swallowing all day long. It does not impede air flow and is not uncomfortable to the patient, only to those who are listening to it. Atropine drops sublingually or Scopolamine topically are both very good at drying secretions. Scopolamine takes more than 24 hours to take effect, so getting an order for 1% Atropine drops (they are the drops that optometrists use to dilate eyes) is always a great comfort measure. If a patient is tachypneic or dyspneic - then Morphine is your drug of choice - not because it slows respirations but because it loosens up bronchioles/bronchi and assists with blood flow (the same reason it is a primary drug for heart attack - remember MONA - Morphine, Oxygen, Nitro, and Aspirin?) I'm sorry that this patient's death was horrible for you. I hope it helps to know that it may not have been as horrible for her as it was for you. God bless your work!

$16/hr isn't even close to reasonable... you have every right to ask for more. Our LVN coordinators - no direct patient care - earn $21/hr.

Our hospice uses a on-call PICC nurse, who places the most wonderful PICC lines I have ever used. Mobile x-ray comes to verify placement before use, just as in the hospital. I love our PICC nurse!

I went in to nursing school with the plan to work for Hospice. I worked on an Oncology floor for 10months before switching to the premiere hospice in our area. I had wonderful orientation with hospice and it was a rapid learning curve, but I think most of the benefit of my experience came from my life experiences before becoming a nurse. If your heart is in hospice - make the switch whenever they are willing to hire you. Obviously not all hospices require you to have 1-2 years of experience or I wouldn't be where I am today. :heartbeat Best of luck to you...!

Absolutely - go for the job you love. Nothing makes a day last longer than hating your job. Not even a bigger paycheck can fix that. Best of luck in your new position!

Our hospice does palliative pleural taps also - generally patient revokes their Medicare Hospice Benefit during the hospitalization, and then we readmit them post-procedure. Morphine and Ativan are standard palliation drugs for dyspnea. Do you have a choice of hospices in your area?

How much training happens before you are sent out on your own... and once you're on your own - is there help READILY available by phone? Oncology to hospice isn't a big leap because you probably had comfort care patients on your floor at one time or another. Support, teamwork, and training are key to being happy and successful with hospice. You'll be great, I'm sure!

Robin, My days are not what a "typical" hospice case manager would have because I see the general in-patients (pts who are hospitalized for something related to their hospice diagnosis), and when there aren't many of those - I do admissions. If I have 2 in-patients - and these could be in any hospital in my city, so drive time takes up a large part of my day - then I am expected to do an admission that day also. If there are 3 or more patients in the hospital, then I only do hospital visits. During a hospital visit, I check to be certain that the patient is comfortable and I assist the floor nurse/aide with ADLs when time permits. I call physicians to get orders for increasing pain needs or whatever the patient's needs are. I work very closely with the hospital social worker and the social worker on my team to help with discharge planning and potential home needs. When discharge is underway, I assist with transportation arrangements and to make certain that someone from hospice will meet the patient at their home for a tuck-in visit. Our hospice also has an inpatient facility, so a large part of my job is determining if our pt's needs would be better met at that facility - and, if so - arranging for transport, copying the hospital chart, and calling report to the facility. (In addition to calling the doctor for order to transfer if needed) LOTS and LOTS of time spent educating pts and family about meds, death and dying, symptom management, etc. LOTS and LOTS of emotional and spiritual (if appropriate) support to family. Active listening is an important skill to develop working with hospice! Depending on the patient load - and acuity of pts' needs - my day starts at 9 a.m. and can end as early as noon or as late as 8-9 pm (and those days usually don't have a lunch hour!) Somehow it all seems to balance out, and I'm salaried not hourly, so my paycheck doesn't take a hit on slower days. I work with the most awesome group of people that I have ever had the pleasure of knowing. Working with a great team is important - and one of the blessings of this job for me. If hospice is in your heart - you'll have great success. Keep us posted on your progress!

I would recommend that you start your career on an oncology floor. Surprisingly, it provides you with lots of varied opportunities for skills - but most importantly - at least for hospice work - you get to experience death and dying more frequently than you do on a med/surg floor. We got patients for comfort care at the end of life from other floors too, which provided great experience when you transfer to a hospice job. Best of luck to you. I feel truly blessed to be working in hospice.

Middle child - second girl - first born girl is a doctor, youngest brother is a chemist. Alcoholic father/mother

Being a care companion and being a hospice case manager/nurse are far different things. That's not to say that sometimes we don't have to help with personal care activities - but, by and large, that's not the main gist of the role. If your heart is in the role of helping a person with the emotional aspect of dying and helping the patient and the family live out the remainder of life for a terminal patient in the most comfortable and complete way - then you are following the right path. Follow your dream...

$27/hr is the prn salary where I live. .44/mile is also roughly the reimbursement we receive. I just accepted a full-time admissions position with the hospice company I was working prn for - and I took a pay cut, not huge - but less than $27/hr. Depending on where you live, it sounds like a good deal - and you'll love working with hospice. Congratulations on your new job!