jwelhwel

I've been a hospice nurse for 23 years and most doctors are not good about telling families that treatment will do more harm than good. Hospice has had for all the years I've been working in the field, the problem of getting "late" referrals which means the doc finally get to the truth and bring up the subject of hospice about two weeks before the patient dies. In reality, Medicare saysthat a person is eligable for hospice when the doc thinks they have 6 months to live. Realistically, families need to think in terms of half the time the doctor estimates a person will survive. I believe, as ana dvocate for the patient, you can always talk about the "benefits vs burden" of any recommended treatment.

It is unfortunate that the hospice nurses did not explain what was happening to your mother.Nausea and agitation are common symptoms in hospice and sometimes more pronounced when the liver is affected by the disease process. Haldol is often used in hospice for both agitation and nausea and it is frequently given when the person is on narcotics. (Ativan can also be used for both.) Nurses who do not work in hospice are usually unaware of how medications are used in end of life care. Different medication most likely would not have allowed you mother to live longer. Studies have proven that doctors frequently "over-estimate" life expectancy by more than 50%. I am so sorry that you were not given better information by the hospice nurses about the medications that were being used and for what reasons. I know that restlessness and agitation are very difficult and uncomfortable for a person when they have little strength and the body needs all of its energy to breathe and keep the heart working. That is why it was so important to keep the agitation under control. It most likey added to your mother's comfort.

You won't know until you try it! As a hospice nurse of 20+ years, I can tell you it is one of the most rewarding types of nursing that you can do. None of us by ourselves is emotionally or spiritually strong enough to do hospice work but that is why hospice works on a team concept so that you will have the support and affirmation that is necessary to do this work.

Sadly, burnout isn't always dealt with well in hospice agencies. I have done a lot of hospice education and the first thing I tell new hospice workers is that in order to prevent burnout, they must SET BOUNDARIES for themselves. People who do not have strong personal boundaries will not stay in hospice work. They must take care of themselves before they can take care of others. Acknowledging limitations is also very important. Hospice is not about "fixing"; it about enabling. Some hospices have half day "retreats" for field staff several times a year at which a lot of greiving takes place by staff. But mostly support comes from peers in the hospice program. Time must be allowed for that among co-workers in hospice. Nurse overload (too many patients per nurse) is one of the biggest burnout elements. Again, set boundaries and when a nurse knows she cannot adequately care for any more patients, she/he needs to make that known and then keepthat boundary. This is a hard concept for most nurses. jwelhwel

Advice from a hospice nurse of 20+ years: Set some boundaries with your employer. Having a case load of 30 hospice patients is insane. (The average should be no more than 10-15.) Most hospices do not accept pateint that live further than 50 miles from the hospice office. (Rare exceptions do occur but the patient should be aware of the slow response time and agree to it.) I would advise you to talk to your director and if nothing changes in a short period of time, go elsewhere! You are working under conditions that put you at risk. There are other hospices that would love to have an experienced hospice nurse! jwelhwel

Many Hospice nurses get into the field after having been inspired by a personal experience of someone who provided wonderful care to a loved one. I, too, considered labor and delivery at one time.(And I've been in Hospice nursing for over 20 years.) Strange as it may seem, labor and delivery and hospice have much in common. If you ever make the choice to do hospice nursing, it will be a most rewarding choice. Jwelhwel

Consider Quality Assurance. Lots of paperwork and you can make a difference in patient care. jwelhwel

At one hospice where I worked, there was a volunteer who, after the death, would ask for an item of the patients clothing (shirt, dress, etc.) and make a teddy bear out of it. The families loved the gentle reminder of the one who died and were very appreciative. jwelhwel

I would request that the charts of the patients you are getting be audited so that errors, omissions would be corrected before you are responsible for the charts and to make sure all information is current. It is also good patient care for you and the nurse who has had the patient to go on a joint visit to meet the patient and family before you actually take over as case manager jwelhwel

The hospice I work for almost never approves the use of a CADD pump for the administration of morphine due to the high cost of using a pump. I feel that sometimes we are providing inadequate pain control because of this.What is the experience of other hospice nurses with this situation?