StJohnRiver

The hospice I work at does hire new graduate nurses, but most of them leave after a couple of years. They say they want to learn more, and I can see why they make that choice. I think hospice is wonderful, but you will be much better prepared for it if you have previous experience, preferably acute care in a hospital. One of the great things about hospice is the autonomy nurses have. You earn that by earning the trust of the doctor. And you will be much better equipped if you have experience in handling meds and orders and dealing with all the specialists you'll deal with in a hospital setting. Another thing needed is life experience -- much of hospice work is dealing with families and their emotions at such an intense and traumatic time. That's something that just comes with getting older and all the experiences and learning that comes with that.

I will be retiring this week as a hospice nurse. I expected the Covid patients would all die in the ICU, but they are spilling over into hospice. I considered sticking around until the economy gets better, but I turn 65 on Tuesday, and the chances of having a Covid patient keep going up, and the last thing I want to do is get sick instead of getting out.

Hospice. Two years. Love it. Prior to that, Neuro/Tele. Hated being a floor nurse. So much better helping people die than aiding their suffering by trying to keep them alive via drugs and machines. Hospice can be hard, but it is very rewarding and most families are so, so thankful for what we do.

Definitely helps. We do bedside report, but a quick "heads up" outside the room is much appreciated. In fact, that is usually the most important info I can get on a patient. I need to know what I am getting into. Many times I get a patient because I am a male and that patient has been, shall we say, making odd requests or comments about his female nurse. I know he is disappointed when they see me, but I usually have no problems from these patients.

As an atheist, I was a bit concerned about going into hospice since I expected religious beliefs to be in the forefront. I figured most of my patients (and their families) would be hoping they were headed for heaven, and I would be drawn into that world. I have been pleasantly surprised that this is not the case. I have never been asked to join a prayer (we have a pastor for that), and I have never felt awkward when dealing with patients who are overtly religious. I have seen how deeply religious families can create a beautiful environment in a room while waiting for their loved one to pass, and how it can bring the peace. And I have had some very interesting conversations with my fellow nurses about my beliefs and how being a hospice nurse has actually strengthened my own conclusion that there is no God. But that is a whole other topic.

I work in an inpatient hospice unit in a hospital. We often get patients who come from ED or ICU and are there to be evaluated before a decision is made on where to place them. Saying the right things at the right times, and being consistent, is critical. Patients MUST be told before they come to the IPU that the unit is for short-term care only, and if a patient is stable, they will be sent to an appropriate place, hopefully back home, or to the nursing home where they had been living, or to a SNF. The problems arise when patients come to the IPU with the expectation that it is the long-term solution to their problem, that the patient has just found a new home. When they arrive, we determine if they have been given the correct information and understand the policy. If not, we make it clear that we do not do long-term care, and we provide a letter detailing this, and why, and what the cost may be if the family does not want the patient to leave the unit despite the consensus that the patient is not appropriate for further time in the unit. This is necessary because, as unfortunately is usually the case, a few families have tried to take advantage of the situation. They don't want the patient back home, for whatever reason, and don't want him or her in nursing home, and really, really like the idea of having them stay with us where they get really good care. We explain that Medicare will not reimburse us for patients that do not qualify for the higher level of service, and unless the patient is End Of Life or in a Crisis, they can't stay. We aren't kicking them out, we are putting them in the appropriate setting (that fits what Medicare will reimburse). Despite all that, some families will continue to kick and scream, but eventually, when faced with a bill of $525 per day, they will relent. I happen to agree with this, since our beds should be for those patients at EOL or actively dying who require the level of care we can provide.

I get the admissions, and I have quickly learned who I can trust to bring in appropriate and, more importantly, appropriately educated patients/families. You don't want the RNs who take report from you cringing when they hear your name because you have passed along inappropriate patients, or painted too rosy a picture of what awaits them in hospice. No, there will not be a nurse with them 24/7 -- that is very different than a nurse being on-call 24/7, for example. Be clear with your admissions and honest with the RNs who will be doing the work caring for that patient, and all will be well.

I have heard this tale of woe before. The thing with being a hospice nurse is that when you visit a home, you have no on-site backup, no fellow RN you can pull aside and ask for guidance when you encounter something new. And as a new hospice nurse, everything will be new. So adequate training is a necessity. Non-profits definitely do it better than for-profits, but even they can fall short. The new RN must ask for more training time. That is about the only way around it. Or you need to establish some type of phone support that you can count on -- someone you can call at anytime to guide you through a situation. Don't accept "Oh, you'll figure it out" as an adequate response. If you could have figured it out, you wouldn't be calling. It's a shame that too many hospices scrimp on the training, because from what I have seen that is the No. 1 reason nurses leave. They feel overwhelmed and don't see a way out. If you can hang in there and get past that initial phase and gain some confidence, hospice nursing is a great job. I'll never be leaving.

I work nights and invariably patients develops runs of A-Fib, A-Tach, PVCs, etc at 2 a.m. I know anything ventricular is not good, but does a 10-beat run of V-tach that comes out of the blue and is not repeated require an immediate call to the attending or cardiac consult? If it was 20 beats, would that make a difference? Do you have set policies/perameters at your place for tele patients and when to call the physician?

The market in Florida is strong. I am a male nurse who graduated last May and got my license in June. Things were a bit slow at first, but then I had four interviews and three offers in the span of two weeks and started my job in August. I ended up at the place I did my preceptorship and in their new-nurse program. That is the best way in -- someplace you know and that knows you and that has a novice or new nurse program.

I see the influx of second-career RNs as very positive for the profession, and not just because I am one of them. My nursing school class was filled with people who had quit decent jobs to pursue nursing. They had not "failed" at their other profession, they left for a variety of reasons, but mostly because they felt unfullfilled in some way at their old jobs. There were engineers, accountants, teachers, salesmen and women. Most, including me, knew they would be taking a pay cut, but were willing to do that. The result was a nursing school class filled with educated, motivated, mature individuals who will step into their new jobs with a lot of life and work experiences that will help them and their patients. I see the same in the coworkers in my novice nurse program. Only a couple are right out of school. The others have had other jobs and degrees in other subjects. I find myself challenged to keep up with them. I don't see any negatives in this. I think the patients will be the beneficiaries.

Being a minority (male) helped me get into nursing school and also gave me an edge when it came to getting a job. That's the reality I experienced (and I am not about to complain). Fair? Well, life ain't fair, but what goes around comes around.

1. South Florida 2. Novice nurse (no experience), with BSN 3. Tele 4. $25.72 5. $2 evening (5 to 11), $3.50 nights (11 p to 7 a), $2 weekends 6. Union in name only (no fees paid, no impact at all -- Florida a right-to-work state)

All depends on the facility and HR requirements. I interviewed at one place on a Tuesday, and thought I nailed it. Got a call Friday that I didn't get the job. Interviewed on a Thursday at another place, got a job offer the following Monday. Another time, went for a Wednesday interview at 11:30 A.M. and the recruiter told me before the interview I would hear by Friday. After the interview, she said they were impressed and I would hear that afternoon. Got a call offering me the job at 2:30 p.m. I have learned to never read into the interview. The ones where I felt things had gone really well are the ones I didn't get, so I quit setting myself up for disappointment. I agree that if you don't get the job, you should try and get back with someone who interviewed you and ask what you need to do to be in a better position. Sometimes they will be honest with you, and that is a help.

I followed this debate while in nursing school. I graduated in May, got my license in early June, and for six weeks was in the "There Is No Freakin' Nursing Shortage" camp. Then over the next two weeks I had four interviews and ended up with three job offers. While the current situation is obviously tougher than pre-recession times, there are jobs out there. You do have to be pro-active -- when I didn't get a call from the hospital where I did my preceptorship, I called the nurse manager of the department I worked in and asked him if he would put a good word in for me, and he did and I got an interview and a job offer. I also took a CCRN review course at a nearby hospital. Since I am a newbie without a job, I can't even sit for the test, but the two-day class was cheap ($75), and I figured I could meet nurses and network while also getting some good knowledge. The class was great, and better yet, I met a lot of nurses working at the hospital hosting the event, they put me in touch with the recruiter, and we had a good chat. Followed that up the next week, got an interview, then a second, and another job offer. Bottom line -- you can make your own luck.