hospiRN

Had a dementia pt up and down for MONTHS..unresponsive for 5 days...I walk in one day and she sits up and tells me she is feeling pretty good (The whole time I had her she did not speak sensically)...next day she passed. It is amazing

I like- The fact that you really get to know your pts and family (depending on their prognosis) Being able to support families and pts at EOL The flexibility Being able to feel like you successfully helped a pt pass with dignity and comfort Dislikes- extreme caseload impossible facilities meetings about meetings about meetings

I literally just took the test a week or so ago. It was super difficult. I've only been a nurse for about 2 years, with 1 year as hospice experience and I passed. As someone else stated, a lot of it was oncology symptom management..phew! My employer did pay for the exam and provided compensation for passing. You could always take a practice test from a study book from barnes and noble and see where you stand. I recommend getting the study guide from the NBCHPN and taking their practice exam as well $35 extra.

What does your hospice agency pay for mileage reimbursement? Do you get the 0.56/mile federal rate? When you do your admissions, do you have to do a FAST scale for each admission? Does your hospice pay for meal supplements (such as Glucerna/Ensure/Boost)?

We only use subcutaneous as well

I have 17...We do get some help from PRN nurses. I have yet to know a 40 hour work week...I am salary, I usually do about 50 hours a week (and yes we take call, at least once per week..we have designated weekend on call nurses). We do admits as well....

Welcome! I have been working for a little over a year now as an RN and I too remember those nights I would cry, feel incompetent, go over every decision I made at night...cried to work, cried in the bathroom at work, cried on my way home...we have all been there!

Oh How I would LOVE if we had an admissions nurse!!! I love hospice! Hospice admissions are quite time consuming, but give you an awesome opportunity to understand and get to know pts and families. It involves a lot such as Full Assessment and determining if they are hospice appropriate or not. I have gone to do an admission at times and the family is actually quite let down when they find out their family member is not appropriate, simply because they need the help...but we have an awesome social worker who can help with other options if they are not appropriate. So..after the assessment and deeming appropriate we would find out what the family/pt knows about their diagnosis/prognosis...this usually involves a LOT of education. We educate on hospice philosphy and go through what we can provide (24/7 support, RNS, CNAS, SW, Chaplain, DME, covered medications, levels of care, etc). If the pt/family is on board and would like our services, we start signing paperwork. We go through medications and determine what we will cover and what we wont (this is getting sticky with Medicare Part D changes going around as we speak)--This is also a time we like to educate on medications that are not medically neccessary at this point and see about discontinuing them (I have mainly dementia patients so we discuss things such as Aricept, Namenda, Exelon, etc). If pt needs DME (oxygen, hospital bed, supplies, etc) we order those. We notify pharmacy of pt being on hospice and provide a Rx card for the meds we will cover. We find out if there is an immediate need for social worker, chaplain (Is the pt actively dying? Difficult family dynamics, hardships, caregiver role strain?) We find out what family needs as far as CNA services, does the RN need to come out 1 or 2 times per week, etc. If you are going to be the admissions nurse it would be of utmost importance to cover all the bases and make sure pt is fully educated and that you have all neccessary information for the pt case manager. Then you chart the admission, which for us, usually takes about 2 hours. I hope I didn't miss anything... Like I said..one of the hardest things is to find a pt inappropriate that would really like services, but it would be medicare fraud to admit an inappropriate pt...you would think people would be relieved that they are not hospice approriate, but like I also said, we offer a wealth of services...and some families/pts really need help, but there are other options. I love hospice! I hope you will too!

I am not in a hospice facility but have pts both in the home and in facilities. Our average caseload is 15. The most I have carried is 18.

Oh girl you sound just like me when I started. As a new grad, you will question everything you do...I know everyone says it gets better, and you may think pffft, not for me...but it will I promise. If the area you are in still gives you anxiety after a while, maybe its not your niche, and you should open up your options. I switched from hospital to hospice after dealing with an incredible amount of anxiety related to night shift, floating, and just everything related to hospital and it has been the best decision I have ever made. Hospice is my niche. I hope I don't ever have to do anything else.

Yep depends on location. I am in SC and have found it easy to get interviews and job offers. However, my friend whom lives in FL has found it to be incredibly difficult.

I wish we had an admissions nurse! We, the case managers, take turns taking admissions unless someone asks for us by name. We do our admissions within 24 hours. What is involved in a three day process??