Progressive care to Hospice?

[Anoetos, BSN, RN]

I work on a progressive unit on which we care, primarily, for people with pulmonary issues (pneumonia, COPD exacerbations, etc), and we see our share of expirations, as well as a good number of transitions to palliative/hospice. Most of our patients are very acute and if we send them to hospice it's because they are going to die very soon, within hours to days, usually. In many cases, we terminally wean them on our unit.

Recently, I had the opportunity to interface with the nurse who comes down to do the admission evaluations for ip hospice placement. She's wonderful, but anyway, on a second visit she started asking me when I was going to come work with them. Evidently, between the patient family report and her own observation of me, she thought I would be a good fit.

I have to say, the idea of working where the family and patient have already crossed the rubicon as it were, and where the effort to "fix" what can't really be fixed has been stopped has a certain appeal, but I am not sure what to expect. I dont mind hard work, but I am used to three or four patients, albeit usually ones with multi-system failures who require a lot of management.

What is the usual patient load on an ip hospice unit? And if you could direct me to a thread which gives an outline of a usual shift I would appreciate it, or, if you like, just tell me here.

[NavySERE]

The normal case load in an in pt unit is any were from 4-7pt's depending on the overall size of the unit. I have worked on two 14 bed unitsdepending on the shift I worked I would have 4 pt's for a Day shift or 7 for a nightshift.

The "acuity" of the pt's are different. You are notdrawing labs, running multiple IV lines, they are not "hooked" up to monitors etc. However, if the pt is in pain crisis or sever terminal agitation you will be working very very hard to get them under control.

You are needing strong critical thinking, and assessmentissues long with good understanding of symptom management.

Depending on the unit, you may or may not have an MD on theunit all the time. So you will need to know the type of medications and dosageswhen it comes to EOLC. (End of life care)

During my time as a nurse I have worked ER and Trauma. Iwill tell you I have left our in-pt hospice unit equally physically and emotionallydrained as I have ever did work those other places.

However, it is so very rewarding!!!

Sounds like you defiantly have the clinical experience. Tobe able to prepare families for their loves ones rapid decline. That is one of the things I see with youngernurse who do not have the experience. If you have not seen a pt hours beforethey go into Resp Distress (for example) and know what to look for how can youprepare families for that experience. Or a pt who is actively dying and saywith 80-90% certainty that "your love one is going to die tonight or in thenext few hours or "right now".

Wish you the best of luck..

Hosice Nurse Educator

NavySERE