Relatively new grad hired in Hospice

jiij · Dec 8, 2013

I am not sure what you are looking to find out exactly but I can tell you that it may be quite challenging for you as a new nurse because you often have to make decisions out there on your own. In my experience, there are many things the hospice doctor leaves up to you, depending on how big your hospice is and how extensive of a clinical support team you have, you really do call the shots. I am not saying that you are going to be working outside of your scope of practice but you really need to have solid assessment skills so that you can know what you are looking at and have some ideas of solutions up your sleeve. Many hospice doctors just want to hear what you think should be done and give you a verbal order accordingly (more like, 'sure sounds good, go ahead'). Often you are doing symptom management with your comfort kit (or e-kit it's called too) and having to make decisions about titrating medications; that part becomes more routine, if you will, and as you start learning the signs and symptoms of dying process you'll get the hang of it. I'm not trying to scare you but you may need to do a lot of homework outside of work for a while; I hope they are going to train you! There is a spectrum in hospice like anything else so you may be started off with less complex cases.

Look up the book "Symptom Management Algorithms: A Handbook for Palliative Care" by Linda Wred-Seaman. Much of it applies to hospice and it comes in handy. On the more emotional work of hospice nursing, I recommend reading "Living at the End of Life: A Hospice Nurse Addresses the Most Common Questions" by Karen Whitley.

So much of hospice is supporting patients and families emotionally, as you know, and that can be extremely exhausting. When I worked med surg it was the physical work that did me in; with hospice I have to really unplug from work and practice a lot of self-care: working out, healthy eating, you know the drill. The more intense work can come in when your own grief is pulled up; you mentioned some losses in your life. Don't underestimate your own grief. If you are a compassionate, loving person, it will come up but it doesn't have to bowl you over. It can be an amazing healing opportunity for you too!

Best of luck to you!

Hospice is incredibly rewarding work and so far it's been the one specialty where I truly felt aligned with the work. It's so holistic, you get to spend time with your patients and address all of their needs (physical, emotional, spiritual, etc) in a truly interdisciplinary way. It is not thankless work (poor med surg nurses never get enough appreciation!) and I hope you will enjoy it.

Best of luck to you!

ksuSN12 · Dec 8, 2013

Thank you so much. I will look into those books. I can definitely understand why it will be challenging. Im not sure yet how much training I will get. They have me coming for one day of orientation and then I will follow another nurse on some cases, but I dont know yet how long that will be for. They are a small and relatively new company and their resources for training arent the same as other places. I dont want that to stop me from being a great nurse, and this is something I actually want to do. I just need to find relevant information over the weeks that will help me be everything I need to be for right now.

TammyG · Dec 8, 2013

We had three full weeks of training in the office, then three weeks with our preceptors one-on-one. And this is for all nurses, including those that have been nurses for 30 years. I would be a little nervous if you only receive one day of orientation. We do not hire new nurses. I would recommend Oxford Textbook of Palliative Nursing, but reading material only takes you so far. You really just need to get out in the field and see how it feels.

Nurseknit · Dec 11, 2013

Hi!

I'm also a new grad who finished the same time as you. I'm definitely going to look up those book recommendations.

I lucked out/found out that where I am did hire new grads so I've been in palliative care for almost a year now. I know a nurse who did palliative care straight out of nursing school and did it for 15 years. I think the hardest part for me was... well learning everything since we didn't work with palliative patients in school. Learning to fine tune my assessment skills from natural end of life restlessness vs confusion due to urinary retention or constipation. Being comfortable discussing death and asking questions that people may not be comfortable bringing up. I think a huge learning curve for me was just being around dying people. It really made me face my own fears of death and changing my mentality to not fear it, but accept it as a stage of life.

I hope that you have a good orientation. I had 3 full days of workshops learning about symptom management as well as a mentor who I could rely on to ask questions and help me work through issues I came across. This also applied to any nurse (regardless of experience). Use whatever resources are available that work provides from reading material to the educator.

Definitely look up your policies about symptom management guidelines. The ones that are common are pain (which is managed differently for palliative patients), nausea and vomiting, constipation, restlessness, seizures, exsanguination, congestion, spinal cord compression. Majority of the patients we come across have cancer.

Learn about the signs of actively dying patients like cheyne stokes breathing, "death rattle", restlessness, skin mottling, no longer swallowing, decreased output, increased sleep, etc.

There's a ton of paperwork to learn but I think that's with all nursing haha.

Definitely talk it out with your coworkers. It's emotionally rewarding to help patients and families go through the end stage of life but it can be draining when a lot die within the same time period. I really love how it is more holistic care as well. We've had issues with nurses burning out so definitely take care of yourself.

During my orientation, there were 2 things that stood out for me.

1) It may be your XXX death you've dealt with. But it's the patient's first death.

2) Think of the end of life process with the patient and family like a dance and you're a bystander. You're there to support their dance. But know when you get too involved when you start dancing as well and trying to change things up. It helps to recognize boundaries.

I'm really happy working in palliative care and can see myself doing it for a long time. Feel it out and see. I know some people who got oriented to it and didn't come back after their orientation. I hope it goes well for you :)