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Nurse Beth Nurse Beth, MSN (Advice Column) Writer Innovator Expert Nurse Verified

Should New Grad Start in Hospice?

Nurse Beth   (2,277 Views 10 Comments)
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Dear Nurse Beth,

I'm currently in my fourth semester of nursing school. I was thinking of working in the hospice area of patient care. Should I first get more nursing experience in a hospital setting or just focus on entering the hospice field?

Dear Wants to Start in Hospice,

Congrats on being close to graduating! Kind and compassionate nurses are drawn to end of life care. Many hospice organizations require 1-2 years of clinical experience. There are good reasons for this.

You will gain fundamental nursing skills by working in the hospital. You will be exposed to terminally ill patients and begin to understand what dying looks like for the patient and the family. You will learn about pain management, multimodal pain medication, and how to position a patient to make them comfortable. You will learn to listen and be present.

Working in the hospital prepares you to work independently in the home setting. Career wise, starting in the hospital and then specializing is recommended over starting in a narrow speciality.

Best wishes,

Nurse Beth[

Author, "Your Last Nursing Class: How to Land Your First Nursing Job"...and your next!

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I agree with Nurse Beth. It is awesome that you are interested in going into Hospice (especially right out of school). However, hospice nurses often have to work quite independently. Unklike an inpatient setting, you will likely be the only provider present and won't have the option to ask a more experienced person (i.e. another nurse or a physician) for guidance or assistance. I'd be sure you feel strong and comfortable with both your assessments and skills before flying solo, and the fastest, most reliable way to do that would be to work on an inpatient unit for a couple of years.

FYI, there should be a Hospice forum under the AN specialties page--they should be able to help you with more specific hospice questions; you could try posting your question on their forum and see what they say.

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I know several new grads whose first nursing job was in hospice. It's worth a try if that's your passion.

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I do not agree with Nurse Beth. There are many hospice agencies that work with HOME patients who live and die at home. Hospital skills add only minimal value when you completely on your own working in a palliative care setting where the goal is COMFORT not cure, symptom management, not lab tests and working towards a cure. Hospital nurses often have to unlearn a number of areas to work in hospice where the focus is 100% different than the hospital setting.

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I started as a new grad doing home care hospice and excelled. It takes a lot of autonomy because you are essentially alone assessing and providing care. Anytime I had a question or felt uncomfortable though my supervisor or another nurse was only a quick call away. I stayed in this position for a year before realizing that I wasn't utilizing most nursing skills I had learned. The hospital environment and acute care is golden but not for everyone. After working in acute care for a few years I landed a great case management position and it wouldn't have been possible without my home care hospice experience.

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I was a hospital RN (step down unit) for 9 months out of ADN school when I had to move. After the move, the only job I could get was hospice. I love it. Like the other posters stated, you do need some skills that are often acquired in a hospital or home health setting. If you are quick on your feet, hospice will treat you well. I am an 'older' new nurse who has been an RN for 4 years, 3+ in hospice. I was grateful that I was able to have hospital experience first.

The other side of hospice is that you will lose skills that you may need as an RN later. For instance, we don't (usually) start IV's, we don't necessarily look at lab values, we have symptom management medications but not a lot of different meds. Medicare will not pay for medications not related to terminal diagnosis. Patients pay out of pocket co-pay for many medications (but not all). So if you get into hospice, just keep this in mind. If you think you may need certain skills later, know that you may be a little rusty.

My point is that hospice nursing is awesome if you are into case management. If you want to work with a multidisciplinary team to help the patient, family and others attached to the patient die as peacefully as possible, then hospice may be your calling. If you're into educating the patient/family, you will have more time to do this with hospice. If you like autonomy or driving a lot, hospice nurses do this. It is very stressful and is not like any other speciality. You have your patients for weeks to years. No other speciality that I'm aware of, has patients for this length of time. If possible, I suggest you do a ride along with a hospice RN to see if its for you. I'm not sure of any hospice who does this, but it would be worthwhile if possible.

If you've had a family member/friend who's been on hospice you will have a better understanding of what to expect.

Fortunately, I was able to figure out pretty quickly that I wanted to learn more about and work closer with persons with dementia as several of my patients have dementia of some type. I will be graduating this December with a Masters in Sociology in Aging and Dementia studies.

Good luck.

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My first job out of nursing school was working at a hospital that has palliative/hospice unit. Many hospitals have one. It would give you the training and support you need while still pursuing something you love.

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I think everyone is different and if you truly have a passion for hospice care, you have nothing to lose by applying and if the hospice agency is interested, maybe they will bring you in for an interview. If you are lucky enough to get an interview, you need to ask good questions about what kind of orientation you will get, how long orientation will be, etc. That being said, if it doesn't work out at this time, consider volunteering for a hospice in your community as you work to gain the nursing skills needed to become a great hospice case manager. I can't think of any agency that would turn away a volunteer!

As ohiomatka said above, another option would be to apply for a hospice/palliative care unit in an inpatient facility.

Finally, if you have another semester of school, is there a way you can do a clinical rotation in hospice? Just a thought :)

Best of luck to you whatever you decide!!

Laurie

Edited by LaurieCRNP2002
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If I were a hospice patient, I would not want a nurse with no experience managing my complicated symptoms at the end of my life. I was once a new grad RN, with 7 years of hospice experience as an LVN previously, and I felt overwhelmed as a newly minted hospice RN. I went to the acute setting, got several years of ER nursing, and now know that I can manage most situations without feeling panicked but while still focusing on my patients comfort at end of life.

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Agree with nurse Beth. Thanks for a good advice and nice approach. Just really need a good experience first before handling a complicated one. One step at a time.

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