skills needed---help please?

Brush up on accessing PICC lines and implanted ports of all types. In hospice I have seen and taken care of all sorts of things one might not expect...chest tubes, NGs, rectal tubes, urinary diversions of ALL kinds, wounds of ALL kinds, stomas of all kinds, ventriculostomy tubes, continuous epidural infusions, continuous intrathecal infusions, continuous SQ infusions, paracentesis, etc etc etc.

I certainly have had to do some research to bring myself "up to snuff" on a particular subject or procedure before seeing the patient. That is part of what I love about this job. It is challenging in SOOO many ways. In hospice we have the advantage of knowing in advance what we might expect so that we can prepare ourselves before we visit. Makes us look smart!

Tewdles, totally agree with your posting. We see EVERYTHING and if you haven't had to do suctioning/trach care recently, I'd brush up on that one as well as I've been getting more and more ventilator pts over the last few years.

Best of luck in your new journey and WELCOME to hospice nursing!

Werblessed...are you familiar with Select Specialty Hospitals? I think (no data to back me up) that they are discharging more of their patients to hospice than they did a few years ago. So, yes, that is my experience as well. Long term vent patients going home to die. That means trachs in most cases.

Yeah, they have Select Specialty in Colorado as well. Most of our vent patients are being d/c'd from ICUs in main-stay hospital settings as Physicians are hearing patients/families stating they want to 'go home to die'. Thank heavens we have enough of a presence within our community of providers that they know who to call when patients make this request and we do whatever we have to do make it happen and NOW! Just had a 68 y/o lady in June dying of pulmonary fibrosis on ventilator and asking to go home as first grandchild was graduating from H.S. Was in ICU on Saturday and going downhill fast. Pt was able to communicate, barely, that wanted to be home for graduation party next day and knew she was going to die soon. Bing, Bam, BOOM - she's home, we staff Continuous Care to support pt. Grandson's party is at 1400, pt. PPS 20% but intermittently aware and comfortable - passed at 1620. THIS is why I love this work and feel blessed by this profession.

I have been out of nursing since 1998 and I'm worried that my skills won't be up to par, but am interested in getting back into nursing. Hospice has always been of interest to me, since I had a grandmother that received Hospice care in her home. I was in nursing school at the time and I remember the nurse gave our family so much comfort.

My question is.....How long of orientation do Hospice centers offer before letting you out on your own. Everyone keeps telling me that all of my skills will come back like "riding a bike", however, I'm not that confident! :)

For profit hospices will want you on the road as quickly as possible and they will, additionally, want you case managing a full load as quickly as possible. Not for profits will be more concerned about getting you comfortable and successful, retention is more important to them typically because it is so expensive for them to start over. IMHO.

I had 2-3 weeks of orientation when I started. That consisted of shadowing our other nurses and I thought it really helped. I was offered more time if I needed it, but I felt confident after the time I had. Much of it is learning as you go as nursing in general goes anyway. As far as skills go, I haven't run into to many yet. Peg tube care, dressing changes and that type of thing are all I have done so far. We do have people with cath's and that need blood drawn but none of them are my pt's. There is so much info on the internet that shows how to do certain skills that you may need to brush up on that I wouldn't worry to much about it. I think the other nurses in your facility would also be a great resource for you.

I'm going into my 4th week of orientation. Very thorough and intense training. When I give them the green light, they will let me go out on my own. I'm loving it so far! :)

Hi,

Congrats on your new position.

After working 10 yrs, mostly LTC and Rehab. My transition to in-house Hospice wasn't too bad. It took some research on my part, especially regarding family grief, medications, pain, and symptom management. A clinical procedual manual always comes in handy if you have been out direct patient care for a while. Hospice has it's challenges as in any setting, however, I have found it very fulfilling.

Best wishes.