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Tips for a new home health hospice nurse

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Hi all! I desperately need some guidance! I am a newer nurse, I have worked in LTC and office nursing for a total of about a year... I started hospice homecare a couple months ago. I came to hospice because my mom had ovarian cancer and during my last semester of nursing school, she was put on hospice.. At 21, I gave up everything including school for a bit to be her care giver and it was the best decision I've ever made and something I feel very proud and honored to have been able to do. A little over a year later and here I am! I was hired PRN, but due to some issues I was asked to temporarily take over a full time case load my first day off orientation. I have also been working nights and weekends and at times am the only nurse working for more than half the state. I am also in school full time. To be honest, I am completely overwhelmed. I am still learning my skills, there are some I've never done. I'm trying my best to just go out there and try to figure things out on my own, but there are just so many things I don't know how to do still! I want to take care of these patients to the best of my ability, but I feel like they deserve someone more experienced to be their primary nurse.... I am still stumbling on my own two feet so to speak. If you have any tips I would greatly appreciate them... I often feel I don't have the resources I need and for someone who isn't someone who cries , I have done so more days than I can count. Everyone assures me I doing great, but it certainly doesn't feel that way..... Any and ALL tips and advice is welcomed. I want to tackle these fears and become more confident in my abilities.

So do I understand you correctly? You are working FT AND going to school FT? No wonder you are wringing your hands! That is too much to take on for even an experienced nurse! I hope your employer is doing something to remedy the situation! There is far too much at stake (for you and your patients) to allow those hours to continue.

I have serious professional reservations about assigning new and inexperienced nurses to field hospice case management. Your story is indicative of why.

Yes school and work full time.... Well actually starting next week I will work one shift less a week thank goodness! That has been a big relief. I just try very hard to remind myself that I won't know everything from the jump, and I call and ask questions all day long. It's better to ask then to assume and make a mistake!

Luckily, I will be case managing only temporarily because if they offer me the position permanently (as indicated they might) i plan to say no, which is not something I do often. I think I need time to learn, and also that the patients need someone who has more experience. Maybe I am wrong, but that's how I look at it.

Did they not do any orientation or provide you with a mentor? That's what I do every day. I train all our new nurses statewide and answer their calls on a mentor basis. Sometimes even riding along to difficult patients.

I did have about 3 1/2 weeks of orientation. But there's really no one we can other than the other staff nurses. Since this post originally I have gotten better acclimated and feel more comfortable, which I am grateful for

We don't have a program for new nurses unfortunately. The answer is that because we are not for profit we cannot afford one.

Oh ok. Well I am a hospice staff nurse also, no extra pay involved, I just do it to help out our new people. Hospice is unlike anything nursing school teaches you, my school anyways, and can be intimidating. I ran a busy ER before hospice and thought after that, nothing would intimidate me. Boy was I wrong haha.

WOW!! Thank you for sharing that, it definitely helps me realize that it is a challenging field. I just have tried to do my best to take it one day at a time and realize I am only one person so if I do my best that is the best I can do. Slowly I'm figuring things out. Still so much to learn, but I feel more comfortable with the things I have learned so that helps.

QuiltDog

Specializes in Hospice Nursing.

It sounds like you were thrown into an impossible situation. That said, I would suggest using all of your available resources (nurse manager, nurse educator, peers) to help you through this time. I have done hospice for 10 years, and feel that it takes 6 months to a year for a new hospice nurse to feel somewhat comfortable. Also, the fact that you are a newer nurse will make this transition harder. Sounds like you are doing a good job...don't give up!

I have serious professional reservations about assigning new and inexperienced nurses to field hospice case management. Your story is indicative of why.

.......that's encouraging

.......that's encouraging

and?...

One cannot pull professional experience out of one's ear to help them feel comfortable with the autonomous role of the field hospice case nurse. There are good reasons that many hospice agencies hire ONLY nurses with at least 12 months experience in bedside nursing in an acute or skilled care setting, hospices by and large do not have a budget which allows that level of basic orientation to basic nursing.

Well I have improved since my original post. I was familiar with a lot of nursing care, I just don't feel the answer to learning how to flush a port or take out a picc line for the first time should be to watch a YouTube video before you arrive to the home and this has been the case for many nurses . I would have loved to have worked in an acute care setting and have applied to the three in my area over 50 times. Unfortunately, I live in a rural area where nursing jobs are few and far between, and the hospitals all say they want 2 years of hospital experience to even get a Medsurg job, which never discouraged me from applying, but also I was told time and time again I didn't have the necessary experience to be considered. It took me over 6 months to find a job with a year of experience. I'm definitely grateful and glad that someone saw my potential. My nursing educator as well as supervisor met with me last week and told me I was doing remarkably well, my assessment skills are great, patients and families love me, and They are extremely grateful for my helping out until they find full time nurses.

and?...

One cannot pull professional experience out of one's ear to help them feel comfortable with the autonomous role of the field hospice case nurse. There are good reasons that many hospice agencies hire ONLY nurses with at least 12 months experience in bedside nursing in an acute or skilled care setting, hospices by and large do not have a budget which allows that level of basic orientation to basic nursing.

Yea just didn't seems like a very optimistic contribution to someone already in doubt, just kind kicking someone when they're down is how it came across to me at least.

Yea just didn't seems like a very optimistic contribution to someone already in doubt, just kind kicking someone when they're down is how it came across to me at least.

I didn't kick anyone, simply made a point that should be made time and again...field case management is not the best place for a new nurse with little to no experience at the bedside. It isn't the new nurses fault, it is the bad judgement of employers who want to pay as little for nurses as possible so as to maximize profit.

We are the only not for profit hospice in our state and surrounding areas... Also were currently $2 million in the red from my understanding. I suppose if anything they are trying to get out of debt. I know they hired a nurse just recently with 10 years of experience and started her at only 10 cents more an hour. All of the case managers are "drowning" which thankfully they've added openings for 2 fullte me positions. Our caseloads are more than double the national average.

We are the only not for profit hospice in our state and surrounding areas... Also were currently $2 million in the red from my understanding. I suppose if anything they are trying to get out of debt. I know they hired a nurse just recently with 10 years of experience and started her at only 10 cents more an hour. All of the case managers are "drowning" which thankfully they've added openings for 2 fullte me positions. Our caseloads are more than double the national average.

Sorry to hear the company is not doing well.

That speaks to why they are working you like a dog I suppose.

Hospice care is wonderful and rewarding work.

It is also very demanding with great potential to generate compassion fatigue in professionals who are given MUCH responsibility with little support and nurturing.

Good luck.