tips for a new hospice nurse

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Hi fellow Nurses!

I'm finishing up my oreintation within the next few weeks. I worked for a little over 2 years in an ICU. While I was in nursing school my Grandma was admitted to an inpatient hospice unit. I believe it was at that point I knew I wanted to work in hospice. I wanted to get at least 5 years in the hospital setting first. Well I could only make it 2. i had enough of the torture:) The company I work for has a great reputation. The people are really great and when they say that want to help, they actually mean it. Caseload 13-14, LPN available on each team to see patients, weekends required like every 16 weeks. Just looking for tips or advice. Charting, talking to patients and families, staying organized, dealing with tough situations, emotions, writing notes, assessments, and completing my day at 5. Any Pearls will be greatly appreciated!

Thanks,

Amy

Jensmom7, BSN, RN

1,907 Posts

Specializes in Hospice. Has 36 years experience.

Welcome to Hospice. It will be different than any nursing you've ever done.

Some of it's an uphill battle-attending docs who aren't "Hospice friendly", family members who haven't been around for years but suddenly swoop in from out of town to tell the sibling who got stuck with being the primary caregiver and POA that they're doing it all wrong and how can they give up on mama like that? And then they swoop out, leaving you to clean up their mess and restore the caregiver's confidence that they DID make the right choice.

One of the most important things-do all your routine visit charting in real time. Finish those notes right there in the home. I really don't do any charting at home-even Recerts and SOC paperwork is done on company time. I do have a bit of an advantage because I do home visits but all my patients are in one facility so there's not a lot of drive time.

I had to learn how to set limits. That's why I don't bring work home with me.

Also, be prepared when you go to IDT meetings. They may be as exciting as watching paint dry, but it's how you justify your patient's eligibility. You need to show continued decline. Your coworkers will be able to give you pointers on how to do that.

It's kind of a foreign concept when you first leave the acute or critical care environment, because there you're focusing on improvement. Ten percent weight loss over the past 4 months? Bring on the dietary consult and supplements!! In Hospice? It's gonna happen, discuss pleasure feeds and reassure families that mama isn't going to starve to death-at a certain point, it's one of the ways the body starts preparing to shut down. My patients usually love it when I tell them they can eat whatever they want, have dessert before dinner, heck, have dessert INSTEAD of dinner!!

Hospice nursing is a journey-remember, you're truly part of a team, and your MSW and Chaplains are going to be invaluable. Many times people will accept information from them more readily than from you.

Specializes in Nursing Leadership.

One of the most important things-do all your routine visit charting in real time. Finish those notes right there in the home. I really don't do any charting at home-even Recerts and SOC paperwork is done on company time. I do have a bit of an advantage because I do home visits but all my patients are in one facility so there's not a lot of drive time.

I completely agree with Jensmom7! Your new mantra should be CHART BEDSIDE! CHART BEDSIDE! CHART BEDSIDE! If you don't finish your charting by the end (or shortly after) your visit, you will get bogged down with other needs during your day and end up finishing charting on your own time. I am amazed at the nurses who say they aren't done charting until 7pm, if you chart bedside, late charting is mostly avoidable.

You will hit a huge learning curve, a couple of speed bumps, and end up loving hospice every step of the way.

Good luck and welcome!

nutella, MSN, RN

1 Article; 1,509 Posts

Get organized from day 1 - if you are not organized you will have problems getting your work done within your paid work time especially if you are case managing home hospice. Get at least one 2 inch binder and protective sleeves. You should have phone numbers of your coworkers, hospice MD, office and so on available, numbers of PCPs and hospitals in your area, pharmacy, and long term care facilities if you go to those. Get a copy of the standing orders, instructions to program the CADD pump you will be using, cheat sheet about hospice conditions of participation, the FAST scale calendar to pencil in your caseload and schedule in case your computer dies, and of course pronouncement forms (plenty of those ....). Get a car charger for your phone especially if you use it as a GPS as well, get a hands free thing - that way you can call the MD or offices or hospitals while you are typing or driving. Get some small trash bags for your car and have some snacks in your car.... You will also need some space in your trunk for supplies , I also recommend a plastic box in which you can store admission paper work packages, info brochures, and so on.

Make sure to make friends with some experienced, friendly hospice nurses so you know who to call if you need advice or help!!! That is valuable as there will be situations where you need to talk to another hospice nurse. I also recommend the core curriculum for palliative and hospice nurse and to keep a copy of instructions on how to calculate different narcotics. Get a cheap calculator and a sharpie.

Good luck!

Specializes in Pediatric Diabetes Educator. Has 10 years experience.

Thanks for the tips. I am also about to make the switch from a Med/Surg unit to a home-based hospice position. I had a clinical rotation with hospice as a student but never really thought about hospice as an option. Now I'm excited to get going!

Jay

Enjoy the ride!

vampiregirl, BSN, RN

1 Article; 794 Posts

Specializes in Hospice. Has 13 years experience.

Welcome to Hospice Amys4304 and Jay S!

You've already gotten some great advice from the above posters. A couple of additional suggestions I have is to get to know the other members of your IDT team and their roles (although there is some overlap - especially for the nurse/ case manager). Also, I learned so much from joining HPNA and the resources available from them.

Good luck - there is a bit of a learning curve but hospice nursing is so worth it!

Kijana

17 Posts

Do you like hospice so far? Apart from driving what challenges are you facing as a hospice nurse? Personally I have to keep reminding my team that patients so and so is not appropriate,so we need to discharge and they always agree