Transitioning from hospital RN to Hospice RN case manager

[RN0510]

So, I was offered a job today and am really excited and totally nervous. I knew all along that I wanted to do hospice, but am worried about transitioning to that role. I would appreciate any insight that anyone has into this.

[jeannepaul, BSN]

I think the hardest part is the different mindset hospice nurses have compared to hospital nurses. Hospital nurses see something and their first thought is to "fix" it i.e. dehydration close to time of death, hospital nurses want to do labs, start IV fluids and it can be difficult to take a step back and treat symptoms only.

Hospital nurses look at the patient from the top going down, and hospice nurses look at the patient from the bottom going up. What I mean by this, a hospital nurse sees a pt and knows what they should sound like, ie Lungs and when they hear crackles, they think oh this sounds bad.

Hospice nurses sees the same patient and will say they sound pretty good, because they know what they are going to sound like before death.

I hope I explained it ok, it does take time going from aggressive care to comfort care, but you can do it!!

[hlfpnt, BSN, RN]

I've been a hospice nurse for almost 2 years & I have to say it's the best career choice I've ever made...I love what I do. I have both inpatient and homecare (Case Management) experience. I much prefer CM. It's not an easy job by any means. Your car will become your "office". You have to be flexible, your schedule may change 2-3 times in one day, hour, minute...no, that's not an exaggeration. There's a great deal of autonomy, you have to be able to work independently. There's also the interdisciplinary team, so you also have to be able to communicate effectively. Sharp all-around (physical as well as emotional) assessment skills are an absolute must in hospice care, especially CM where you're on your own so much, you are the relied on eyes & ears of the team. One of the main differences between hospice & hospital care is "family care". Many times your care will be more centered around the family than the pt, especially in the home setting. Family dynamics will sometimes dictate much of the pt care. Teaching is a huge part of hospice. Also, CM requires good organizational skills. Hospice nursing is often much more emotionally draining than hospital nursing. You can't allow yourself to take personal hits in hospice nursing. It's a difficult time & many times people will say/do things that they ordinarily would not say/do. You must learn to take care of yourself as well. Just remember that your Chaplain's are there for you, too, & it is confidential. It is a specialty all it's own &, in it's own way, it is a very rewarding job. Through all the ups & downs, ins & outs, & sometimes roller coaster type days I have to say...."I'm a hospice nurse, & I love what I do!". I hope you find it as rewarding as I do, all my best to you. :redbeathe