Working in Hospice

[nurseontheway]

I have worked in dialysis for four years but would like to work in hospice prn. I have always had an interest in hospice and could use your advice. I am learning that it is hard to switch over from one specialty to another- even with a BSN. I love dialysis but want to try something new. Is there any advice that you can give me? There is an agency that would hire me but they do not offer training and would just 'throw me to the wolves.' That is too risky for me since you are working with people!

[westieluv]

I would never go with an agency for trying hospice nursing for the first time. I have worked for agencies, and you're right. They throw you to the wolves after four hours of orientation, or eight hours if you're really lucky. Hospice nursing is completely different from dialysis and will require good, solid training from a good, solid hospice nurse. It's not just the patients who need you in hospice, it's their families and close friends, and you need to be able to answer questions and facilitate the grieving process for them, as well as provide comfort and symptom management for the patient.

I am in the process of leaving dialysis to go back to hospice nursing, but I do have some experience in various areas of hospice nursing, and have only been doing dialysis for a couple of years. My suggestions to you would be:

1.) Do not go into hospice through an agency for the reasons I listed above. Find a good, local hospice company with a good reputation in the community and try to get a position with them. Ideally, you would start out in an inpatient hospice facility, so that you would have other trained hospice staff around to help and to bounce things off of. Working in the field can feel very lonely if you aren't very well trained and haven't done it with a preceptor. It's just you, a dying or dead patient, and friends and family members, and you walk into some very "interesting" situations at times.

2.) While most dialysis patients are not dealing with end of life issues, some of them certainly are, as you know since you've been working in dialysis for four years. I only worked in a chronic unit for less than a year, and in that time we lost at least half a dozen patients to ESRD related illnesses. I would be sure to mention somewhere on your application (and definitely in your interview if you get that far) that you have dealt with patients dying, due to the dialysis patient population being such a volatile one, health wise. You have also no doubt had to deal with patients' families, since being on dialysis is such a life altering condition and you get to know the patients and their families so well over time. Any type of diplomatic role that you played while working in dialysis (dealing with a patient's wife who is angry because his chair time was changed due to noncompliance, or a daughter who is grieving her mother's loss of independence since she became a dialysis patient, etc.) is good training for hospice, where you deal with families and their emotions on a daily basis.

Even if you want to stay in dialysis and only do hospice on a PRN basis, I would still avoid the agency route, even if they offer you something. A lot of nurses who work in other specialties assume that hospice is easy (I'm not saying that you feel this way, but some do), and that caring for dying patients doesn't require a lot of special training or skills, but there are so many issues that are unique to end of life patients and their families that it really does require good training. Going into hospice for the first time as an agency nurse would be overwhelming, IMHO.

[nurseontheway]

Thank you so much for taking the time to respond. I have always been against agency nursing- I wouldn't mind doing it for dialysis since I feel that I have a decent background but I certainly wouldn't in a new specialty. I can't understand why people would think that hospice would be 'easy.' If anything I think that there would be more responsibility- especially to the family and loved ones that are looking for answers. I hope that someone will give me a chance but I will just keep trying and go from there.

[westieluv]

Well, I'm no fan of agency nursing either, as you can probably tell. I never worked in hospice through an agency, but I did work in the hospital setting through a few, and it was pretty rough. Brand new to the hospital, wasn't trained on their computerized charting system, didn't know where anything was or who anyone was, but was given all of four hours of orientation before being on my own. That's just nuts!