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Whether you’ve been a nurse for one day or 20 years, there are 5 strategies you need to survive hospice nursing.
It’s not unusual for hospice nurses to say that it’s their calling. However, it takes more than a calling to make it as a hospice nurse.
No matter how much you love hospice nursing, sometimes the demands of the job and the documentation are just too much.
Let’s get real for a moment. Hospice nursing can be exhausting and overwhelming.
As a hospice nurse, you are expected to manage a lot. And, it’s one of the most complex nurse case management jobs out there.
Yet, for some reason, people think hospice nurses are just out here singing kumbaya and pushing narcotics.
NEWS FLASH: Hospice nursing requires strong critical thinking skills as well as advanced assessment knowledge. Not to mention it’s extremely time-consuming.
Additionally, it can be a little lonely if you work as a home hospice nurse.
In my opinion, hospice nurses are the mavericks of the nursing world. (I might be a little biased though, lol!)
But I digress.
As a nurse manager, I noticed that some nurses seem to thrive in hospice while others seem to struggle.
So, why is that? If nurses say this is their calling, then why do they quit?
No, I’m not implying that if you struggle, you don’t love your job. However, if you find yourself wondering if hospice is for you, then it might be that you haven’t mastered these five strategies.
Before we begin, I want to say that hospice is not for everyone. However, you should try implementing these strategies before you throw in the towel.
So, let’s talk about what separates long-term hospice nurses from those who call it quits.
TOP 5 Strategies to Survive Hospice Nursing
If you love hospice nursing, but find yourself at a crossroads, these tips are for you.
Strategy #1 Develop a Routine
To begin, I’ll be the first one to say you should get organized. However, this step is not just about organizing your trunk or making sure you have all of your supplies.
RELATED ARTICLE: How to Survive Your First Year as a Nurse
It’s about making sure you get the most out of your visit.
I’ll give you a sample visit outline later on.
First, experienced nurses with longevity, know that they have a set amount of time to get things done. Over the years, I’ve noticed that nurses who have a plan and set clear expectations during their visits, get stuff done.
Furthermore, they’re happier because they don’t have to spend hours at home documenting and making phone calls.
So, what can you do?
To begin, use a checklist and don’t get off track. It’s ok for you to spend time talking to the family. However, you’re there to make sure they have supplies, meds, and other support.
You should also include time during your visit to start your documentation.
Again, document as much as you can during the visit.
This will decrease the time you spend doing it at home.
If you’re like most hospice nurses, you will have a lot of tasks to complete so make sure you carve out time during the day for them.
Strategy #2 Document Properly
Are you constantly getting calls from your supervisor or quality team to correct your documentation?
This is not only frustrating for you, but it is also extremely time-consuming.
Successful hospice nurses understand documentation requirements and they get it done right the first time!
Now, I know you might be thinking, there’s so much going on or the rules seem to keep changing.
Yes, that may be true, but if you can master the art of hospice documentation, you will save yourself a lot of time.
For instance, if you struggle with the electronic medical record and make the same mistake frequently, you can meet with the quality assurance team or your manager for additional training.
Unfortunately, not all hospice agencies have an education department so you might have to go directly to your supervisor.
Most importantly, don’t get caught up in the mindset that documentation is “just” about your agency’s needs.
This is about you! And you need to get your charting done so that you can have a better work-life balance.
PRO-TIP: use checklists and tip sheets.
Strategy #3 Don’t Waste Time
At the risk of sounding controversial, don’t waste your time in the office. Unless you absolutely need to be in the office, your place should be in the field.
Successful hospice nurses also don’t waste time on the phone with their peers. On the contrary, they use the drive time to make calls to pharmacies, DME, and their supervisor.
Also, if you don’t have Bluetooth, stop right now and get it!
Time is a precious commodity so don’t waste it on frivolous activities.
This also applies to the interdisciplinary team meeting (IDT). Nothing wastes time more than using IDT as a reunion or party.
Don’t get me wrong, it’s nice to see everyone. However, IDT is long enough without wasting valuable time. Instead, use the time to wrap up IDT documentation or routine visits.
Ideally, you should block your schedule so that you have time for important tasks.
Long-term hospice nurses, understand scheduling and make time for peer contact in the field.
Strategy #4 Provide Patient-focused Care
Honestly, this is fancy for letting the patient’s needs be your guide. All too often, I see nurses develop long care plans that address every issue the patient has.
Unfortunately, this leads to lengthy documentation and extra charting for everyone. To make matters worse, you end up adding charting time to your IDG notes as well.
According to statistics from the National Hospice and Palliative Care Organization (NHPCO), the median length of services for hospice patients is only 18 days.
As a result, you should try to capture those problems that will matter most in the next couple of weeks.
Additionally, hospice nurses with long careers know the importance of staying focused during your visit and providing individualized care.
Strategy #5 Learn the Hospice Rules & Regulations
First off, you might think this is not your job. Well, you’d be wrong!
As a hospice nurse, it’s imperative that you understand more than simply how to manage your patient’s care.
For instance, experienced hospice nurses understand hospice eligibility and Local Coverage Determinations (LCDs).
This is especially helpful when you are completing admissions and re-certifications.
Additionally, you don’t want to document the wrong visit type and miss critical information because you didn’t understand the rules and regulations.
I can’t even tell you the number of times that I’ve seen nurses make additional visits because they scheduled a pre-certification visit outside of the CMS window.
In addition to the things above, you need to know what is required for admissions on the certification of terminal illness (CTI) and other documentation.
Hopefully, your agency offers periodic training and education on hospice rules and regulations.
If they do, avoid the temptation to blow them off because you’re too busy.
Chances are you will miss something and end up spending more time making corrections down the road.
Routine Visit Schedule
I’ll be the first to admit that sometimes, things just don’t go as planned. This is especially true in hospice.
However, if you are making a routine visit, you can use the schedule below to keep you on track.
Call before your arrival so the family is ready for your visit.
Visit Timeline (Approximate)
0-15 Minutes: Greet patient and family. Review what has happened since the last visit and state your plans for the visit.
This is your time to chat! Stay focused. This will make the time you spend at the end of the visit documenting feel less invasive and impersonal.
16-25 Minutes: Perform physical assessment, dressing changes and gather information needed to complete documentation
26-40 Minutes: Review medications and check supplies. Call pharmacy, physician, and DME companies if needed. (this is a great way to build rapport)
41-55 Minutes: Start charting (even if only partially), review visit with family and answer any questions.
56-60 Minutes: Wrap up and remind patient/family of your next visit date/time.
Conclusion
Finally, if your goal is to have a long hospice nursing career then you’ll want to add these strategies hospice nurses frequently use to your daily routine. Remember, change takes time so start small and add a couple of these strategies at a time.
Before you know it, you’ll be feeling confident and have more time than you ever imagined.
To recap:
- Develop a Routine
- Document Properly (the first time)
- Don’t Waste Time
- Provide Patient-focused Care
- Learn the Hospice Rules & Regulations
Do you have any strategies for hospice nursing or insights to share? Leave them in the comments below. I’d love to hear from you. This will also help your fellow hospice nurse on their journey to a long career.