So you decided to make the leap to hospice and now you are wondering if you made the right decision. You are not alone! I will share tips and tricks that will help you survive your first year as a hospice nurse. I can’t promise that it will get easier but I can guarantee you that you will get more confident over time.
If you stick with me, I will spill the tea and help you navigate this crazy world of hospice nursing.
Since you are here, there’s a good chance that you have found your calling in hospice but are struggling to understand all of the nuisances of hospice care management. Believe me, I’ve been in your shoes and wondered how I was going to get it all done.
There are a few lessons that you just can’t learn from the textbook.
To be honest, you won’t even learn some of this from your preceptor. That’s because hospice orientation can be disorganized.
You never know what is going to happen during the day. For instance, if you have a patient that is actively dying, you may not be able to leave the bedside and your whole day may change.
Hospice Nurse Survival Guide
Organization and Supplies
Organize your trunk.
One of the first things I realized when I started as a home hospice nurse was that my trunk was going to have to double as a supply closet. If I was going to survive as a hospice nurse, I had to get my car organized.
Hopefully, you work for a hospice that orders supplies from a vendor and then drop ships them to the patient. However, this is not always the case.
Even if they do allow you to ship supplies to your patient, you should make sure that your car and trunk are organized so that you have the supplies you need, when you need them.
If you are like most nurses, you have a family and need to access your trunk for groceries, backpacks, soccer, and other sports equipment.
(Personally, I store my shopping and antique hoards in my trunk.) SHHH…
Honesty is the first step to recovery. 🙂
Now back to you. There are several ways to organize your car and trunk so do what works best for you.
I found that totes are great because you can transfer them from your trunk to the garage or house when you are not working.
Expert Tip: Invest in a couple of totes and a 3 drawer plastic cart.
Keep back up supplies.
Again, I can’t stress this enough. You should keep extra supplies in your trunk. No, I am not saying that you should go around hoarding a bunch of supplies. As a manager, the hoarders always made me cringe! Mostly because I would inevitably find expired supplies and this is a no-no.
Hospice nurses work a variety of hours and can get called out in the middle of the night. As a result, they can encounter situations where the patient does not have the supplies needed to address their needs.
For instance, if your patient has a leaky catheter it is nice to have one in your trunk. Otherwise, you might be pulling the catheter and coming back the next day to replace it.
It is beneficial for hospice nurses to get and stay organized. You can use a trunk organization checklist to help make sure you have what you need without worrying about running out of supplies.
To help nurses out, most agencies will allow you to have “car stock.” So what exactly is car stock? Typically, car stock items are supplies used to meet the basic care needs of the patient. This includes items like Foley catheters, adult diapers, wipes, gloves, and wound supplies. This is not an all-inclusive list. You should consult with your agency to ensure that you are following their recommended guidelines and formulary.
Expert Tip: Keep a backup uniform in your trunk just in case yours gets soiled.
Document at the Bedside
If you have read any of my other posts, you have heard me say to document at the bedside. At the risk of sounding like a broken record, I will say it again. You should get into the habit of documenting routine visits while you are still at the patient’s home. Not documenting at the bedside is a common mistake that hospice nurses make.
Some people might suggest that you go down the road and document so that the patient and family aren’t uncomfortable. Here’s the truth, in most instances, the only person uncomfortable is YOU! I know that is a hard pill to swallow but I’m not going to sugar coat it just so your feelings aren’t hurt.
First, you should absolutely spend the initial portion of your visit with the patient. The average routine visit lasts about 45 minutes to an hour so plan to spend the first 30 minutes focused solely on your patient. This one tip alone will help you survive as a hospice nurse.
Then explain that you want to open the chart to make sure that you didn’t miss anything. If you are down the road, you can’t ask questions that you missed during the visit. You can typically use this time to order supplies, refill medications and make sure that your patients have what they need.
Families like it when they see you working hard for their loved ones. This was one of my secrets to keeping the after-hours calls at a minimum with my patients. Your co-workers will thank you!
Oh, did I say document at the bedside!
Have a Go-To Person
Just when you think you’ve seen it all, you will have an encounter that trips you up. From family drama to Kennedy ulcers there is never a dull moment in hospice.
When it comes to the unexpected, it is nice to have a go-to person to reach out to for advice.
This doesn’t necessarily need to be your preceptor. I suggest that you connect with someone who is knowledgeable and easy to work with.
When I started nursing, my mentor was around my age and easy to relate to. She took me under her wings and it made it a lot easier to ask questions without feeling stupid.
Utilize Your Team
End-of-life care is complex. You won’t survive your first year as a hospice nurse if you don’t work well with your interdisciplinary group (IDG). Hospice patients need a lot more than nursing care and medications.
Thankfully, there is a whole team available to care for the patient’s needs. For instance, if you find that there is a lot of drama (there usually is at the end-of-life), you should involve the social worker.
Furthermore, there are chaplains for spiritual needs and volunteers that can help support the family and caregivers.
My point is that you don’t have to do everything. I understand that you’re a superhero but you will NEVER make it alone! You should get to know the members of the interdisciplinary group and utilize them appropriately and as often as you need to.
Keep Healthy Snacks Handy
Hospice days can get long and it is not unusual to get behind. Remember earlier I said that your car will be your breakroom. I wasn’t kidding!
You will spend a big chunk of your day behind the wheel of your car. This can take a toll on your diet if you are depending on fast food and gas stations to sustain you.
Invest in a good lunch box, Ziplock bags, and some healthy snacks that you can eat on the run.
On the same note, stay hydrated. Although I love a good diet Coke Polar Pop (don’t judge), yet I know that I can’t do that every day. A great alternative is using your favorite water bottle and filling it up before you leave the house.
Personally, I love Hydro Flask because it can hold 40oz and it comes in so many cute colors. It’s easy to fit ice into it and it’s insulated so I don’t have to worry about it sweating and making a mess during the warmer months.
Take Care of Yourself
Nurses do a horrible job of taking care of themselves. Learn to say NO.
As a new hospice nurse, you are trying to prove that you have what it takes to make it and that you are a team player. This is ok as long as you remember that you can’t pick up everybody’s call all of the time. If your caseload is getting out of control, ask for help.
Hospice is not different than any other field of nursing.
If you don’t speak up, you will get dumped on and you will not survive as a hospice nurse. If you are the easy-going nurse that always says yes, you will always get the calls.
Additionally, patients will die and this can be sad. Make sure that you are taking care of yourself and applying therapeutic coping techniques. Spend time with your family and friends and always remember why you became a hospice nurse in the first place.
Summary
Being a hospice nurse is challenging. So if you want to go from just surviving to thriving, you will need to learn the secrets that resilient hospice nurses already know.
Organization and communication are key elements to becoming a successful hospice nurse. Utilize your team and take care of yourself.
It sounds simple however, many nurses get burned out because they don’t apply these principles to their everyday practice.