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Have you ever wondered what those nurses who always seem happy have going for them that you don’t? You might be surprised at how simple it really is. What successful hospice nurses know that you don’t!
After years of working as a nurse, I want to share 40 tips and secrets of highly successful hospice nurses. It’s not as hard to be happy as you might think!
When I first started as a registered nurse, my goal was to just make it through my 12 hour shift without hurting anyone.
Honestly, I kept my daughter’s picture on my nursing cart to remind me that I could not quit. Most days, I wanted to get back on the elevator before my shift even started.
Now, I feel confident when I walk out the door because I implemented these simple habits into my daily routine and so can you.
Organization Tips & Secrets
1. Organize Your Trunk
To start, if you are not organized, you will always feel overwhelmed and you won’t be able to enjoy this wonderful job.
This does not just mean organizing your paperwork and patient load, this also means organizing your car and supplies.
Keeping up with what is required to meet your patients needs, makes everything just a little less stressful.
2. Keep Extra Supplies
As a general rule, you will inevitably walk into a situation where your patient is out of supplies or has developed a new wound.
You should have extra supplies for situations like these. It will save you time and help meet the needs of your patients.
Common supplies include dressings, diapers, wipes, and gloves.
If you’re lucky, you work with hospice nurses who stays stocked up and can bail you out in a pinch.
You can find a full list of supplies by downloading the Hospice Nurse Hero trunk checklist.
Successful hospice nurses are organized and use cheat sheets and checklist to stay on top of their game.
3. Store a back up uniform in your car
Have you ever spilled coffee on your shirt before work? This can be a real bummer. I spilled blood on my scrubs one time and had to go borrow a pair from the surgery department.
My point, accidents can happen.
If you are a hospice nurse, you could be miles from home and if you have an incident where your uniform is soiled, you will need to have a back up handy.
4. Document at the Bedside
Let’s just keep it real. I know that you don’t really want to hear this.
If you are like some nurses, the thought of documenting in front of the patient is absolutely appalling.
Well, in my opinion, it is more frustrating to document for hours when I get home.
I’d much rather spend my time at home binging CSI Miami or Chopped.
If you can help it, avoid this common mistake. Successful hospice nurses document as much as they can in real time.
5. Invest in a notebook
Sometimes you won’t have access to internet and will need to make notes about your visit. In these cases, it is a good idea to have a notebook to jot down your assessment.
6. Schedule your last patient closest to your home
Some nurses may disagree and I am ok with this. My opinion is that it is nice to be close to home at the end of the day.
Personal Safety Tips
7. Use GPS
True story… One time I was going visit a patient who lived near a forest preservation area and my GPS told me to “get out and walk, the destination is on your left.” YIKES!!
I learned to keep GPS and my phone to make sure I wasn’t wasting time driving in circles.
One word of advice: some areas don’t have services and you might just be out of luck.
8. Use Bluetooth
Practice safety.
If your car does not come equipped with Bluetooth, invest in a good Bluetooth headset or earpiece.
You can use your drive time to call doctors and pharmacies so make sure you are hands free and safe!
9. Carry an emergency kit in your car
My #1 recommendation is to have an portable jump starter at all times. This is way better than having jumper cables because you don’t need another vehicle to help you get going again. This seems so simple but when you’re in the county, you could be waiting a long time for someone to come rescue you.
Believe it or not, I have had to pull out my portable jumpers on more than one occasion. They are easy to use and I love them.
10. Always have a spare tire
It doesn’t do you any good to call a tow truck if you don’t have a spare tire. Even if you can’t fix a flat, you can bet someone passing by does.
The most successful hospice nurses know that you don’t leave things like safety to chance.
11. Keep valuables out of site
Your car is a target for shady people. That’s just the way it is. Keep valuables in the trunk and don’t leave your computer, tablet, phone, or back pack in plain sight.
12. Avoid hospice magnets on your vehicle
Again, your car is a target for shady people. Not all neighborhoods are created equal.
For whatever reason, people think hospice nurses carry drugs on them.
If you’re in a tough neighborhood, you might get flagged as an easy mark so don’t advertise your hospice on your car. Leave the marketing to the marketers in this case.
13. Wear your name badge
So you might think the reason for this is patient related. Well, it’s not.
If you’re driving all day, you might find that you encounter small towns and speed traps. If you get pulled over and you have your badge on, you are more likely to get a pass from the friendly neighborhood police officer.
I am not sure if I am supposed to say this out loud, but truth is truth!
Communication Tips
14. Don’t give out your personal cell phone number
This goes back to professional boundaries. Sometimes, patients will have your number because you’ve called them to confirm their appointments.
Try to explain to the patient that if they call your personal number in an emergency, they may not reach you.
Encourage them to use the emergency or after hours phone number.
I have had patients pass away and call their RN case manager only to be frustrated when they didn’t get a call back. This is unfortunate and preventable.
15. Know the pharmacy hours in your coverage area
This is a life saver tip!! Working in rural areas, I noticed that I would go to admit a patient only to find out that the local pharmacy had already closed.
Many pharmacies have limited hours so make sure your know your options.
Successful hospice nurses know that you don’t want to be caught without medicine for symptom management.
16. Order the comfort kit for new admissions
Don’t be that nurse whose patients never have what they need. Just ask the on-call nurse who goes out at 2am to check on your patient.
Nothing is more frustrating than watching a patient suffer in pain because their nurse did not order comfort medications.
Teamwork Tips
17. Communicate with your team
Give report!!! I’ve always been disappointed in how some nurses don’t feel the need to communicate or do a proper hand off of their patients. For instance, if your patient is actively dying, give the on call nurse a heads up!
18. Attend events with the volunteers
Hospice has many joys and one of them is watching the volunteers interact and support patients and their families.
If your volunteers are hosting an ice cream social or caroling, try to show up. It makes the volunteers feel appreciated and your spirits will be lifted as well.
19. Find a go-to person
This does NOT need to be your preceptor. Find someone who is experienced and open to receiving your calls. If you have a weird situation come up, you will feel less anxious if you have a go-to person.
20. Use backup when needed
While you might be able to handle most situations on your own, you might occasionally need back up.
For instance, if you are working in the NH and can time it at the same time as your nurse assistant, it might be easier to check out wounds and examine the patient.
If you are dealing with a difficult family situation, take a social worker with you the the visit.
21. Get to know IDG members and roles
The IDG is part of the team and will help you keep your sanity if you use them properly. Spend time shadowing them and take advantage of their unique expertise.
22. Take a class on drug conversions
One question that I get a lot is do you need to be good at math to be a nurse. My answer is always YES!
As a hospice nurse, you will need to be good at drug conversions. For instance, you patient may need to be switched from oxycontin to morphine.
If you haven’t done conversions in a while, it might be a good idea to brush up on your skills.
Self-Care Tips & Secrets
23. Keep healthy snacks in your car
You will be in your car a lot.
Try to keep items such as nuts, fruits, granola bars, or other non-perishable snacks handy.
If no one told you this, your car will be your new lunch room. Now you know.
24. Invest in a good insulated water bottle
I’m smiling as I write this because I used to swear by my daily 32oz gas station Polar Pop. (You know who you are!)
Nowadays, I am loving Hydro Flask because it is insulated and doesn’t leak on hot days.
25. Take advantage of your time on orientation
If you need more time on orientation ask for it.
Hospice is complex and you will be managing multiple co-morbidities.
If you are still confused on documentation, ask for help.
The only way for your supervisor to know that you are struggling is for you to ask for help.
26. Learn to say NO
Nurses have a tendency to neglect themselves and to put others first.
However, if you want to avoid burnout you will need to say no from time to time.
If you keep accepting extra patients and extra on-call, you risk getting overwhelmed.
27. Take care of yourself
Practice self-care and take time away. Working with terminally ill patients can be taxing and mentally exhausting.
Also, try to remember your why.
28. Allow yourself to grieve
Losing a patient can be sad. Allow yourself time to grieve and know that it is ok to miss your patient. You don’t have to attend every funeral either.
29. Invest in comfortable shoes
Take it from someone with plantar fasciitis. Your feet are as important as your hands as a nurse.
Invest in shoes that offer support and are comfortable.
Nursing shoes should be replaced twice a year or every 500 miles.
As someone who suffers from plantar fasciitis, I believe in good shoes and compression socks.
Nurses are on their feet for long periods of time and it is not unusual for them to complain of tired legs, swelling, and varicose veins.
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So, in addition to good shoes, don’t forget to wear good compression socks.
30. Know what is on your company’s formulary
Try to understand what your company does and does not pay for. You will be happy that you did.
By this, I mean if your agency doesn’t cover trilogy machines, don’t tell the nursing home they do. You risk disappointing the patient, family, and facility.
Hospice Nursing 101
31. Brush up on wound care
Sadly, hospice patients can end up with a lot of wounds due to immobility and poor nutrition. Brush up on wound care and supplies.
32. Carry rubber bands
Not everyone lives in clean pristine homes. It is not your place to judge. Rubber bands can be used to prevent critters (roaches) from traveling in your pants.
33. Make friends in the nursing home
Similarly, to being a guest in someone’s home, you are a guest in the nursing home as well. Hospice nurses do not take the place of nursing home staff.
Also, remember that the facility staff is like family and if you wouldn’t say it in front of the family, don’t say it in from of the nursing home staff.
34. Utilize critical thinking skills
Unlike the inpatient setting, hospice nurses are often alone in the home. It is imperative that you utilize good judgment and critical thinking skills. This is one of the exciting aspects of hospice. You get to take care of a variety of patients with various issues. You can tap into the different specialties that you learned about in school.
35. Program your phone with frequently used numbers
I think this speaks for itself. Your pharmacy and DME vendors are two numbers that should be in your phone.
Other numbers that might come in handy are the supervisor, chaplain, and social worker.
36. Know the fax numbers of pharmacies that you frequently use
Granted a lot of physicians are using e-scripts so this is not always an issue. However, there are still a fair number of physicians that are still faxing scripts from their office.
You will make friends in the office if you can provide them with the pharmacy fax number and they don’t have to look it up.
37. Have facts ready when calling the doctor
Remember back in nursing school you learned SBAR? Well it applies to hospice as well. Use SBAR to communicate with the physician.
Situation: Your name and the problem
Background: Diagnosis, pertinent history, current plan, and any changes noted
Assessment: VS, Pain, Wound and other pertinent facts
Recommendation: State what you are asking for
38. Call your supervisor if you need help rescheduling patients
Don’t be a martyr. If you get tied up with a patient, ask for help rescheduling your patients. One complaint that I used to get a lot is that family members did not like waiting around only to have the nurse not show up.
39. Call your patients and give them an ETA
Similar to the point above, no one likes just waiting around. It’s kind of like waiting on the cable company all day. To be blunt, just call your patients ahead of time to let them know when you will be arriving.
40. Get into the moment
Most importantly, get into the moment with your patient and your families. It is an honor to care for people during this very fragile time. Don’t miss the beauty because you are too busy worrying about the next task you have on your schedule.
Conclusion
Finally, hospice nursing is the most rewarding job I’ve ever had. By learning to adopt these 40 principles, I have been able to enjoy the ride and my hope is that you will too.
There are many resources available to help you be a successful hospice nurse. If you have other tips that you think nurses should know, please share them in the comment below.