Interested in an easy few years of hospice nursing before retirement? Think again.
Often when I interview nurses wanting to work at our hospice inpatient unit, they tell me that they are looking for a “change”. We discuss their need for a fulfilling career that allows them to care for patients as people and ensure their patient’s final days are comfortable. Many of the applicants assume that hospice will be easier than their current job in the ER, ICU and/or Medical/Surgical units. It’s almost as if they are looking to move into a position where they can relax and retire. That’s when I paint the picture of what a day in the life is for our highly skilled and compassionate inpatient hospice nurses. And, let’s just say, the perception and reality of hospice care nursing aren’t as similar as you might think.
As healthcare regulation changes, so does the landscape of healthcare delivery in all venues. Hospital acuities are changing to where Medical/Surgical patients are more like ICU patients. Surgical patients are going home the same day as their surgeries, and diagnosis-related groups are driving quicker treatment and discharge of patients. This is the case throughout healthcare where patients are more acute than before and everyone is being forced to do more with less. The reimbursement for healthcare services continues to decline, and scrutiny of all is on the rise. Hospice is no different - Taking on more difficult patient cases while receiving decreased reimbursement. We might all still be playing the same game, but the rules are changing quickly on us with each passing day.
Our hospice inpatient unit prides itself on meeting our patients and families where they are to ensure their wishes are fulfilled. At times this means utilizing interventions that are more complex, intensive, and require a higher clinical skill level than before. These interventions are not considered typical hospice interventions. For example, the patient who wants to remain on a ventilator until they feel ready to remove it or a patient in excruciating pain experiencing uncontrolled agitation and requiring multiple lines with medications previously used to sedate horses. We are seeing more tube feeding, wound vacs, TPN, left ventricular assist devices (LVAD’s) and complex medication regimens than ever before. Our nurses are masterminds at medication calculations, symptom management, and even juggling cats. Well, maybe not the cats, but it sure seems like it when you are managing six terminally ill patients all with symptoms out of control that 10 years ago would place them in the ICU until they died. In the past, hospice never would have been thought of as the logical option for these patients.
Why do we do it?
We are committed to doing what is right by our patients. We are committed to caring for everyone and honoring their wishes, even the ones who want to have interventions that hospice normally would shy away from. In turn, this makes hospice care more complex and intensive than ever before. That isn’t exactly what I think of when I think of retirement. Personally, I would like to be on a beach enjoying some peace and relaxation. If you’re interested in finishing your nursing career in hospice, you should know that hospice nursing is a noble profession that will challenge your intellect, skill set, and organization and critical thinking all while respecting patient wishes and making for a peaceful passing. Healthcare is constantly changing and hospice sure isn’t an exception to this change.
We will continue to look at our patients and ask “Why can’t we do that?” It is our privilege and responsibility to meet our patients where they are and it is important to know that hospice nursing is not a profession to retire in, but rather a profession to aspire to. The fact of the matter is, our patients deserve it.
Stacey Stafford RN MSN OCN CHPN
Inpatient Care Center Manager
The Denver Hospice | Optio Health Services