Here are some ideas that may be beneficial to those of you who are new visiting hospice nurses:
* Just before the week starts (I typically do this on a Sunday evening), create a rough plan (knowing that it will most likely change) for the week of whom you will see on what day in what order. Concerning what order, think of both the patient/family condition/needs and where everyone lives to you. In the best case, you can do a circle or a form of a horseshoe. Revisit this framework one to two times a day.
As part of the framework, if you know you must do something special or different (whether it be a recert visit, putting in a Foley, or discussing a given topic), make a note of it to help you remember.
* I recommend reaching out to your first two visits of the day to give them an ETA; as I head to my second visit, I'm calling the third family to give them a heads-up, and so on. I cannot stress how important it is to let the patient/family know about the visit days and give them a heads-up about when you will be there, if you are running late, etc.
* Case-by-case: Spend time with the patient and family to get to know them better before your assessment. Start your assessment conversationally (PQRST for pain, shortness of breath, N/V, other forms of discomfort) and what they do for it (which allows you to affirm/encourage, tweak, or start new). Then, do the actual physical assessment.
Always tell the patient/family what you will do next before you do it. I.e., I will typically say to the patient, “I'm going to listen to your heart, your lungs from the front, then your belly before I have you lean forward and listen to the lungs from the back” — now depending on the patient's AOX, mental status, etc. I only give pieces beforehand.
* Document in the home with potential exceptions for admission. This huge time saver will help your documentation be spot on. Remember to document what declines you see “as evidenced by” and comparative. For example, weight loss as evidenced by Left MUAC 18 compared to Left MUAC 22 on 10/25/2020.
* Educate as you document when you are able to kill two birds with one stone. Always document what specific type of education you provided. Take credit for education.
* Focus on one chief complaint/problem at a time regarding comfort. Sometimes, the patient/family will press for more; try not to take on more than 3, as one to two can be exceedingly tricky.
* Call in medication refills, new equipment orders, etc., while in the home; try to keep everything in its box/compartment when able.
* Be yourself, be open, and be as transparent as possible. Learn the difference between sympathy and empathy, and be very careful when you show sympathy, which can come across quickly.
Breathe and bloom!
I've been a hospice registered nurse case manager since April 2018, after a short break as an RN House Supervisor for a nursing home. I love the field. Please contact me if you have any questions or recommendations for doing anything differently or want to discuss your hospice experiences.
Equipment I use or recommend:
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