Tips for new Hospice Registered Nurse Case Managers

Published on February 11, 2021

Updated on December 25, 2023

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. In relation to what order, think of both the patient/family condition/needs and in relation to 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/different (whether it be a recert visit, put in a Foley, discuss a given topic), make note of it to help you remember.

* I recommend reaching out to your first two visits of the day to give them an ETA; from there, as I head to my second visit, I'm calling the 3rd 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 to give them a heads up as to when you will be there, if you are running late, etc.

* Case-by-case: try to spend time with the patient and family to get to know them more before your assessment. Start your assessment conversationally (PQRST for pain, and , N/V, other forms of ) as well as to what they are doing for it (which gives you the opportunity to affirm/encourage, tweak or start new). Then do the actual physical assessment.

Always tell the patient/family what you are going to do next before you do it. I.e. I will typically tell 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 is a huge time saver and will help your documentation be spot on. Remember to document what declines you are seeing “as evidenced by” as well as comparative. I.e. Weight loss as evidenced by Left MUAC 18 compared to Left MUAC 22 on 10/25/2020.

* Educate as you document when able to kill two birds with one stone. Always document that you provided what specific type of education. Take credit for education.

* Focus on one chief complaint/problem at a time when it comes to comfort. Sometimes the patient/family will press for more; try not to take on more than 3 as one to two can be exceedingly difficult.

* Call in medication refills, new equipment orders, etc. while in the home; try to keep everything in its own 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 are showing sympathy which can come across wrong fast.

  • Breathe and bloom!

I've been a hospice registered nurse case manager since April 2018, having a short break as an RN House Supervisor for a nursing home, and love the field. Please feel free to reach out to me if you have any questions, recommendations for doing anything differently, or just want to talk about your hospice experiences.

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