Chief Executive Officer at Re-Framed
As a former hospice nurse manager, I noticed two kinds of hospice nurses; the ones who loved hospice nursing and stayed and those who loved hospice nursing and left.
I knew longevity couldn’t only be attributed to passion since the anecdotal story of most hospice nurses is that their career choice is a calling. It also wasn’t all about being organized or efficient.
During routine ride alongs, I began studying habits that differed between nurses that were content in their hospice career and those that struggled.
I noticed the nurses who struggled in their roles had extended visits in the home. They were excellent problem solvers but seemed to lead the conversations.
Even after leaving, they verbalized they couldn’t stop thinking about the patient. Often, they didn’t feel comfortable or were too overwhelmed to start documentation in the home and acknowledged spending hours in the evenings completing their work instead of recovering for the next day.
The content nurses let the patients and families drive the visit and negotiated with them to ensure all their needs were met. Once the nurses met their patients’ needs and completed their required tasks, they had a clear and unapologetic wrap-up time to their workday.
Here are the five habits that set nurses apart in a short- or long-term hospice career.
Routines help hospice nurses ensure that they complete all the necessary tasks, even when a curve ball is thrown. It also helps them provide equitable care since the setting, culture, and caregiver relationship can vary from home to home.
The routine can include elements of a typical introduction, information gathering, the physical assessment, agreement of a plan, reconciling medications, ordering refills, checking supplies, and completing, at least, partial documentation.
In some cases, nurses will build their routines over time and others may follow the practice suggested to them by the hospice agency.
When nurses first meet their patients’ families, sometimes they will be introduced to a recommended routine and given their expectations. This orientation often sets the tone, boundaries, and expectations for all parties involved.
For a long-term hospice career, routine-building is essential.
Hospice nurses have required elements for every visit; however, the patient’s and family’s goals should always be met first.
Before nurses start their routine assessment, they will share developments from their last visit and any new concerns with the family; unaddressed problems can hinder the visit or learning experience.
Nurses who have a long-term hospice career never assume their patient or family members want intervention to the problem or concern. Sometimes, it was the patient’s and family’s desire only to discuss the issue.
If this step in the visit is undetermined or unclear, they will ask the family about their desired outcome before making any changes to the care plan. They were also honest about reasonable expectations.
Nurses with long-term hospice careers are comfortable with electronic medical record (EMR) systems.
Even if they don’t like it, they follow standard workflows and request additional education when needed.
They accept feedback and make corrections that are necessary for compliant documentation.
The end goal isn’t necessarily getting a high compliance rate, but more so, avoiding spending time re-doing it. Getting documentation right the first time takes some practice, but not letting it take significant time out of your shift pays off daily.
Long-term nurses in a hospice career know the business.
They understand hospice covered services, medications, and physician visits according to the patient’s benefit and their agency’s philosophy. If there is a decision to be made by the care team, the nurses communicate this information with the family and invite them to be a part of the meeting.
A general understanding of the hospice business can truly help a new nurse to answer questions quickly. Nurses with long-term hospice careers know that if they must stop and call a manager to answer questions, it not only takes more time, but risks losing the family’s confidence in them as a provider.
However, it is important to note that being transparent with the patient and their family is necessary, and if a nurse truly does not know the answer, it is imperative that they ask their superior rather than guessing.
Unless a nurse must attend a required face-to-face meeting, they typically steer clear of the office. When attending these face-to-face meetings, they have a plan to accomplish all their office goals simultaneously.
If nurses have office needs outside of a meeting day, they coordinate with other team members who might meet with them in the field.
While it is essential for these nurses to build good relationships with their team members, they typically focus on the opportunities for routine interactions that they would naturally have during the week.
According to the Hospice and Palliative Nurse Association, it takes at least six months before a new hospice nurse starts to feel proficient.
As with any manager, it was always in my best interest that hospice nurses achieve contentment and avoid burnout. I witnessed the emotional and physical toll it took to be a good hospice nurse, whether a struggling or content nurse.
I believe all hospice nurses can have a fulfilling career in hospice care by adopting these five habits that I have witnessed throughout my career.
If your organization has standard workflows and processes for you to follow, I urge you to take the time to understand and use them. If not, ask to have additional ride alongs with a long-term hospice nurse from whose experience you can learn.
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A B O U T T H E A U T H O R
Cathleen Adams is a freelance nurse writer and clinical consultant. Cathleen brings more than 20 years of clinical experience and was certified as a Hospice and Palliative Care Administrator, Hospice and Palliative Nurse, and Executive Nurse Practice. She worked in virtually all areas of hospice clinical management and has worked as the Chief Nursing Officer at Care Partners In Asheville, NC, the Chief Operating Officer at Midwest Care Center in Glenview, IL, and executive director of VistaCare in Temple, Texas. Cathleen has had responsibilities for various patient care services, such as admissions, direct patient care, education and outreach, compliance, and care coordination. She also is a curriculum trainer in end-of-life nursing education.
Ms. Adams has a Bachelor of Science in Nursing (BSN) from the University of Mary Hardin-Baylor in Belton, Texas. She completed her master’s in business administration at Lake Forest Graduate School of Management. She was also is a Captain in the U.S. Army Nurse Corps.
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