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A Day in the Life of a Hospice Nurse- What do Hospice Nurses do?
Have you ever wondered what it is that hospice nurses actually do?
Before I became a hospice nurse, I was curious as to what a day in their life would look like. I scoured the internet, but I couldn’t find much information on what it was like to be a hospice nurse.
So, now that I am a hospice nurse, I figured I would run through what a day (rather, a night) in the life of a hospice nurse looks like!
As a hospice nurse I take care of patients who have a terminal illness and who have been given a prognosis of less than 6 months to live.
Patients will vary with how long they have to live-it could be days to months. But the basic care that we provide for our patients does not change and our goal remains the same. Our goal is to keep patients comfortable so they can enjoy their final moments here on Earth.
I work in a hospice inpatient center which is different from home health hospice, but the patient population is still the same.
As a hospice nurse that works at an inpatient center, I assume care of up to 6 patients for a 12-hour shift. Typically, I have a patient load of 2-4 patients but the census at our facility varies day to day.
The acuity of the patients varies, but we typically have a mix of patients that are days away from death and patients who will likely live for a few more weeks or months and who will be transferred to their residence.
Before Work
I typically wake up around 1-3 PM in the evening before I go to work.
I don’t do too much before I go to work, but I do like to clean up the apartment, spend some time with my son, and eat dinner with my family before I have to head out.
The shift starts at 7:00, so I usually arrive around 6:50 so I can get my things settled. Report starts at 7:00, so I only get there a few minutes ahead since we can’t start report any earlier than 7:00.
Narcotic Count
The first thing we do in our shift is the narcotic count. For the narcotic shift count, two nurses count the narcotics that were used during the previous shift to ensure there are no discrepancies. This narcotic count takes place before every shift.
This usually takes around 5-15 depending on how many patients are at the facility and how many narcotics were administered in the previous shift.
Group Report
Next up is report. At the facility I work we do group report, so the oncoming nurses get report on all the patients and then we make patient assignments after we get report. We make assignments based on acuity and required documentation.
Report usually takes anywhere from 10-30 minutes depending on how many patients are at the facility and how involved they are.
First Round
Once assignments are made, I like to just pop in and introduce myself to my patients and their families. I don’t do a head-to-toe assessment yet, I just simply take this time to introduce myself and
We only do vital signs once a shift and our awesome CNAs get vital signs on our patients while we work on verifying our MARs.
Verify MAR
The facility I work at uses paper MARs, so we do not have an eMAR. For this reason, we must verify that our MARs are up to date and correct according to the physician’s orders.
I go through each MAR and ensure there are no inconsistencies.
Once the MARs have been verified, then I can move on to preparing meds.
Medications
Most of our patients will have scheduled medications and their first med pass is at 2100 on the night shift.
The policy at my facility is that patients should receive their 2100 medications anywhere from 2030-2130. It is my priority to ensure that medications are administered within this window.
Our patients rely on us to administer pain medications on schedule so that they don’t end up with breakthrough pain.
Assessment
Whenever I am in the patient’s room administering their medications, I will do a head-to-toe assessment.
In hospice, we are assessing for signs of improvement or signs of decline.
If a patient starts to improve and we get them on a good medication regimen, then they will be discharged from our facility and can return to their residence.
If a patient starts to decline or “transition” and we feel their death is imminent, then the patient will likely stay at our facility and we will care for them until they pass.
Some of the signs and symptoms that I assess for that indicate a patient is declining are as follows:
- Terminal secretions; “gurgling”
- Terminal fever
- Terminal restlessness
- Mottling
- Increased pain
- Faint radial and pedal pulses
- Shortness of breath, periods of apnea
- Decreased urine output
Based on assessment data, it may be necessary to administer other medications.
For instance, if a patient is experiencing terminal secretions, then I would administer a dose of Levsin.
We continually assess our patients throughout the shift in order to ensure they are comfortable and free of excess pain, anxiety, restlessness, or shortness of breath.
Charting
Once meds have been administered and the patients begin to settle, then it is time to begin charting.
Charting is a task that is done throughout every shift.
“If you didn’t chart it, you didn’t do it!”
We are required to document hourly encounters for each patient. It is very important that we accurately document the times we were in the patients’ room and the care that was given to the patient.
In hospice, we have quite strict charting guidelines, so it’s really important to have accurate documentation
Activities of Daily Living, Hygiene, etc.
The majority of the patients admitted to the inpatient facility do require moderate to total assistance with activities of daily living.
For this reason, we spend a lot of time performing tasks such as turning and repositioning, changing briefs, providing bed baths, performing oral care, etc.
If pain is a large problem for a patient, then the nurses will premedicate the patient with pain medicine before attempting to turn and reposition or provide a bed bath.
Post-mortem Care
Whenever a patient dies at the facility, the first thing that we do is inform family if family is not present. The family is welcome to come visit the patient if they choose to do so.
If the family is present at the facility, then once the family is ready, we will provide post-mortem care.
This includes freshening up the patient by ensuring their brief is not soiled and lightly cleaning the patient’s body with some cleansing wipes. If there are IV sites in place, then we will remove them.
Some invasive items such as Foley catheters, chest tubes, NG tubes, etc. are left intact due to bodily fluids that often will leak after death. Keeping these items in will prevent such leaking from occurring.
Once the patient has been cleaned up, then we do a little ceremony for the family. We simply read a poem for the family and offer our condolences.
The family is usually given up to an hour or two if they need it, and then once the family is ready the funeral home is called.
The funeral home then comes within an hour to pick up the body.
End of Shift
The oncoming shift arrives around 7:00 AM to relieve the night shift.
Again, narcotic count and group report is completed.
In report we want to inform the oncoming shift of any new developments and any PRN medications that the patient required throughout the night.
Then it is out the door to head home to my comfy comfy bed!
That’s gonna be it for this one!
I hope you learned something new about hospice after reading this post.
If you want to read more about hospice, then check out these other posts I wrote.
Until next time,
Happy Nursing!