As a hospice nurse manager, I've observed two distinct types of hospice nurses: those who thrive in their roles and those who struggle. It's clear that longevity in this field isn't solely about passion. Many hospice nurses feel called to this work, yet not all stay. I realized that organizational skills alone don’t determine success. Through routine ride-alongs, I began to identify the habits that set content nurses apart from those who found the role overwhelming.

Understanding the Differences

The nurses who struggled often had extended visits in patients' homes. They were excellent problem solvers, but they tended to dominate conversations. Even after leaving a visit, they couldn’t stop thinking about their patients. Many expressed feeling overwhelmed and uncomfortable starting documentation in the home, leading to hours of work in the evenings instead of time to recharge for the next day.

In contrast, the content nurses allowed patients and families to guide the visit. They negotiated to ensure that both the patients' needs and the hospice's requirements were met. Once they fulfilled their patients' needs and completed necessary tasks, they had a clear and unapologetic wrap-up time for their workday.

Everyday Habits of Successful Hospice Nurses

Here are some everyday habits that distinguish long-term hospice nurses from their peers.

They Built Routines

Routines are vital. They help nurses complete necessary tasks, even when unexpected challenges arise. A consistent routine also ensures equitable care, as each home presents different settings, cultures, and caregiver relationships.

A typical routine might include:

• A warm introduction

• Gathering information

• Conducting a physical assessment

• Agreeing on a care plan

• Reconciling medications

• Ordering refills

• Checking supplies

• Completing at least partial documentation

  
  

Some nurses develop their routines over time, while others adopt practices suggested by their hospice agency. When meeting families for the first time, they introduce their routine and explain what to expect in future visits. This orientation helps set the tone, establish boundaries, and clarify expectations for everyone involved.

They Let the Patient and Family Drive the Care

While nurses have required elements for every visit, they understand the importance of prioritizing the patient’s and family’s goals. Before starting their assessments, they engage with families about developments since the last visit and any new concerns. They recognize that unaddressed issues can hinder effective communication and progress during the visit.

Nurses never assume that patients or families want interventions for every problem. Sometimes, they simply wish to discuss their concerns. If the desired outcome isn’t clear, they ask families about their goals before making any adjustments to the care plan. They also maintain honesty about what is reasonable to expect.

They Were Masters of the Electronic Medical Record

Content nurses are comfortable with electronic medical records (EMRs). Comfort is different from enjoyment, but they know the importance of following standard workflows. Even if they dislike the system, they seek additional education when needed. They accept feedback and make necessary corrections to ensure compliant documentation.

The goal isn’t just high compliance rates; it’s about avoiding the time-consuming do-overs that can add stress to their day. Getting it right the first time takes practice, but it pays off daily.

They Knew the Business of Hospice

Long-term nurses understand the hospice business. They know what services, medications, and physician visits are covered according to the patient’s benefits and their agency's philosophy. When decisions need to be made by the care team, they inform families about when they will discuss matters with the team and invite them to participate in those meetings.

This knowledge allows nurses to answer questions quickly. If they need to call a manager for answers, it consumes valuable time and risks losing the family's confidence.

They Stayed Out of the Office

Successful nurses minimize time spent in the office. Unless attending required face-to-face meetings, they focus on patient care. When they do have meetings, they plan to accomplish all their office-related tasks simultaneously. If they have office needs outside of meeting days, they coordinate with team members who can assist them in the field.

Building strong relationships with team members is essential, but these nurses prioritize opportunities for routine interactions throughout the week.

The Importance of Longevity in Hospice Nursing

According to the Hospice and Palliative Nurse Association, it takes at least six months for a new hospice nurse to feel proficient. As a manager, it’s in my best interest for hospice nurses to achieve contentment and avoid burnout. I’ve witnessed the emotional and physical toll it takes to be a good hospice nurse, whether struggling or thriving.

I believe that all hospice nurses can enjoy long and fulfilling careers by adopting the habits that experienced nurses have cultivated over time.

Encouragement for New Nurses

If your organization has standard workflows and processes, take the time to understand and utilize them. If not, seek additional ride-alongs with long-term hospice nurses from whom you can learn.

Remember, you are not alone in this journey. Embrace the opportunity to grow and develop your skills. Each visit is a chance to make a difference in someone’s life.

Conclusion

In conclusion, the habits of successful hospice nurses are not just about individual skills; they reflect a commitment to patient-centered care. By focusing on routines, engaging families, mastering documentation, understanding the business, and minimizing office distractions, you can thrive in this rewarding field.

Let’s work together to ensure that every hospice nurse can find fulfillment in their role.

Bibliography

1) Candidate Handbook Certified Hospice and Palliative Nurse, 12/21 edition, The Hospice and Palliative Credentialing Center