In a nutshell: I am an experienced hospice nurse and also a CHPN. I have an interview with a very small (0-19 patients/day, according to the stats on the national hospice locator website), just-starting-out hospice based out of a large, affluent LTC facility in a city 20 min. south of where we live. The job could be either part-time or contingent.

At the same time, I have a well established, medium-sized hospice (50-149 patients/day) that is affiliated with a large regional hospital system and is located about 20 minutes north of where we live calling and wanting to interview me for a contingent position that could eventually go full-time.

My gut tells me that the larger hospice with the solid backing of the hospital system would be more stable, but my husband and I are hoping to move back to the metro area where the other, much smaller and probably less stable hospice is located, possibly sometime in the next 2-4 years. I also don't know if I would ever want the hours of a full-time case manager.

Any thoughts on what you would do in this situation? I don't know a lot about the very small hospice, but I am slightly afraid that if they don't make it in this competitive business or their census drops and stays down, I will be looking for a job again, and I am really also looking for longevity with one company right now.

Hi Westieluv - Here we are again-lol. I would say there are pros and cons to both opportunities.

The new (start-up) hospice may offer opportunity for advancement for a nurse, like yourself, with hospice experience (plus your CHPN), into something like Director, Clinical Services or Administrator, if that's something that interests you. That would give you the opportunity for the longetivity piece. The cons (I've experienced), is the growing pains with little to no orientation, minimal policies and procedures for their particular hospice yet in place, a lot of room for error (in the eyes of immediate supervisor), depending on their individual preferences of how things should be decided vs. your independent thinking as well as a lot of turnover. Smaller hospice agencies tend to pay less and more likely to attract "new" hospice nurses who need a lot of initial guidance. Sometimes when they realize what they've gotten themselves into, they leave, creating a shift in assigned patients and turnover of nurses, which impacts the patient's continuum of care.

I always enjoyed case management (PRN or otherwise), knowing that there was always an in-patient unit possibility should the patient require it for intractable pain, out-of-control medication stabilization, family crisis, etc. I'm guessing that would be an opportunity with the large, hospital-based hospice. Sometimes distance, as you know, is irrevalant since we do so much driving anyway. With the larger hospice agencies, I find they have more fine-tuned territories, and nurses are not geographically, criss-crossing so much of the time. Also, a well-established hospice agency is doing something right, if their turnover is low. Maybe that means that the current case managers are happy!

I think it boils down to what you find happiness in doing. You seem to be gifted towards hospice nursing which equals patient satisfaction. So, your personal happiness is important. Good luck in your decision. I hope this helped in some sort of way! Take care!

Thanks for you reply. I don't want to get into specific details here on a public forum, but I interviewed for the small hospice last week and it is SMALL! Small, as in, their census had dropped to two patients recently and they don't have many more than that now. They already employ three nurses (can't imagine what they do all day!) so if I accepted this contingent position, I doubt if I would get any hours at all except covering on-call on the weekends, and I doubt if I would get any calls anyway! Oh, and they're located in a city with at least two huge hospice companies that have a lot of clout and get all of the referrals from all of the area hospitals. The only place this small hospice picks up patients is in the LTC facility where they are located, at least for now. It just seems too risky.

After discussing the situation with my husband in depth, we decided that it would either be one of these hospice jobs or another opportunity that I have to get back into acute inpatient nursing working for the internal agency of a large local healthcare system that I worked for for several years as a Med/Surg floor nurse before getting into hospice nursing. The hours are more stable, the pay is much better ( not that money is the most important thing, but my husband's job is kind of precarious right now so it has to matter), and most importantly to my husband, I wouldn't be out running around at night, especially in the winter on bad roads. Long story short, I accepted the inpatient position and will probably start next week. Hospice will always be a part of me, and I will probably go back to it someday, but for now, I like the idea of the flexability, premium pay, and lack of driving that the inpatient agency position affords me.