[MT RN]

I am thinking of applying for a hospice position. My local hospice has two large inpatient facilities, and I am wondering what the staffing is like in such facilities.

In other words, are they generally run like a hospital floor with several RN's and a set patient assignment, or are they more like a ALF with one RN responsible for a very large group of patients?

[debbers]

Our unit is small, with a small pt load. On day shift each nurse has apprx 4 pts. On night shift we have apprx 6-8 pts. It is wonderful, as there is time for family along with time to adequately meet the needs of the pt.

[HospicePalliativeRN]

In my area, there is currently one inpatient hospice unit with 12 beds. Because the census fluctuates often, it only employs a small core of FT & PT staff members and relies on a larger pool of per diem nurses to help fill the holes. The unit is staffed according to census and acuity, but there are typically 2 RNs and 2 CNAs on each shift. If the census is low (<6 patients) and the acuity is not high (this doesn't occur often), the unit may only have one FT/PT RN and 2 CNAs on the unit and the per diem RN who was scheduled for that shift goes on call in case admissions start to roll in the door.

Please don't be mislead by thinking that having a small patient assignment of 4-6 patients is an easy tasks. The acuity of inpatient hospice units is usually quite high, as many of the admits are d/t pain and other symptoms that are unable to be controlled/managed at home. These patients arrive in a crisis state, and family members are often having many issues themselves, so there is a lot of work involved medically, psychologically, emotionally, & spiritually. In fact, the manager of the inpatient hospice unit in most cases will not hire RNs to full-time positions on the unit because she has found that 40 hrs/wk has often led to staff nurse burnout (mostly mentally/emotionally) in a short period of time, which then results in increased turnover.

My best advice would be to get in contact with the nurse managers of the two inpatient facilities in your area and find out more about the units. I would also suggest asking if you could "shadow" one of the more seasoned staff nurses for a few hours on each unit to get a better idea of what an inpatient hospice unit is like. I think this is important, because nurses may find out the duties, patient/family issues, etc. are not what they imagine them to be in their minds. It is better to know what the work is going to be like before being accepting a position.

[ginger58]

Originally Posted by HospicePalliativeRN

I think this (shadowing) is important, because nurses may find out the duties, patient/family issues, etc. are not what they imagine them to be in their minds. It is better to know what the work is going to be like before being accepting a position.

Very good point. I worked in a Palliative Care/acute medical floor in CA. Although I could have five patients max, the end of life patient took most of my time (and gladly spent time). I had to be sure of their comfort, help the family cope--there's more to their care than one thinks. Anyone who thinks an end of life patient is easy hasn't done it.

[MT RN]

Thanks for the info HospicePalliativeRN. And the reasons that you state are exactly why I am interested in Hospice to begin with. Working med-surg I never feel that I have enough time to give the patients all of the care that they deserve, and I am looking for a nursing specialty that might answer that need.

I have seen the wonderful work that hospice does many times over the years with various family and friends that were under the care of hospice. I also spent a few days shadowing a visiting hospice nurse while in nursing school.

I really don't feel that I want to do the visiting nurse aspect, but the inpatient facility sounds interesting. The reason behind my original question was to get an idea as to where these units stand regarding nurse-patient ratios. Don't get me wrong, I'm a very hard worker and I love being busy at work, it helps the time go faster. I am just tired of being so overwhelmingly busy that I seem to never have time to stop, and going home every day with the feeling that my patients didn't get all of the care that they deserved because I simply didn't have the time to provide it.

All of the hospice nurses that I have encountered over the years seem to always have the extra time to answer questions and provide comfort to both patients and family members, and I would love to be able to do just that, but never seem to have adequate time in my present position.

I know I'm rambling so I'll close, but thanks again for the info...

[ginger58]

MT RN, You sound like you'll be an asset to hospice. I'm not sure I'd like the in home hospice as much as a facility either. You're right, med-surg is grueling and it is overwhelming in terms of work, feeling like you haven't spent as much time as you'd like with patients and then the paperwork! I wish we had an inpt hospice here.

[ayellowbyrd]

HI, I would guess that each hospice is different on how they staff their PCU's. Ours is staffed with one RN, myself , one LPN, one CNA, and a housemom that functions as a cook and part time CNA. We take care of up to 11 patients and the average stay per patient is 2 weeks. Our PCU's are used for management of accute stages during the patients disease prossess. Such as uncontroled pain, nausea, care giver breakdown, etc. Clients come in we work with our team to get there indiviual chalenges under control and then they are transfered back to homecare.Hope this helps

[IMAHospiceRN]

Your post is a couple of years old, so hopefully you've already settled on an area that works for you. I will say, though, that in response to what other hospice nurses wrote, do not always expect such an easy nurse/patient ratio. I work in a 30 bed facility and both first and second shift RNs often have 7 or 8 patients with only one care partner. Night shift can have from 10 to 15, depending on whether someone calls out. It a very rewarding job, but can also be terribly demanding and difficult if you want to do it well---and you should. I cried often during my first year of work and can't say that I was a really proficient end of life caregiver until I'd been doing it for at least two years. Too many nurses come in thinking it will be a cakewalk because there's often no CPR, etc., but we have trachs, respirators, wound vacs, rectal tubes, lots of PCA pumps, and a huge number of spiritual and emotional issues to help patients and families through. We get addicted patients who constantly demand increasingly greater amounts of narcotics, infants who look perfect, but have congenital defects that are inconsistent with life, angry family members who take their grief out on staff, COPD patients with panic brought on by air hunger combined with fear of death, patients who are brain dead on respirators with family who can't let go, patients with AIDS who are often younger than the staff, parents trying to figure out how to live life without their children who are dying.... In other words, it's demanding work that takes a willingness to open your arms to whoever comes through the doors, giving your best to every one of them no matter what's going on in the next room. They're all at a huge crisis point in life and they all need and deserve the best that nursing has to offer them. If you're able and willing to give that, hospice work is a great career!

[Allow Mystery]

Hi all,
I'm contemplating working in-patient as opposed to out-patient
case management. I've been advised that working in-patient may entail
up to an 8 patient load with a CNA, and acuity will not factor in.
Pros for in-patient include (1)less travel (2)more patient care (3) no
on-call responsibility (4) set schedule (5) less IDT (6) less stress with
recertification process
Cons for in-patient (1) Acuity may make an 8 patient load a nightmare
(2) Institutional setting, and a belief that a good death would be in one's
own home surrounded by loving family
I'm sure they're many more pros and cons, please help me out! Thanks!