[brainnurse]

Glad to find this board.
I'm about to enter hospice nursing....with the same fears and anxieties as everyone else, but that will be okay. I've been managing perioperative care for the last 13 years for Parkinson's and movement disorders patients, and before that was an OR nurse for 12 years. So, there's not much that rattles me.

I've interviewed so far with 3 agencies, and have 2 more scheduled. They're all structured just a little differently....can you take a moment and help me sort it out? I'm in Ventura County, CA....about an hour north of LA.

1. AssistedCare hospice: Pay's per visit $65 new admit and $50 f/u visit. Instead of mileage, it's a $10 "trip fee". They have a phone triage call person, but call visits are managed between 4 nurses (2 RN, 2 LVN). hmmmm....census is currently about 44, but that is limited by staff, so will grow as more are hired. I liked the manager a lot. LCSW, very kind and nurturing personality, but most importantly....real.

2. Buena Vista Hospice: This one is privately owned....not part of a national chain. The territory covers about 100 miles, although they "try" to make the assignments geographically reasonable. They pay hourly $36. They have per diem call coverage when available, no phone triage....but if a visit is needed, the RN calls the LVN to go do it (??) Actually, I've already eliminated this one because of the description of the weekly IDT meetings. They use aromatherapy and music to bring out their feelings....and then talk about the feelings. They also make little memory bears out of the deceased patients clothing or bedding. This is a little too touchy-feely-fuzzy for me. I'm compassionate, but in a more pragmatic way....okay maybe a little cynical....okay, downright irreverant! I'm sure I would say something hysterically funny that would offend them at the first meeting, and they would show me the door.

So.....moving on

3. Yech. Not worth mentioning. Also hourly pay. I'm curious what people think of hourly vs. per visit. The arguments I've heard from the recruiters is that per visit incentivizes you to make more visits, thus causing you to rush thru patient care, and on the other side, hourly makes you stretch what could be a 20 minute look see into 2 hours to make your hours.

Next up, tomorrow morning is Skirball Hospice, a division of Jewish Home for the Aging. It is brand new, and I suspect non-profit, so they probably don't have their act together yet. Maybe they'll make me director. lol

After that, I'm interested in talking to Vitas. They are large and established, probably have the most comprehensive orientation and training and, perhaps room for advancement. Also, they are the only one that has "admission nurses", and this is the role I think I'm interested in.

So.....if you've read this far, whaddya think?
Thanks,
Ro

[BeExcellent]

Tough decision. Here's the skinny. All will have good and bad points. The superviser u like may change jobs and King Kong takes his place. At Hospice A u start out with a light case load and then...someone quits and your caseload doubles. "Start up" hospice? Expect to be called on to be a "team player", that translates to LOTS of hours working. Pick a hospice that leaves time for YOU to think and be with your family. Hospice enriches your life and if you don't have time to live, it is a bummer.

[doodlemom]

I agree with BeExellent. A start up hospice equals a LOT of hours, on call, and a lot of turnover and burnout. I have never worked for a hospice that pays per visit - only per hour or salaried. Our PRN's get paid per visit. I have known people that have worked for Vitas and as much as I can't stand the for-profit end of this business, I would probably choose them over any other for-profit if I had to. Their training is supposed to be good. My experience has been in working with long time established (25 plus years) community based (read non profit) agencies and this has worked well for me. The staff are there because they believe in the mission and that = decreased turnover. Some of the people I have worked with have been there for 15-20 years. I worked for a (very) short time for a start up with a small census and got burned out in a matter of weeks and left. Just to give you an idea of how long a visit can be... You may do a quick 30-45 minute visit with a stable patient. A time of death can be 2-4 hours depending on what's going on. We try to get the chaplain or SW to come and relieve us if we are very busy but our policy is to wait until the funeral home gets there. A 10.00 flat fee for driving could be a rip off if you are not being paid per hour. Your driving time could be more than an hour round trip so keep that in mind. If you had a 2 hour visit and your drive time was an hour round trip, you'd get paid 60 bucks - that's 20.00/hr. The 65.00 that you speak of is for the admission visit itself? If it is, this is way too little. Just to give you an idea, our full time admissions nurses do 2 admissions - sometimes 3 and that's pushing it - in an 8 hour day. Good luck making your decision. I hope this helps some.

[aimeee]

Here's another factor to consider regarding admissions....large hospices may have somebody doing the signup (giving the info about how hospice works and having the patient/family sign the admission consents etc.) and then the admission nurse is doing the assessment part only. This is an important thing to know, especially if they are going to pay you per admission rather than hourly. The signup part can be hugely variable...from 10 minutes for a patient/family who has already experienced hospice and knows this is what they want to do, to over an hour for those with lots of questions and lots of angst. Also, on pay per admission, what if you go out and then they DON'T admit (they change their mind or they die minutes before you arrive)?

The nursing portion of the admission is also tough to predict. If the patient is in a terrible state with lots of symptoms to be brought under control and the family needs lots of teaching and reassurance it can take a couple hours to just begin setting things to rights.

We may have a more elaborate process and higher expectations of that admission visit, but I don't think I have ever seen one done in under 3 hours (including all the signup explanation, paperwork, and charting) from start to finish. About 4 is average, and it can run up to 6 for a messy one with a long travel time.