Hospice or not?

nutella, MSN, RN · Apr 17, 2016

Are you thinking about home hospice (which also includes hospice in longterm care and assisted living)?

I do not think that volunteering in hospice is a good idea if you are a nurse and are in fact thinking about working as a nurse in hospice. Volunteers in my area do not perform hands on care plus you might get into conflict.

Hospice nurses are usually case manager (field based), meaning they have a case load. Nowadays it seems that most hospice agencies are more or less "abusing" nurses and push them to the max with high case loads and productivity. In addition, you will get a lot of calls during the day,make lots of calls, get pushed to make death visits/extra visits/ extra admissions - and often salaried (which means you have the short stick). Hospice is a 24/7 production - which means weekends, on call and coverage when other people go on vacation. Your car will turn into a mini office/supply place with no place in your trunk to actually put groceries in.

Don't get me wrong - I love hospice, I am specialty certified, but I left because of ongoing bad work conditions. So did most other people - hospice agencies have a revolving door due to poor work conditions, poor payments, inability to do your work within allowed time frame, and really not that much time for the patients who are dying...

Although hospice came from a grass roots movement kind of it is now a huge business. Medicare is cracking down on fraudulent payment but an honest not for profit hospice agency needs to watch money as well,which nowadays means high case loads and crazy productivity.

Even if you are mostly in facilities - the paperwork and documentation required is huge and care coordination can be difficult.

If you want to work in hospice I would say apply for home hospice and also a hospice house. If you get interviewed ask question in regard to what I wrote ("how many visits is your productivity?" ...), orientation, and support.

But the most important part is to shadow a nurse. For at least half a day so you get an idea what it is like on the road. Home hospice goes to all kind of people in different areas. Not all places are nice and clean - a lot of them are cluttered, dirty, bugs, smells...

Plus people start and after a while find that the constant dying affects them in some negative way.

Good luck!

HazelnutCream · Apr 17, 2016

Yes. Volunteer, shadow, talk to nurses working in the field in your area. Nutella mentioned some of the challenges of working in hospice, but it can be very rewarding as well. Like most nursing jobs, that depends on the specific organization you work for, management style, and the team you work with. In the right setting (they are out there!) hospice can be an amazing job. Best of luck to you!

nrcnurse · Apr 17, 2016

Hospice hires PRN staff that make visits but do not carry their own caseload, or take call. It's my favorite role. I get all the satisfaction of the hospice role, without the political garbage. And, I am paid for every hour that I work, which cannot be said for full time staff. I have worked as many as 60 hours per week, so getting hours is not a problem. Full time staff frequently work 60 hours /week and are paid for only 40. I don't get health insurance or PTO, but I have the flexibility to work when I want, as much or as little, as I want.

curious nature, ADN, RN · Apr 17, 2016

Thank you all for your input! I really appreciate hearing the truth and seeing that hospice has much to offer, as well as the downsides. Right now I feel fortunate with good hours, moderate travel, no heavy lifting, and excellent benefits, which is great since I'm no spring chicken! But somehow I need to find a way to get some real patient contact, so maybe a PRN position might work for me. My mom was a hospice patient, and I was grateful and impressed with hospice then (16 years ago). Thanks again!

nutella, MSN, RN · Apr 17, 2016

You need to have some experience to work PRN hospice. That would mean full training and at least somewhat close to fulltime work for a while to get the necessary experience.

I wonder why you want to leave your position since you mention you are not that young anymore.

Why did you leave bedside nursing to begin with? It is not getting much better with bedside nursing - hospice included....

westieluv · Apr 17, 2016

I have done on call after hours hospice nursing, hospice intake and admissions, and hospice triage. My suggestion to you would be to try to find a job in an inpatient hospice unit or possibly work on call after hours if you don't mind not knowing what each new shift will bring. I have never been, and will never be, a hospice case manager because I have seen first hand that 8-5, M-F is simply a guideline and usually not the realty. A lot of them do work for salary, and a lot of them work over more often than not.

I interviewed for a CM position about four years ago and was told that my caseload would be between 15-20 patients. That is a lot of visits/week, considering that many of them are seen 2-3 x week, and when something happens, because they know you and have formed an attachment to you, you are the one they want, not the after hours nurse who is actually supposed to be on duty after 5 pm. I have seen so many hospice CMs with hearts of gold who cave in and go after hours because they can't let a patient or their family down. It is easy to get burned out doing this job, especially if you are making salary and working 50-60 hours/week, which I have seen happen a lot.

HazelnutCream · Apr 24, 2016

If you enjoy the benefits and stability of your fulltime job, but want to add in more patient contact for personal fulfillment, I'd recommend volunteering for a hospice. Wouldn't be paid work, but definitely feeds the soul and allows you to see the tangible benefit of your work. You can do as much or as little as you want, with flexibility in your schedule. Hospices love our volunteers! We have a number of retired RNs who volunteer with us, and they bring so many strengths in communication, empathy, and the power of their presence.

If after being exposed to working in hospice in this way, you want to get more involved down the road, that's always an option, too.