Hospice RN vs Case Manager

[anashenwrath, ASN, RN]

Hello all! Looking for some opinions/advice.

I worked 2 years as an LTC nurse on the Alzheimer's/Dementia unit of a SNF. Enjoyed it, but became frustrated with the constant staff shortage and 16-hour shifts, so I moved onto a special care unit in a social-model senior assisted living facility. I've been working as Director of the Memory Care Neighborhood for about 7 months. I realized pretty quickly that this was not for me. I LOVE doing the family education piece, and I love spending time with my residents, but most of my day is spent trying to keep everything "tour ready," and chasing the aides to lead residents in engaging programming. I have learned that I just don't enjoy being a part of that high-level management circle. I think some people are natural team leaders, but I prefer one-on-one interactions working directly with those I serve.

Hospice has always been my goal in nursing. It's why I became a nurse. And now, finally, I've made some excellent connections and I'm ready to step into this field! Unfortunately, the local hospice that I most admire has invited me to interview for a Hospice Case Manager, and I'm not sure if that's the role for me? Don't get me wrong, I work well on a team! I just don't think I make a great team leader... and I'm not sure how much a Hospice Case Manager is expected to manage the rest of the Hospice Team, or if their focus is primarily with the patient and family.

Thank you for any advice and info!

[Raviepoo]

I suspect it depends a lot on the agency and your case load. At my agency there is very little real management of the CNAs. It's just a bit of coordination. We have awesome aides who do a great job, and if they don't, upper management takes care of that. Case Managers are asked for input, but they don't do the difficult stuff. At my agency the case managers work more with the patients and families.

[anashenwrath, ASN, RN]

That's excellent to hear! So you feel like a nurse, not just an administrator?

[KimberlyRN89, BSN, RN]

Hello! I am hospice nurse and that title "case manager" can be sooooo misleading. You are doing hands on skilled nursing. I think how well you adapt will depend on your company. When I got hired at mine, it was so short staffed and I was unable to get a proper orientation due to that. Six months into it and I'm feeling beyond burned out. Our turnover rate is high. I could go on and on...

[Libby1987]

Case management in home health and hospice is more about coordinating your patients' care as well as providing hands on care. The coordination would include things like bringing in other disciplines in a delegation sort of way to meet patients' needs, you're managing the patients' care, not the other staff. In other words, a case manager is not a supervisor.

Agencies run differently, ours for instance tries to keep one nurse with the patient, to admit/follow/treat/discharge. Others have admission nurses set up the care then other nurses follow.

[Jensmom7, BSN, RN]

As Libby said, case management in Hospice is totally different than what you normally think of as "Case Management".

The Hospice case manager is simply the nurse assigned to the patient. The team concept is very important in hospice, meaning you have constant communication between all disciplines; Nursing, Medical Director, Chaplain, Social Worker, Bereavement, and sometimes most important, the CNAs.

You are nowhere near an administrative position as a Hospice case manager. You are the hands on nurse.

Assuming your Hospice team is great (the ones I've been a part of have been), you have all the tools at your disposal to provide the care your patients need. Every two weeks there is an IDT (inter departmental team) meeting, where we discuss all the patients, review and revise the plan of care, and generally make sure our patients and families have all the support they need.

[anashenwrath, ASN, RN]

Guys thank you so much! Not only do I have a little more confidence about the role, but your info gave me some good things to ask about during my interviews!

one more question if anyone is still scrolling this thread: can I expect the position to be salaried or hourly?

thanks again all!

[Jensmom7, BSN, RN]

Guys thank you so much! Not only do I have a little more confidence about the role, but your info gave me some good things to ask about during my interviews!

one more question if anyone is still scrolling this thread: can I expect the position to be salaried or hourly?

thanks again all!

That depends on the agency. I'm salaried, but some pay hourly or per visit.

That's why I refuse to bring work home with me. I don't get overtime, and I was in a position before that was salaried but I was doing 4-6 hours of unpaid work at home. Nope. No. Nein.

[anashenwrath, ASN, RN]

That depends on the agency. I'm salaried, but some pay hourly or per visit.

That's why I refuse to bring work home with me. I don't get overtime, and I was in a position before that was salaried but I was doing 4-6 hours of unpaid work at home. Nope. No. Nein.

Testify! I'm salaried now and making less as a Director than I did as a 7-3 SNF nurse! I put in 60 hours a week, never take a break or lunch, and that's fine! But I'm not paid for it, and after a while it starts to feel like I'm being taken advantage of. Given the choice, I definitely prefer to get paid by the time.

[nutella, MSN, RN]

The hospice case manager is not managing a nursing team. It means that you would be managing a case load ....

That is the way it is structured. You get a certain number of cases you are expected to coordinate, visit and such.