Is this legal? Hospice RN required to do Home Health visits

[deblowe52]

I work at a small home health and hospice company. I applied for and was hired as a RN casemanager for hospice and receive a salary. I have worked there over 5 years and have carried as many as 13 patients seeing them twice a week. I am also expected to take on- call every three weeks for seven days Monday to Monday. Over the last several months, our census has dwiddled downward and i now only have six patients. Our administrator has now informed me that i am expected to also work home health. I have no experience in med surg or home health, i do not want to work home health and feel it will put my license in jeopardy if they force me to agree. Please i need advice quickly

[MissyWrite]

A hospice case manager does hands-on care. That's what they do. They're called a case manager because they manage the case as well -- even though they work as a team along with a social worker, HH aide, volunteers, a chaplain, etc., they have the main responsibility for coordinating all the care and doing things like re-certification at specific time periods.

Hospice really is quite different than home health. They are two different things. Just because both types of care happen in someone's home doesn't make them equal. I loved hospice, but I couldn't stand home health. It's like night and day.

But if that's the work they have available, and you want to keep working for them, give it a try. If you can do hospice nursing, chances are you can do HH -- the question is, do you want to? There's a lot of new paperwork to learn, such as the dreaded OASIS, and the admissions/discharges are frequent.

Someone here said "wound care is wound care and patient education is patient education," but that doesn't make sense. Wound care is very different in hospice. There's not a lot of high-tech wound care going on if a patient is only expected to live for a couple of weeks. And there's a difference between teaching patients how to manage their pain vs how to manage their diabetes.

I'm with you, though -- hospice is hospice, and HH is HH. Two different specialties.

I find myself wondering why the census has dropped so much.

If you do decide to move on to another job, get one with a company that only does hospice. Then you can avoid this situation in the future.

[caliotter3]

Wound care is wound care is a statement made as a generality to point out that the OP seems to be making a mountain out of a molehill. As an RN she is expected to be able to perform basic patient care. Anything that is beyond her experience or expertise is her responsibility as a professional to seek help/orientation/training on. If newly licensed LPNs can adapt to both home health and hospice visits, there is no reason why an experienced RN can not do the same. It is up to the RN to seek help if they feel overwhelmed. But if they don't want to do the work, it is also professional to seek work elsewhere. The employer needs an employee that is willing to be trained and then to do the work. With decreased revenue, they can not afford to keep on someone who limits their usefulness. Since the OP has not returned to provide an update, it is hoped that she was able to favorably resolve her dilemma.

[tyvin, BSN, RN]

Wound care is wound care is a statement made as a generality to point out that the OP seems to be making a mountain out of a molehill. As an RN she is expected to be able to perform basic patient care. Anything that is beyond her experience or expertise is her responsibility as a professional to seek help/orientation/training on. If newly licensed LPNs can adapt to both home health and hospice visits, there is no reason why an experienced RN can not do the same. It is up to the RN to seek help if they feel overwhelmed. But if they don't want to do the work, it is also professional to seek work elsewhere. The employer needs an employee that is willing to be trained and then to do the work. With decreased revenue, they can not afford to keep on someone who limits their usefulness. Since the OP has not returned to provide an update, it is hoped that she was able to favorably resolve her dilemma.

Oh, I thought she was in the office coordinating care of the patients and responsible for assigning the cases...OK, well than it's really a baffling question as the nurse would have had to be doing direct care on the hospice patients. Which is really in some ways, no different than general med/surg with super emphasis on pain management.

Hospice care is like doing med/surg out of the trunk of your car.

If you can't do HH, than how can you do hospice care?

[TheCommuter, BSN, RN]

If you do decide to move on to another job, get one with a company that only does hospice.

The trend, at least in my area, is for companies offering both home health and hospice services. Since home health patients are potential sources of automatic hospice referrals if their health conditions decline, this helps the company maintain census and remain financially viable.