very confused about my hospice job- need advice

[maybug, ADN, BSN, RN]

I graduated in May 2012 and only did home health for a couple months before coming into Hospice. I have been an RN Case Manager with Hospice for 7 months now. I really do enjoy Hospice, especially comforting my patient and their family in those final hours. I feel confident for the most part in my role, and feel that I do a very good job. The issue is that my company is expanding and we are new to the area I am in. I am currently the only nurse covering an 80+ mile radius. I only have 8 patients as of this moment, but I do at least 1 admission a week, and am worried about our area growing too fast before another nurse is hired. Supposedly they are looking for a PRN nurse to assist me, but it has been 2 months now with no applicants, which I don't understand. The other issue is that almost all the call is placed on me. I take call anywhere from 20-25 days out of the month. It is very draining. I am unhappy more often than not. I spend a lot of time thinking about and searching for new jobs. I am worried that this is just how it is, how all of nursing is, how the working world is, and I just need to get used to it. Is that the case? Would I be better suited for a Hospice House with set hours, and patients in the condition I find most rewarding? Should I switch gears completely and try hospital nursing? The hours of the job are killing me more than anything. I work with an incredible team of nurses, and dont know if I even have the balls to leave them in a bind- 8 patients with NO nurse. This company gave me a shot as a new nurse that no one else would, and I am very grateful, but I am invaluable to them at this point in time, but feel as if I am being somewhat used. PLEASE lend me your advice and support!

[tewdles, RN]

What nurse takes call when you do not?

Why is that call rotation and expectation more equitable?

Does your nursing manager cover some of the call?

It is unrealistic to expect an RN to be a FT case manager and cover 25/30 days oncall. Wow

[salvadordolly]

On-call twice a week is the most I've heard of. There are alot of people starting up hospices and home health companies that do not know what they are doing. I'd find out if they have even advertised the job, if not I'd start looking for a more established hospice agency.

[maybug, ADN, BSN, RN]

Nurses from a neighboring city take the calls for my area when I take days off. What is even more frustrating is that even on those specific days I take off, I've had those nurses contact me and ask me to take the call anyway. -_- There is also a newly hired nurse for a city 1.5 hours away that will come at least once a month and stay with friends for a weekend in my area to take call for me. Like I said before, since I'm the only nurse in the area, I'm the one that needs to be on call, which I understand, and feel rather guilty when I take days off... I just wonder how much longer I'll have to go like this.

[maybug, ADN, BSN, RN]

The company I work for is very established and highly reputable, BUT the specific office I work for has only been in business for maybe 2 years. My office is located in a city 1.5 hours away, and I was the first nurse hired for my specific area. Do either of you have any input about Inpatient Hospice nursing?

[SuzieVN]

Inpatient hospice is a rare thing. But I have to tell you it is the most 'luxe' of nursing jobs. Mellow, slow, focused, calm, beautiful food and music, and etc. It is so expensive to maintain though, that most 'hospice' companies make their profit from home health/outpatient visits, often using a lot of volunteer staff. Normally, the patient has to be actively dying (1-2 days), from my experience, to make it into an inpatient facility. My mom was in one, wow- what a beautiful experience.

[SuesquatchRN, BSN, RN]

Career Builder. After you hang in for another five months. You can do it standing on your head. You WILL find another job. Get that one year in one job in place. And hugs.

[NavySERE]

Maybug,

Sorry to hear you are so drained. Depending on the size of your company it is not unheard for a CM doing addmission along with taking call.

I am surpised that your case load is only 8, the is great normal national average is 17-20. However, most of the time those nurse are not doing admission and taking call. If they are only a most a couple times a month.

Were I work the CM are required to work 1 major and 1 minor holiday per year. We have a seprate on-call team that works nights, weekends. Though they CM can pick up overtime doing a weekend or evening.

Hospice work is very hard, as you are experincing but also, very very rewarding. We call it the "hospice heart".

It is the only type of nursing I could see myself doing long term and an education (teaching).

So don't give up hope I would say once you have at least 2 years under your belt. You could go any were else in hospice and maybe get a better overall exerince.

Wish you the best

NavySERE

[maybug, ADN, BSN, RN]

I've gotten a lot of good and bad news in the last couple days. We were told we may be getting an admissions nurse (YAY!) but that still may not be for months... and i was told my boss was having an interview with another nurse for my area today. Unfortunately, she did not show. More bad news... One of our nurses is newly pregnant and has doctors orders to be off the rest of the week and possibly longer, and another nurse is choosing to go from full time to part time. We have absolutely no room for anyone to be out, so I'm stuck doing other nurses work now plus my own and am scared what is going to happen in the next few weeks/months. I do not want to be working 60 hour weeks I'm trying very hard to stick it out, because I love my team and my patients. Pray for me please!

[Career2_BSN, BSN]

It sounds like you love everything about your job except the hours. Speak up, ask for help. If it's a well-established company, they may be able to offer nurses from other offices incentives for travelling out there and covering a few days at a time until they fill positions with local nurses. Before walking away, I would at least give the company the chance to improve conditions. If you give them a chance and find yourself months down the road in the same situation, then you can look elsewhere with a free conscience.

[MissIt]

Tell them you are going to leave if you don't get help. The office will collapse without you. As long as you're willing to work this much, they won't be as serious about finding you help. Give them a deadline. I do think that if there is any way for you to make it to a year, you should try. Maybe you're the one that needs to switch to part time or just do the after hours on-call. If you have to keep doing things the way you're doing them, try to envision it as a 5 month, intense, short-term, experience. Try to eliminate as many other activities and outside of work responsibilities as you can. You can't do this long term no matter how much you like your team. Nurses are like this, we don't want to let down our co-workers or patients (NURSING GUILT!!!!), so we do jobs that most other sane professionals would never agree to.

[AnnemRN]

Inpatient hospice is a rare thing. But I have to tell you it is the most 'luxe' of nursing jobs. Mellow, slow, focused, calm, beautiful food and music, and etc. It is so expensive to maintain though, that most 'hospice' companies make their profit from home health/outpatient visits, often using a lot of volunteer staff. Normally, the patient has to be actively dying (1-2 days), from my experience, to make it into an inpatient facility. My mom was in one, wow- what a beautiful experience.

As a former inpatient hospice nurse I have to say it was anything but "luxe". I literally ran my butt off the entire 12 hours sometimes, having to be in patient's rooms every hour for symptom control. It was extremely difficult to maintain the pace day after day and often I would go without lunch (which was the only meal time we would get). Several co-workers quit before I did.

We did have actively dying patient's, but also had respite patients. Each nurse took care of 5-6 patient's each shift. Many times the families and their pets would sleep in the rooms with them.

Don't get me wrong, from the patient's & families perspective we did a wonderful job. They just didn't know the inner workings. It was anything but mellow and slow which really was a shame. Hopefully, that's not the case with other hospice inpatient facilities.