Would inpatient hospice be a good fit for me?

  1. I have been working as a RN for 10 months in a LTC/Rehab facility. I graduated from an entry level master's program, so I have a MSN degree, and just that 10 months of experience.

    I very much want to get into hospice work. I did my community health rotation at a hospice, I have taken care of some hospice patients at the facility where I am working currently, and I did my master's thesis on palliative care/ hospice of elderly patients with ESRD.

    My long term career goal is to get certification as a palliative care nurse practitioner.

    I have an interview lined up at an inpatient hospice unit. I really don't know what to expect in terms of patient ratio, acuity, etc.

    At my facility where I am currently employed, I am a NOC nurse and I have 60 patients, plus all the extra duties, and I find that I just can't do the work within the shift. I frequently have to stay overtime to finish charting.

    So, that is my main complaint about where I am working now, there's just not enough time to take care of all the patients properly, do a med pass for 60 patients, all the documentation, and handle emergencies when they arise (and they frequently do).

    Will the work load be better at an inpatient hospice facility?
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    About PeacockMaiden, MSN

    Joined: May '13; Posts: 150; Likes: 127


  3. by   evgeneia
    Hi Peacock Maiden,
    I'm wondering the same thing! What is it like working in hospice at a facility?

    I interviewed recently for a position in a facility, and each RN had 3 patients so that they could spend adequate time with the pt and their families.

    Are there any facility hospice nurses who can share what a typical day looks like (if such a thing exists)? What do you enjoy/dislike about your job? If anyone can share information about what it's like working hospice in a facility--I'd be grateful!

  4. by   PeacockMaiden
    What I enjoy about my current job is working with elderly patients. Doing real nursing, like properly assessing them, actually taking time to have a short conversation with them beyond, "here's your pill", providing more hands-on care.

    What I don't like is spending my shift being a pill pusher for 60 patients, the mountain of documentation that needs to be done, and the extra stuff they throw at the NOC nurse that couldn't get done during the day.

    After 10 months at this, I still almost never get out on time. The work atmosphere is hostile too because many of the AM nurses find things to complain about your work and the CNAs work and tattle to the management. The management and many of the daytime nurses are all friends, they go out and party together after work, etc. This is a small town and this facility has formed this clique that really reminds me of high school days. Nursing is my second career, I'm in my 40's, and I'm much beyond dealing with the high school clique attitude.

    Overall, liked the hospice philosophy that I observed when I did my 10 week community health rotation with a hospice company. That is the work I want to do. I have applied for jobs as a visiting hospice nurse, but the feedback is that I don't have the 1-2 years of acute experience. I am hoping if I get inpatient hospice work experience, it will allow me to eventually get into a hospice/home care position.

    Also, this week I turned in applications for some Adult/Gero NP post master's certificate programs. I'd like to start working toward that goal too.
  5. by   MissIt
    In my experience, inpatient hospice is a lot more like floor nursing. Our ratios are 1 nurse to 5 for days. From reading posts on here, it seems like 4-6 is pretty normal for days. Our patients can be very acute and we do a ton of education and family support. It probably does depend on the specific inpatient unit, if it does mostly symptom management, respite, or end of life. I think inpatient hospice is a great place to start in the field. Actually, I think all new nurses would really benefit from starting on an inpatient hospice unit.
  6. by   GoalsInTransition
    Hi there,

    On our unit, we typically have 4-6 patients/nurse and one tech for 10-12 patients, both days and nights. We have some VERY high acuity patients (vents, drains, drips, chest tubes) and others who are more "typical" hospice patients (one main symptom, fewer tubes, etc.). It can be rather med/surg-ish at times, but with some wonderful differences:

    1) Awesome teamwork, everyone (nearly) with the same philosophy, goals of care, etc
    2) Treatments and meds are pared down to what will benefit the patient
    3) Extra support from psychosocial services (chaplain, SW, music therapy)
    4) More empowered nurse practice
    I really enjoy my job- with a few reservations. Feel free to PM me with specific questions. :-)
  7. by   Caffeine_IV
    Depends on the place. I work in a hospice house that is having a lot of turnover and unreliable staff. The night nurses have had between 7-9 patients frequently. The patients can be high acuity or just "busy" especially respite patients. The charting is time consuming. Many times I am just pushing pills and giving SQ injections left and right. Many enjoy it but it is not my niche.
  8. by   Daisy_08
    Where I work we have 5 pts on days 7-8 on nights, no aides. We get rid of most IVs, no vents or treatment that is not providing comfort (at least we try). Dressing changes, meds, mostly s/c and lots of them, a lot of teaching with the family, symptom management and bowel care, bowel care bowel care!
  9. by   Nurse_Diane
    I knew I wanted to work in hospice before I even graduated. I realized I needed to gain the med/surg hospital experience. Wasn't my cup of tea, but I will NEVER regret it. I then started in an inpt hospice setting; I worked for a fabulous agency and learned so much. Eventually I wanted to do home hospice (Case Management). The inpt experience was invaluable. Without that experience, I don't know that I would have the sx management skills necessary to keep pts comfortable in their homes. I have been doing Hospice Case Mgt for 3 years, and I've never looked back. All the best to you!
  10. by   PomMom65
    I work in an acute care inpatient hospice facility. I usually have 4 patient assignment.
  11. by   duskyjewel
    I'm a hospice CNA and while I've been trained in everything my employer has for CNAs to do, I usually work inpatient. The nurses I work with usually have 5-7 patients each on both shifts. Usually it's me and two nurses for 12-14 patients on night shift, and on day shift the bigger units get another CNA.

    I've never worked LTC because I am too slow and it would kill me. I did work the hospital and hated it. In hospice, I feel like I take care of people instead of just doing stuff TO them.