Admissions vs CM? New job considerations

vampiregirl, BSN, RN · Aug 1, 2023

Regarding work/ life balance, that is going to depend on several factors. The most important one being is the company you work for. I'm fortunate to work for a company that promotes work life balance and self care. Another piece of the puzzle will be your time management skills and your boundaries, as well as the quality of your training with the agency. It took me a bit to get the hang of it but completing the charting at the visit (except for admissions and an occasional very complex visit where I need a minute to clear my head to organize everything so that my charting makes sense) is a game changer. Thanks to COVID, our agency uses a lot of technology so completing all the tasks I need to before leaving the driveway is possible most of the time - including ordering meds, updating the provider, ordering supplies, coordinating follow-up etc. Also understanding the expectations of each visit type for my agency was another thing that increased my efficiency.

Some agencies require case managers to be part of the call rotation. If this is the case, you will want to find out the frequency and expectations for call.

You will need to be able to work independently with minimal supervision, be proficient in skills (blood draws, catheters, port access, g-tubes, various drains, comfortable with wounds), and have excellent assessment skills to be an effective hospice nurse. Education is a huge part of the job - hospice nurses are teaching caregivers how to care for people at the end of life. Many oncology units have interdisciplinary teams - this is one of hospice's strengths and greatest resources. A good hospice nurse also needs to be non-judgmental regarding home environments but at the same time very alert to potential safety concerns (for the hospice staff or the patient).

Hospice is an amazing area of nursing, it's my niche. I've never worked in a hospital bedside role so unfortunately I can't accurately compare/ contrast that to hospice.

If there are other questions, please don't hesitate to ask! Good luck!

Keta, BSN, RN · Nov 22, 2023

As vampiregirl said, this will depend on several factors.

I work in community hospice as a case manager and we are paid hourly and have a GREAT & active union. Where I work, Case Managers and Admission Nurses often put in extra hours due to patient scheduling wishes and fear of not meeting "visit expectations" (number of patients seen daily). Personally, I do not worry about this as I can account for all of my work hours.

If you want to maintain a set schedule, I would definitely look at working in a hospice house setting that has set shifts.

I love being in the community - seeing my patient's in their homes.

Each company has different set ups - we have evening and night shift nurses so Case Managers/Admit Nurses do not take call. I have worked for other agencies where CMs do have to take call and it was awful. When working salaried, RNs were taken advantage of (imagine that!) so I love being hourly. I believe in being paid for my education, experience, and time and will not give it away.

Hospice work is so fulfilling.

Peachpit · Dec 12, 2023

Most hospices, at least in the area I work, either don't have Admission Nurses per se or the Admission Nurses have worked in hospice for several years.

Whatever hospice you apply to ask if they have a dedicated on call team, a lot of the larger hospices do so the Case Managers don't have to rotate through call. That being said, Case Managers have a LOT of responsibilities from overseeing the overall care of their patients to IDG every week or 2 weeks depending on the hospice. There is a lot of documentation in hospice and if the EMR is HCHB (PointCare) its challenging for nurses who are new to using it.

Also, keep in mind that Case Managers work, normally, 5 days a week vs the 3 12's you are working now. Just depends on what you mean by work/life balance. Most hospice and home health nurses, until they really develop there cadence, do document from home. It is really not possible, especially at the beginning, to document EVERYTHING at the patients location.

Good luck