Advice needed; SNF v. Hospice decision

LessValuableNinja · Jan 18, 2017

I think you'll find that with 8 patients, you can accomplish quite a bit. If you've become bored, you aren't doing everything that you can for them. But based on your post and my perception of your likely personality, I don't think you'll do less for them than you can.

I think your current position sounds like it is, or that you perceive it to be a situation where you are understaffed and do not have management support. Will hospice be for you long term? Maybe, maybe not. However, it does not sound like your current position is a great place for your health, stress level, or protection of your license. If it were me, I'd probably be ready to try something new. I also thrive in high paced environments, but have found that with most positions, if you dedicate yourself to excellence, you can have a very busy day regardless of your patient census (consider ICU as an example). There's always something to do to make lives better. Will you want to go to something that's naturally a little busier? Maybe. But I think based on how you speak of your current position, it's probably time for a change.

AceOfHearts<3 · Jan 18, 2017

I have a special place in my heart for hospice. I was lucky enough in school to have clinical at a beautiful hospice center run by the Quakers. I currently work in a hospital and my unit gets hospice patients from time to time. The hospice patients we get can require frequent comfort medications, plus there are the psychosocial issues- providing comfort and information to family, etc. I think you will be plenty busy with 8 patients, just a different type of busy.

As for the pay and loss of hours, you could always see if it is possible to stay at your current position as per diem. You could also find a reputable agency and pick up hours that way. I think if you could find a good agency you would be able to increase your hourly wage.

I think it is wonderful you care for your CNAs and want to make sure they are ok, however this is a business decision. I frequently have to remind myself of that- that it's not personal- and that I shouldn't feel bad for wanting to advance my career or increase my earnings.

With the information you have given I personally would give the hospice a try. Good luck with your decision!

CoffeeRTC, BSN, RN · Jan 18, 2017

Do it!!! I've been an RN in LTC for ever, so I see where you are coming from. If you are worried about the less pay...you can probably pick up hours prn at your current facility or any other.

dogmom2016 · Jan 18, 2017

Thank you for your insightful comment. I very much appreciate it! Yes, I worry about a slower pace since I do tend to thrive on "too much" but, long-term I think my current position is not only, as you pointed out, dangerous for my license, but for my health. I may love it but the rest of my life is suffering. I have a hard time not feeling personally responsible for my CNA's since they text me on my day off to tell me how bad the nurse the night before was and how she slacked off. That makes me upset since 'my' residents deserve the best. But, I can also give my best to a fewer number of people and provide higher quality care. I don't want to job-skip and am hoping that my next job will be the last job. Thanks again for your help:)

dogmom2016 · Jan 18, 2017

Thank you! Yes, I can pick up occasional hours and for much more money than having a scheduled shift.

dogmom2016 · Jan 18, 2017

Thank you! The business/personal is very difficult, isn't it? I find myself wondering how my residents are doing on my nights off. Each time I convince myself to be strong and look for other work one of my 'special' residents will say something like "oh, I missed you last night!" Or, one said recently "I thought you were never coming back and I was sad." That guilt keeps me hanging on. Oy!

LessValuableNinja · Jan 18, 2017

It sounds like you have the right attitude to enjoy/do well in most or any environment. I have a feeling that you'll find your niche eventually, and that you and 2 aides for a billion residents is not your (or anyone's) niche. Onward, ho!

Something I think you may find worth doing is attending local nursing organization meetings. Your state nursing association is usually (I think? Mine is) associated with ANA. For example, our state NA is TNA, and has meetings all over my area. You may find these meetings valuable both for networking, and for considering/discussing/finding out about other options for spending your time.

Thank you for your insightful comment. I very much appreciate it! Yes, I worry about a slower pace since I do tend to thrive on "too much" but, long-term I think my current position is not only, as you pointed out, dangerous for my license, but for my health. I may love it but the rest of my life is suffering. I have a hard time not feeling personally responsible for my CNA's since they text me on my day off to tell me how bad the nurse the night before was and how she slacked off. That makes me upset since 'my' residents deserve the best. But, I can also give my best to a fewer number of people and provide higher quality care. I don't want to job-skip and am hoping that my next job will be the last job. Thanks again for your help:)

dogmom2016 · Jan 26, 2017

Good morning! I did take the new job. I want to thank all of you for your input. It was all very helpful and I appreciate it.

Libby1987 · Jan 26, 2017

I love your attitude, you'll be successful wherever you go.

Hospice won't be the adrenaline rush that you have had at your particular SNF position because it's different kind of energy. Instead of racing against the clock with an impossible patient load, you'll find other ways to dive in and do more as you gain experience.

dogmom2016 · Jan 31, 2017

Hi all - I just wanted to thank you all for helping me with my decision. I did formally accept the hospice RN position and start soon. I am looking forward to working in a rewarding field and being appreciated for what I do. No more crazy!!!

AliNajaCat · Jan 31, 2017

Thank you! The business/personal is very difficult, isn't it? I find myself wondering how my residents are doing on my nights off. Each time I convince myself to be strong and look for other work one of my 'special' residents will say something like "oh, I missed you last night!" Or, one said recently "I thought you were never coming back and I was sad." That guilt keeps me hanging on. Oy!

Mmmmm. This makes me wonder. Once we start thinking how very special we are, we are usually headed for a big, big fall.

I hope one of the psych nurses here will chime in on this. Davy?

Meanwhile, I think you will find ample opportunity to stay engaged, provide matchless care, and help people in the hospice job you describe.

ETA: I posted this before I saw you had taken the hospice job. I'd still be interested to hear from Davy and the other psych folks here about my question, even if it doesn't apply directly to you now.