Am I Making The Wrong Choice To Go To Hospice?

[Nurse Beth, MSN]

Hello Nurse Beth,

I’m in the middle of a career dilemma. I became a nurse after having a difficult birth experience with the nurses taking care of me in the hospital with my first born child. I had a home birth with my second, and then decided to go back to school and get my BSN (from scratch 5.5 years of school) because I want to become a nurse midwife. I got my career start as a float pool new grad, which was quite a challenge, and a great learning experience as I got a variety of training in many different med/surg/Tele environments.

After two years in med/surg/Tele I made the move to labor and delivery. I have been in this role for a year. I realize I’m still “new” and I have so much to learn, but, I’m finding that I really am unhappy with hospital based bedside nursing. Even with a bachelors degree, our pay is not stable, and we are forced to use our PTO when they cancel our shifts with 2 hours notice, and if I run out of PTO I can’t take a planned week off unless I take it without pay. They run us fairly short staffed and constantly make us worry about the budget. My unit is also very cliquey.

I’m experiencing burnout very quick. I felt it on medsurg when I left medsurg and now I’m feeling it again in my more ideal environment. Switching to day shift is a seriously significant pay decrease, and as the primary provider, that’s just not a reasonable option.

Here’s my question:

I have been approached by a home hospice for RN case management salary based position that has more of a work life balance. I realize it’s more of a med/surg role, as well as a more personal, and highly invested care role-as it’s not acute care, and I know it’s not the same as what I’m doing now.

I’m scared to leave my role in labor and delivery, would it be career suicide if I figure out that home hospice isn’t for me?

I am not ready to return to school just yet, as my children are still growing, as well as the market where I live does not have a good nurse midwife market. We just moved to our area 3 years ago and love it, so I’m not ready to move all of us again to a new area.

I just don’t want to make the wrong choice.

Dear Wants to Make Right Choice,

It is a big decision. I hear you about the being made to use up PTO issue and running short staffed. If hospitals paid more attention to dissatisfiers like these, there might be less turnover. Cliques can happen anywhere, but they do tend to thrive in specialty areas for some reason.

It sounds like you are leaving the hospital more than you are choosing hospice nursing. Hospice nursing can be very rewarding, but it can definitely cause burnout as well, because of the emotional strain.

Is it possible for you to shadow a hospice nurse as you decide? I'm also concerned about the role being salaried because you could end up working long hours without any overtime. With documentation requirements and long hours, the work-life balance you are looking for may not materialize.

In addition to the salary, look at the entire benefits package, such as health insurance, tuition reimbursement, and employer savings plan.

What you do know is that you're not happy where you're at. You have been in L&D for one year. But let's say it turns out you don't like hospice care. You don't want to start a pattern of one-year tenured jobs. Once you leave the hospital, it can be a challenge to get back in.

My advice is to find out as much as you can about the role, and talk to some hospice nurses so you will feel more secure in your decision.

Best wishes,

Nurse Beth

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[Polly Peptide, BSN, MSN, RN, APRN]

Hospice case management can be very rewarding but there is definitely a reason you are salaried! You will often be working "after hours" with charting and preparing for IDG (interdisplinary group) meetings, which happen weekly. If you are still interested, ask about on call requirements and if there is a dedicated admissions nurse. If you will be required to do those things, it will mean more work beyond your "salaried" time for you. Picking up back-up on call once every 6 weeks is fine but covering on call every other weekend or so isn't okay. Having to do all your own admissions and managing a full caseload of 15 patients, etc., is a challenge. Ask those questions.

Every so often you will get done earlier than 5 or be able to squeeze in a doctors appointment but that is more the exception than the rule.

I actually love hospice, the experience, the patients, the families (for the most part). But maybe ask about a hospice or palliative unit in the hospital first? Or if you are interested in case management, see if you can do a CM job in the hospital before jumping ship? The RN CM jobs in hospice will be there if the others don't work out.