Burnt Out: Thinking of Leaving Hospice But Feeling Guilty

[Kelaaax3, ADN]

I’ve been a nurse for a little over a year now. I previously worked on a med-surg floor for almost a year and I decided to leave mainly due to the fact that I was driving 7 hours a week. I also began to feel like a pill pusher, we were very understaffed, unsafe ratios, just general issues like that. I was also home sick. Our floor also done inpatient hospice so I decided that would be the perfect thing to do when I found a job closer to home so that’s what I did. 

I have been doing outpatient hospice for about 3 months now and I’m so overwhelmed. I do call every weekend (it’s just me, so the company depends on me heavily) and hardly get any sleep. I did not realize we would have patients an hour-two hours away which I think is ridiculous. Being on call every weekend is very difficult, a lot more than what I imagined. There is very little support. I do love my patients and I love being able to spend more time with them and educate them and I do feel as if I'm making more of a difference with this career but I'm also forced into working overtime a lot ever since I first started due to the fact that staffing is so horrible. There is a very high turnover rate with the company and during meetings and surveys we even had two employees recommend that nurses don’t work here at all. We have mostly one medical director over all of our patients and he is very rude to the families and also to the nurses. I had a family member of a patient call me breaking down in tears about how rude he was to her. Management is aware but they continue on like it’s all fine and dandy. I’m overworked. Things are very disorganized. Cant get ahold of physicians to put in orders for GIP patients, number is wrong in the chart and I call my manager about this at 2am, and I still have the wrong number. 

I also hate when there is a death or another medical emergency and I’m an hour and a half away, and that’s with no traffic. I feel so bad for the families when that does happen. This job has given me so much anxiety, I have nightmares when I’m on call and trying to sleep. I know they will be very disappointed if I quit but I’m not sure what else to do. I feel very guilty about it but I’m sick of running on no sleep and they are well aware of the issues going on but continue to turn a blind eye when it’s obviously not working and they can’t keep staff. I’m very hurt because I really do love the patients and want to provide the best care possible but it’s hard to do under some conditions. I will have another position lined up which is a travel nurse job that’s actually not far from my home. I’m also looking in to other positions. I’m just not happy at all and my anxiety is crippling at this point. My manager is very nice and I know there will be a big fuss when I do quit. They will have a hard time replacing me because it’s a tough job and feels almost impossible at times. I wanted to give a 4 week notice but I will probably just settle for a 2 or 3 week notice. I’m not a quitter and I hate that I’m giving up after 3 months, but the overtime, staffing issues, and issues with the primary doctor is killing me. They tell me I do such a good job but it’s not worth the stress anymore, especially for the pay cut I took. 

I’m just venting and hope someone can understand and provide some insight on whether or not I’m making the right decision, knowing that this will be hard on the company. The nurses who work throughout the week were taking call on weekends before I came along and I hate that they will have to go back to that because they’re already so overworked themselves but I feel like I have to put my mental health first. Wondering how I can make this a smoother process. 

[NightNerd, MSN, RN]

This is insane, and I hope you'll do what you need to for your own health and well-being. On call *every* weekend? Not a chance.

Is there an inpatient facility or maybe a facility-based hospice program you can apply for? It sounds like hospice in general is a good fit for you, but this particular company is taking advantage.

[Peachpit]

There are much better hospice companies out there then the one you are working for now that would treat you with more value.

Your health and well being are priority one. You need to do what you need to do to take care of yourself. The company you work for certainly takes care of itself and has no issue w/the high turn over so that should tell you all you need to know about how much (or rather how little) they value their employees. 

[JKL33]

It's understandable that you might feel bad about this situation in general,  but you and your leaving are definitely not the problem here. You need to get a different perspective. You should not feel guilty for the results of others' decision-making.

8 hours ago, Kelaaax3 said:

My manager is very nice and I know there will be a big fuss when I do quit. They will have a hard time replacing me because it’s a tough job and feels almost impossible at times.

Yes, that's hard. Managers are people, too. But the bottom line is your manager doesn't have to work there under these conditions either. Your purpose in life is not to be taken advantage of so that your manager doesn't have to make hard decisions like the one you're making. People often have choices, including your manager.

8 hours ago, Kelaaax3 said:

I’m not a quitter and I hate that I’m giving up after 3 months, but the overtime, staffing issues, and issues with the primary doctor is killing me.

In terms of life decisions, this certainly is not quitting. You have some goals in life related to your profession. These may be things like developing good relationships, providing good care to patients, having a healthy work-life balance, and many more. Now imagine that you are figuratively driving on a road in the general direction of your goals. If the road takes a sudden turn such that staying on that road is going to take you in the opposite direction you need to go, you make moves to get yourself back on a road that is going in the right direction. If that ever happened, you would never think of that as quitting! It's just reasonable navigation. That's all. Don't frame this in a way that amounts to self-deprecation.

8 hours ago, Kelaaax3 said:

I’m just venting and hope someone can understand and provide some insight on whether or not I’m making the right decision, knowing that this will be hard on the company.

I'll be blunt: I don't care whether anything is hard on a terrible company, at baseline. They might earn some sympathy if every single person running and directing the company is exhausting themselves to get back on track. That's an effort I might participate in. But not this. This is just people taking advantage of other people. It is --not-- your problem.

9 hours ago, Kelaaax3 said:

The nurses who work throughout the week were taking call on weekends before I came along and I hate that they will have to go back to that because they’re already so overworked themselves

They have choices, too. Period.

9 hours ago, Kelaaax3 said:

I feel like I have to put my mental health first.

You don't have to justify this.

9 hours ago, Kelaaax3 said:

Wondering how I can make this a smoother process.

"Dear [Manager],

I am writing to provide notice of my decision to resign my position as [title of your role] at [Company]. My last available date to work is [Date 2-3 weeks from today]. Thank you for giving me the opportunity to work with patients providing care and services to them in their homes.

Sincerely,

[Name]"

??

[JBMmom, MSN, NP]

I think that this company is aware of the environment they have created for nurses and what you describe seems like unreasonable workload. You shouldn't feel guilty for leaving a position that is clearly unhealthy and not set up for anyone to be successful. Yes, it's unfortunate that your leaving will create some hardship for other nurses already working in difficult circumstances, but you are not responsible for that either. In a field as challenging and important as hospice care, it's truly heartbreaking that large corporations have taken over and made it yet another "bottom line" field. Good luck finding something that is better for your work life balance. 

[amoLucia]

Wise comments from previous posters.

Had some very great words of wisdom from ex co-workers I used to work with - 'XYZ Hosp existed before she got here, and it'll exist after she's gone'.

Another gem was 'when she's gone, they'll miss her there for 2 weeks'.

Yes, you'll miss the pts & coworkers, but they'll go on without you! It's difficult to understand that in the beginning, but it's TRUE. And the employer is just that - your employer. They show you NOOOO special consideration, so it's time for you to move on.

Good luck to you.

[UrbanHealthRN, BSN, RN]

On call every weekend is not sustainable. No way. I get that healthcare needs to make itself available to treat patients, but putting an expectation like that on one staff person is borderline abusive. If you like home based nursing, maybe there's a better agency to work for, whether it's hospice, long-term homecare, or something else. But please don't continue to put yourself through this. You deserve better. 

[Jedrnurse, BSN, RN]

Why isn't weekend call divided up amongst staff?

[Hannahbanana, BSN, MSN]

Staffing and management decisions are NOT YOUR PROBLEMS to solve. Your own mental and physical health are, and don’t let them or anyone guilt you into the “what will my team do without me?” trap. 

Repeat into your mirror until it sinks in. 

[PamtheNurse, BSN, MSN]

Kelaaax3,

Could you please clarify whether you work only weekend "on-call".  Or do you have other hours you must work besides the weekend "on-call"?  As a former hospice nurse I have seen and worked in both models, neither is sustainable without support.  Regardless your burnout must be addressed appropriately now and in the future.  Simply leaving for another position will not resolve burnout it is insidious and will revisit you.  I wrote an article about burnout and it has accompanying research (too much info for here) that suggests interventions, the interventions used in the past are not always effective.  Article link: https://allnurses.com/are-you-someone-you-know-t736138/  Burnout is serious, difficult, and leads to nurse/patient safety issues I am doing research to hopefully lend to the exploration of interventions https://allnurses.com/research-the-relationship-self-efficacy-perceived-t736280/  My thoughts are with you on this trying leg of your life journey. 

[Kelaaax3, ADN]

1 hour ago, PamtheNurse said:

Kelaaax3,

Could you please clarify whether you work only weekend "on-call".  Or do you have other hours you must work besides the weekend "on-call"?  As a former hospice nurse I have seen and worked in both models, neither is sustainable without support.  Regardless your burnout must be addressed appropriately now and in the future.  Simply leaving for another position will not resolve burnout it is insidious and will revisit you.  I wrote an article about burnout and it has accompanying research (too much info for here) that suggests interventions, the interventions used in the past are not always effective.  Article link: https://allnurses.com/are-you-someone-you-know-t736138/  Burnout is serious, difficult, and leads to nurse/patient safety issues I am doing research to hopefully lend to the exploration of interventions https://allnurses.com/research-the-relationship-self-efficacy-perceived-t736280/  My thoughts are with you on this trying leg of your life journey. 

Really interesting article. So I’m on call every weekend which I know is pretty normal with hospice positions but I don’t think I’m the type to handle it well especially when sometimes I go for 2 days without any sleep. I don’t think it’s sustainable. I’ve communicated with my boss about these issues and we do have backup but it doesn’t matter when it comes to issues like getting enough sleep, it only matters if there’s 2 deaths at the same time. That’s the only time when they like you to call for backup help. 
 

I also have to do lots of admissions and referrals on the weekend which is hard to do in between emergency visits and now my boss wants me to start putting them in myself but I’m already so busy during my weekend on call shift that I don’t have time to sit and put info in when she can easily do that from home. We are very short on staff so I’ve been picking up a lot extra throughout the week. I’m fine with driving within the area but I’m not okay with having patients that are 1-1.5 hours away when there is an emergency. I’m carrying a lot of guilt about that too. I do believe I am experiencing burnout. I knew I was on med/surg and I’m disappointed in myself for hopping into the first job I got close to home, not considering that it would only exaggerate my burnout. I also just don’t agree with a lot of the company’s practices. Instead of caring for patients, it is more about making a profit. I’ve seen shady stuff. I’m just not happy here, although I do love caring for my patients. I’m definitely going to switch once I find something I enjoy and shadow. I guess sometimes it’s about learning what you don’t like. I’m getting there. Thank you for your response. Do you have any advice on dealing with burnout? I wish I could take a couple of days but that’s out of the option. 

[FolksBtrippin, BSN, RN]

You are making the right decision. You can’t go on like this.