Calling all hospice nurses

FolksBtrippin, BSN, RN · Aug 6

I am a hospice nurse and I work on call at night as the runner. My shift is Monday to Sunday 5pm to 830 am for one week and then the next week I am off. It is totally unpredictable as sometimes I get called all night and sometimes I just sit at home and nothing happens.

This is generally not where you would start in hospice, you would probably be an RN Case manager. The case managers at my company have a caseload of 11 to 16 patients in the same geographical area that they manage the care for. They decide how often patients need to be seen by RN and HHA and write the orders for those visits. The RN has a lot of autonomy in hospice, docs are not seeing patients and we take care of almost all the care, we call the doc and get orders and then we have the pharmacy send the meds to the home. Our company has a policy that actively dying patients are seen by a nurse and HHA daily. Generally we don't stay in the home for a long time, but there is something called "continuous care" for patients who need it. Few hospices actually utilize continuous care because it is hard to staff. As the case manager you also order all the necessary dme, and soft supplies from diapers to wound care supplies, catheters, etc.

When I was a case manager I was usually in the field from 10 to 3, and the rest of my time was at home documenting or attending online meetings, phone calls etc. I usually saw 3-5 patients a day. Less patients when I had a far distance to drive between them, or when I had to recertify them for hospice and more when I didn't.

I find hospice to be extremely rewarding and challenging in a good way. It does make a difference which company you work for, so pick the best one with the best reputation.

There are hospice companies that load up the case managers with 20 patients. I would not recommend taking that job, unless all your patients are in 3 or less locations (like if you had all the hospice patients in 3 nursing homes and that was it.) nursing home patients are in some ways easier to manage than home patients because they have a nurse already caring for them, and you don't need to worry about supplies for them, but in some ways it can be really difficult when there is conflict or disagreement between facility Staff and hospice staff.

Feel free to ask me anything, I love talking about hospice

Anonnurse316 · Aug 6

That is so helpful!! Thank you! The case manager RN sounds like it has to be a full time position. What would PRN position look like if you were only working say once a week?

FolksBtrippin, BSN, RN · Aug 8

Anonnurse316 said:

That is so helpful!! Thank you! The case manager RN sounds like it has to be a full time position. What would PRN position look like if you were only working say once a week?

You're welcome! We have per diem RN case managers too. They just take a much smaller case load. Or you could just have a hodge podge of things to handle if you work per diem. You could do RN home visits without managing the case. You would probably do admissions and as needed visits. At my company we have a per diem nurse who almost exclusively does admissions. I think it most likely would be a mix of everything.

OnceIWas · Aug 13

Anonnurse316 said:

That is so helpful!! Thank you! The case manager RN sounds like it has to be a full time position. What would PRN position look like if you were only working say once a week?

Having worked hospice in the past, if you are new to hospice or a relatively new nurse (less than 2 years licensed) none of the agencies in my area would hire you PRN due to lack of experience UNLESS you had worked in hospice in another capacity (aide or LPN for example).

Some of the agencies around where I am do hire part time case managers. Keep in mind too that if the agency does not have a dedicated call team case managers rotate the call. And some agencies with call teams still have case managers on call as back up or fill in when the on call person is off. Make sure to ask this as case managers are expected to manage their case load in addition to the on call needs.