Care Manager vs Inpatient Hospice

[principessaGG, BSN]

I have been an RN working in various hospitals, med surg and med tel since 2006.  As a last hurrah, I recently started working in a step down ICU.  I love learning new things but HATE how task oriented it is and how NOT patient oriented it is.  I am 51 years old working in a sea of 20 something year old nurses who, I feel, are now being taught differently.  I am not saying it is wrong, but I just find myself very unhappy.  I know my biggest strength is bonding and taking care of the "patient".  I don't love all the drips, labs, CPR etc...  so...I find myself thinking that it is time to move to hospice where my people skills will be most useful.  I had a phone interview with a large hospice company that has openings in several in patient hospice centers (pro is that they are 12 hr shifts) but I am afraid it will be too much like med surg.  They also have a care manager position which is day shift ( I know work nights because I can't handle the pace of days in the hospital anymore in the physical sense) but it is 8-5 Monday to Friday, no weekends and no on call.  It would be going to some long term care facilities and acting as their case manager.  The recruiter, when I told her about my people skills said I would probably like the care manager position better  Does anyone have any thoughts on this?  My fear with the care manager role is taking home charting which I don't really want and the 5 days a week.  However, if it is more of a laid back job....tell me your thoughts.  Thank you so much!

[Julieanne1219]

I just graduated May 2020 and lasted all of 8 months in a hospital setting. Wasn't for me. I started with hospice in March 2021 as a case manager (care manager) and LOVE it. My company's expectations are to chart, order supplies, refill meds etc as soon as you finish seeing the patient so I never chart at home. I have several in long term and/or assisted living settings as well as home patients. It's Mon-Fri 8-430 and being home for dinner every night is EVERYTHING. And if I'm done at 3 and have no issues to deal with, I head home. There's still stress (I mean because... nursing... amirite) and occasionally difficult family dynamics to contend with but overall my stress level from working a medsurg/ortho unit is next to nothing comparatively speaking. I had a similar issue with not connecting with patients on the floor. Getting connected to the patients and families and helping one person at a time is the vision I had of nursing through school. Hope this helps ?

[principessaGG, BSN]

Thank you so much for you response @Julieanne1219.  So today I found out their medical is no where as good as hospital but after the HORRIFIC night I had, I may make the leap anyway.....My body just can't do it anymore....Do you find this job less physically demanding?  Thank you so much.

[Julieanne1219]

There's still repositioning patients and usually teaching the family how to do it properly but absolutely less demanding. The biggest beef I have right now is figuring out how to avoid fast food everyday! ? The biggest perk is that while I usually have a full schedule (4-6 visits a day), I'm in charge of it and can readjust as I go if a family needs more of my  time. It's a lot education and a lot of repeating yourself because most families have little to no medical background and have a hard time understanding when you want to discontinue a heart medication the pt has been taking for 20 years. But to answer your main question,  most are usually bedbound/incontinent/chairbound etc so yes, there's a lot less "work workouts". 

[grifton66, BSN]

I left an IPU in a large metropolitan hospital for a home hospice case manager position earlier this year. I miss the hospital. Being a case manager seems like a lot less hands-on nursing and a lot more busywork. I went from 3/12’s to M-F 8-5. Having so much less time off has been hard, but I have to admit that I am much less exhausted in general. The case manager position has a ton of autonomy, which is probably the best part about the job, but if I had it to do all over again, I wouldn’t have left the IPU/hospital. Don’t know if that input helps, but best of luck to you with whatever you choose!

[nuangel1, BSN, RN]

I just did the opposite went from fulltime casemanager mon thru fri with overnight oncall and weekend oncall position to IPU. After three years of CM caseload 12-25pts.all the endless charting I was exhausted .My IPU position is 3 12 1 sat shift every other week.NO oncall.love it better work life balance 

 

[toomuchbaloney]

On 5/31/2021 at 7:53 PM, principessaGG said:

I have been an RN working in various hospitals, med surg and med tel since 2006.  As a last hurrah, I recently started working in a step down ICU.  I love learning new things but HATE how task oriented it is and how NOT patient oriented it is.  I am 51 years old working in a sea of 20 something year old nurses who, I feel, are now being taught differently.  I am not saying it is wrong, but I just find myself very unhappy.  I know my biggest strength is bonding and taking care of the "patient".  I don't love all the drips, labs, CPR etc...  so...I find myself thinking that it is time to move to hospice where my people skills will be most useful.  I had a phone interview with a large hospice company that has openings in several in patient hospice centers (pro is that they are 12 hr shifts) but I am afraid it will be too much like med surg.  They also have a care manager position which is day shift ( I know work nights because I can't handle the pace of days in the hospital anymore in the physical sense) but it is 8-5 Monday to Friday, no weekends and no on call.  It would be going to some long term care facilities and acting as their case manager.  The recruiter, when I told her about my people skills said I would probably like the care manager position better  Does anyone have any thoughts on this?  My fear with the care manager role is taking home charting which I don't really want and the 5 days a week.  However, if it is more of a laid back job....tell me your thoughts.  Thank you so much!

My wife and I are retired.  She retired with hospice as her last area of work.  It was a perfect transition for her in her 50s. She preferred case management in the field.  But she also managed some hospice patients in the hospital setting or coordinated complicated home transfers. At the last she managed the region and did the visits that she wanted.  

I say trust your gut...that's just your knowledge and experience whispering in your ear. 

[grifton66, BSN]

On 7/2/2021 at 12:02 PM, grifton66 said:

I left an IPU in a large metropolitan hospital for a home hospice case manager position earlier this year. I miss the hospital. Being a case manager seems like a lot less hands-on nursing and a lot more busywork. I went from 3/12’s to M-F 8-5. Having so much less time off has been hard, but I have to admit that I am much less exhausted in general. The case manager position has a ton of autonomy, which is probably the best part about the job, but if I had it to do all over again, I wouldn’t have left the IPU/hospital. Don’t know if that input helps, but best of luck to you with whatever you choose!

Update...I left the case manager position and went back to the IPU/hospital environment, and I am so much happier. I go home at night, and while I may wonder how my pts are doing, I'm not anxious or obsessed about it. I am now able to reframe the physical exhaustion of the IPU in the context of how good it is to use my body and get some exercise, instead of sitting in my car most of the day. I learned a ton as a case manager, but turns out, I'm an IPU nurse.

[vampiregirl, BSN, RN]

So glad you found a position that is working well for you! 

There are some differences in the skill sets for case management and IPU but both skill sets offer "tools" that are very helpful in the other setting.

[Clearnightsky1]

I just got an inpatient unit offer for nights. They have 14 beds and only 2 nurses and no CNA at night. This seems way too high but I don't have inpatient experience. Can anyone comment?

[Peachpit]

I know this thread is old but I am wondering what the OP decided to do?

I moved into a weekend on call position a few months ago instead of moving back into the hospital setting. And I regret it. 

While the position is not physically or technically demanding like the hospital, I have found it to be much more stressful. I would not work a dedicated on call position again. Kudos to those who love it.