ER to hospice and the difference

[rearviewmirror, BSN, RN]

I don't know if you remember, but I recently posted a thread regarding whether hospice CM is similar to regular case management, to which lots of people responded negatively, therefore I thought it was appropriate for me to write little about hospice and what I feel so far about it, coming from level I emergency room where most of things I see is 95% non-sense (my belly hurts-lab work-ct abd/US/whatever-then most of times discharge, lady partsl discharge, atypical cp with negative trop, cough, rash, etc that does not require ER but more of pcp or clinic but who has money for that right? people need to spend money on iphones and just throw the bill in the toilet) to the rare 5% cases where I truly felt like I was doing something (sepsis, STEMI, stroke, intubation, lv 1 and 2 trauma, G60).

To begin, I like hospice. Well, for someone who completely hates being a nurse (thank you HCAPs, administration, entitlement) and who believes that the healthcare system and administration is totally flawed, I can tell I enjoy working at the hospice more than I worked at the ER where you see so much negativity about humanity all the time; only ER nurses can understand :)

First, patient and family members are much much more appreciative. In the ER, I think the biggest communication I had to make with pt and family member is why we aren't giving them dilaudid and why labs/xray is taking so long. Under-appreciation, even scornful attitude was at best what I received, and it really hardened my heart. I really didn't give a horse's butt if I was helping them or not, as long as I keep the ER doc happy, follow protocols, then all was cool. But almost everyone with hospice service is very pleasant and appreciative, which motivates me to be more assertive and attempt to actually help them.

Also, it's less pain on my body. There's no 12 hr bedside care, and with physical fatigue, twisted hip and spine, and yrs of night shift, this was fairly important for me. I visit LTCF and homes, where I am not doing much of bedside. The pay and hour is definitely better as well.

Of course, I never had a real orientation, and it's more of a figure-out-as-you-go type of thing, as most of mid-sized hospice companies can't really afford real orientation; but I'm literally learning as I go, and I feel like this is heck lot more meaningful than what I used to do.

I plan to eventually move over to insurance CM or office-based setting, but nonetheless, this has been quite pleasant experience so far, although at times stressful, but the stress I have been having at the ER was unbearable (many times no tech or medics at 50+ bed level I ER...), however for the mentioned reasons above, it's manageable and I am getting to enjoy this (I'm not saying this is easy, don't take it wrong way please).

I'm getting to learn all the details like criteria for CC, comfort kit, s/s of distress, what to do with death, who to call for what, what meds/services are covered and what aren't, etc. It's been fun learning.

[softrbreeze]

So glad you're enjoying it! I previously worked ER as well but have been settled in hospice for 10 yrs now. I have been considering a move to case management as well recently- hospice is a pleasant change from hospital work but after a decade, I'm feeling a little peaked

[rearviewmirror, BSN, RN]

It is real pleasant change from darn er/in-patient setting. However I know I am not favorer of clinical nurse, and I plan to get away from patients contact as much as possible. Although that is my goal, I feel blessed to hold this position in hospice.