Field Hospice Nursing vs. Inpatient Unit Hospice Nursing

[westieluv]

I currently work at an inpatient hospice facility on a contingency basis. Since we contingent RNs aren't getting many hours at this point, I interviewed for a different position within the company in which I would take turns being a triage nurse from home and being an off hours visit nurse. I think the position sounds very interesting, and every day would definitely be different which, after several years as a nurse in inpatient units, sounds refreshing. However, I have some safety concerns. I would love to hear from any of you who are visit nurses during the off hours and have to go out to patients' homes at all times of the night. Have you ever had a close call where you were actually in danger? Has it been actually very safe and rewarding? I don't live in a dangerous city or anything, but there is a very large urban area that is part of our field, and I am a bit concerned. I have been told that I can call for a police escort if I feel unsafe. Have any of you ever done that? I am a woman in her 40s who would be doing visits alone for the most part. Any information, experiences, suggestions, etc. would be very welcome. I like working in the inpatient unit and it does feel safe, but it also gets boring.

Thanks!

[tewdles, RN]

I do travel to dangerous urban areas...

but for the most part field visits at night is reasonably safe. You will find that patient families are interested in you arriving and leaving their home safely and will often escort you to and from your car. Most agencies also have a policy which directs your actions in an "unsafe" area...ours prefers that we notify the local police for an escort if the situation is unsafe.

Mostly it is very rewarding work. Good luck.

[westieluv]

Thanks for your response. It makes me feel much better about accepting this position. :)

[caliotter3]

Once I asked for a police escort and got told off rather handsomely. My agencies have never shown concern about personal safety so that is why you need to be proactive in this area.

[westieluv]

See, that's one of the things that concerns me, because the clinical director who interviewed me even gave a little disclaimer like, "You can always call for police escort. Of course, we aren't going to be the police's first priority..." Exactly. Like, what if I call for police escort for a patient who is in a pain crisis and needs me right away and they tell me that I have to wait...and wait...do I just go in and take a chance? The majority of the patients in our field are in a mid-sized college town and the small towns that surround it, which is all pretty safe, but a nearby large, dangerous city has me a bit worried, because I would be covering a little bit of that city and all of its suburbs on weekend call, even though only a small portion of our patients are in that area.

[caliotter3]

In a typical home health or hospice job you can turn down assignments in areas you do not care to go to. But oncall for the weekend, you will not have that option, I am certain. Is there someone else who could accompany you if push came to shove? If you can't resolve this one way or the other, I would reconsider. Call the police department on a normal day and ask about escort services. The person I talked to was very blunt about telling me forget it, the police had better things to do. If this is the case, you know you will have to fend for yourself. The Director is giving you a line that she hopes you will fall for. Yes, chances are low that a problem would come about, but it only takes once.

[heron, ASN, RN]

I work inpt hospice and deal with our on-call visit nurses a lot. From what I've heard from them, the bigger safety issue is driving while exhausted/answering the phone or otherwise pre-occupied. Depending on your agency's on-call staffing and backup situation, you could go looooooong stretches without sleep and still be expected to make the next visit ... not to mention getting your paperwork in on time.

That being said, I've met some who absolutely love the job.

[Bubbles]

I was an On Call nurse in a large metropolitan area a few years back. The majority of our calls came in by 11 PM, but there were situations in the middle of the night that required going to the patient's home. Some patients lived in very modest homes while others very nice. Never had any problem safety wise. We did have several serial murderers who were randomly shooting innocent people 'for sport' and the streets and neighborhoods were very empty at that time. I just tried to be aware of my surroundings. I found the work very rewarding. Wishing you the best! :)

[westieluv]

Thanks! I am going in this evening to shadow a visit nurse and hopefully go on a visit or two with her if she gets calls. I am so excited about trying something that seems so rewarding and is so "out of the box" of what I have been doing for my entire nursing career.

[Hospicetex]

Usually in the less savory areas I am on constant alert and watching my surroundings. I have had many families meet me at the door and walk me back to the car. The families are usually as fond of us as we are of them and they don't want bad things to happen to us.

I have been nervous going a few times but so far so good and to be truthful I have been more nervous at three in the afternoon in the hood then 1 am.

[Hospice Nurse LPN, BSN, RN]

I have had a few pts in the past who lived in "less than desirable" neighborhoods. Like the others stated, most families will watch out for you. Sometimes I've called a family back to let them know I'm turning on their street and someone will be standing outside watching for me. I've just never really been scared, I figured that since I have business being there God will look after me. I am careful though, keep my doors locked, watch my surroundings, ALWAYS wake my husband to let him know I'm going out. I actually asked a family member once if my husband (who volunteers for us) could ride along and they were o.k. with it (death call in the projects). Just use your smarts and you should be fine. Don't count on the police either....you aren't their priority. Good luck!

[Hospicetex]

You know I forgot to add in my post that I have also called the answering service and given addresses and details when I get spooked or things don't seem quite right and that if I don't answer in such a such time or call them by a time frame to please call 911. I have only done that once but things were very creepy and I was quite nervous.