HH or Home Hospice? Which one??

[mb55]

I'll try to keep this as brief and to the point as possible 😊

I've been an ICU Nurse for @13 years. Have been in different units and hospitals. I am totally done! Burned out beyond belief. I've decided to leave the hospital environment and go into Home Health or Home Hospice. I am not expecting it to be easy or less stressful.... Just different, and I need/want that.

I've been offered a case manager position with both.

I've always liked my palliative /comfort care patients the best. I feel like I'm truly helping instead of just prolonging a painful death or extending a life with no real quality of life.

But I feel HH would be more interesting.

Both positions have there pros and cons. I'm hoping someone here has done both or decided between the two and can help me through the thought process so I make the best decision.

I'll gladly answer any questions. Thank you in advance for your help.

[makeitwork, BSN, RN]

Over the last four-plus years in hospice I have met several co-workers that worked in the ICU. The common thread was that they were tired of seeing patients whose families would not let their loved on go and they kept them on life support even if the patient did not want it. "Vegetable Row" was one term I heard. Some of these patients were there for months. These nurses felt it was cruel to the patients and a huge waste of resources--and they got tired of it.

They mostly made the move to hospice because they felt it was the next natural step in their careers. To provide comfort to end of life patients is just one aspect of hospice nursing. Should you choose hospice, you will, or should, begin to look at the family/household as the patient. Hospice nursing is more encompassing than administering morphine and lorazepam. I will tell you that I commonly spend as much time, or more, with family members than with the actual patient. Oftentimes, comforting and educating family provides me with as much job satisfaction as successful symptom management--and I get a lot of job satisfaction in this field.

We also coordinate care with the team which can include the chaplain, MSW, hospice aide, volunteer, comfort therapy, and, of course, the patients MD.

After all that, I will ask you to feel if you have a calling toward hospice and that you are not just looking for a refuge. Follow your heart. You will chose hospice if you do find you have a hospice heart. I wish you the best.

[Libby1987]

The sheer volume of non intuitive bureaucratic info you have to learn and assimilate as well as learn how to logistically schedule and then make changes on the fly without getting rattled make the first year of home health even rougher if you come to it exhausted and burned out.

Your current skills will benefit you greatly but home health covers just about everything so there will still be clinical knowledge and skills to gain, while simultaneously learning the above.

Another thing I've seen with CC nurses is the shock at the type of patients we manage at home. It's very common to hear, "they're not appropriate to be at home!" From my perspective, it's exciting and satisfying to manage complex patients at home where they want to be and to be able to teach and reassure their families how to care for them.

I would strongly advise you to apply to a variety of HH and Hospice agencies and ask to ride along for a day to really see what it's like, then multiply that X 10 for your first year.

If you can embrace all of the above you could really love home health, it's been an amazing career for me.

Another idea, look for an employer who has both HH and Hospice with the opportunities to experience both A large organization deep with resources and not 5 nurses having to share a huge service area and on call.