Home Health AND Hospice

[bshaw96]

I come from a hospice background, absolutely LOVED it until getting into the management part of it, where I became quickly jaded by my agency's total lack of concern for the patient and focusing only on how much money the pt. could get them from Medicare. Anyway, after a couple of years off, I've accepted a job as a part time HH nurse. I was asked since I had hospice experience if I'd mind the occasional hospice visit as well. I don't mind, as I loved being a hospice nurse. As I've gotten into the orientation this week, it appears I will be splitting hospice/HH pretty much 50/50. I'm a little nervous about how this will work. I've not done HH, but can't imagine doing them both. Hospice is a mindset I got into as a nurse. It was all about helping the patient die with dignity and being there for the family. And HH is about getting the patient better usually. I can't imagine trying to switch back and forth between the two. Not so much from a paperwork standpoint such as OASIS vs. LMRP, but from the actual care of the patient and family. Anyone do both and have any suggestions? I'm thinking of asking to do just one or the other, preferably hospice. Thoughts?

[caliotter3]

If you feel that you would be more comfortable doing only one, then go ahead and ask them for this option. There's nothing wrong with that. Maybe later on, you could add the other component on a schedule that you are able to control. There are a lot of nurses that do both at the same time. I've done a few hospice visits, not many, but am pretty much exclusively home health now. I don't think the mind set would be a problem. Just clear your mind and go into the home with the proper perspective for each client. It helps if you have set shifts during the week, like two home health shifts back to back, and two hospice back to back. But still, I don't think that will be a problem for you. Good luck and welcome to home health.

[bshaw96]

Thanks for the encouragement. :nuke: Maybe you're right, and I will be able to handle both. I mean, it would be nice to see someone get better on occasion I suppose. I just know if I had to pick one, it would be hospice, and I don't want my HH to interfere with the job I do for them, ya know? I think I'm just gonna see how it goes when I'm out of orientation. I will have set days, and I think they're planning on giving me my own smaller load to case manage, so it won't be like they're different every day. If nothing else, it'll strengthen my organization skills, which already border on OCD :wink2:

[annaedRN, RN]

My VNA has both HH and hospice. There is a clear hospice team and a clear HH team...but we do occasionally do the "opposite" visits. We try to have inservices so that the entire VNA is informed of how each side works. The hospice team is much more team oriented and the HH side is much more independent. I enjoy hospice nursing but my heart is HH - I want to see those wounds heal and IVs out etc. The main time I see a hospice patient is if the hospice side is very short-staffed for the day or when I am on call. All the RNs are on call about every 5-6 weekends - we need to know how to do the pronouncment and where to get the after hour meds etc. So, I would just talk to the supervisor about your concerns and preference to be mainly hospice---there may be another nurse who would like to be mostly HH. Anyhow, glad to welcome you back to the home nursing arena!