hospice home health or hospital med surg?

ErinS, BSN, RN · Mar 25, 2011

My work hours are 8-5 M-F. I work in hospice. I average closer to 50 hours a week than 40. And this seems to be fairly standard across the board, particularly with a census of 20. I case manage 13-17 and work long hours. I am not sure what an average of '14' visits means, but it that is per day, than run, don't walk from this job. I am working working 50 hours a week and averaging 5-8 visits a day. My weekly requirement to hit productivity is 25, although I usually do closer to 30-35. Hope this helps.

By the way, I make much more than hospital nurses in my area do. Also, there is something very different about seeing pt's in the home. And while I certainly spend less amount of time with pt's during an average shift, I have much better quality time with them. I often intimately know their family, friends, clergy, pets, and their history. That is one of the best parts of my job. There is also something very sacred about being invited into someone's home to care for them, and there is a different power balance. We are working together towards a goal, not the doctor says do this, so the pt does it.

merlee · Mar 25, 2011

I don't understand - 20 patients but only 14 visits? What are doing with the rest of your time?

NPvampire, MSN, RN, APRN · Mar 25, 2011

There were two things I detested about home health:

#1 the environment: it is not the hospital, it is not always a nice clean house, sometimes it is a one-cat-crap-overflowing-litterbox x 1000 cats using it in 100 degree heat because the person has no air condition. It is getting in and out of the car in said 100 degree heat or pouring rain or 0 degree winters, to meet a person in a smoke-infested house that smells worse than the club. I have allergies and the environmental thing really made me sick last summer--one of the main reasons I got out of HH.

#2 in regular (unsure about hospice) HH there is a LOT of computer charting for medicare and writeup and if you have patients that require a lot of education and hands-on skills (IV, wound care, etc etc) you will be doing the computer charting after the rest of your family goes to bed (medicare states regular HH must be submitted next bus day). That kind of got to me, between that, calling the doctor, social worker, family, pharmacy, on and on, I felt I was never "done..." I was constantly taking and making calls even on my "off" days.

But our agency considered 25 visits per week to be full time, not 14. And in a rural area it is a lot harder, too, they are so far apart the driving and finding the places takes forever. (get a good gps if you take the job). 14 does sound better, shoot, I used to do that many in 2 days. Hence all the charting at home.

And the flexibility and autonomy is really nice...no manager vulturing over your shoulder, no passing 50 different meds, no doctors turning up their nose at you and treating you like dirt, you can come and go and use the bathroom or eat as you want, take breaks, pick up your kids, get up a little earlier or later to get done for the day. I loved those parts! (and having weekends off)

Compare the money though...in our area HH doesn't pay well at all. Not sure about hospice. Oh, duh, I just saw yours pays more than the hospital. If that were true for me, I probably would've tried to stick it out and take Benadryl after work for the animals...but after 6 months we were just drowning in debt. Also, if you take the job, get a high-minutes plan for your cellphone because you will use them.

evolvingrn, BSN, RN · Mar 25, 2011

our facility provides cell phones for in home staff

ninaricci · Mar 25, 2011

Thank you so much for your insights! Although I am still concerned about the possible lengthy hours I am going to accept the job with hospice home health. My patients will be in skilled and/or unskilled facilities which, I think, is preferable to actually going into private homes. They also provide a laptop which hopefully will enable me to chart from home if need be. My other job option was with the hospital, days, but straight weekends which really troubled my 12 year old. the hospice job will give me weekends, holidays, even some snow days which is more complimentary to the kid's schedule.

If I can ask a couple more questions: I will do call one night a week 5p-8am. Triage nurses are the front line for on call so I'm hoping that will provide a cushion (ie. lessen the times I have to go out). Do you all do call and if so how frequently does it occur and what types of incidents and stress level? My second question: I have 2 years experience in critical care which is the totality of my nursing career. I am somewhat fearful that removing myself from the hospital, especially with limited experience, to do the home health care will make it hard for me to be accepted back into the hospital setting if indeed I find I made the wrong choice and what to go back. Any thoughts?

Again, I truly thank you...your comments are helping me achieve a greater level of peace with my decision!!!!

evolvingrn, BSN, RN · Mar 25, 2011

Thank you so much for your insights! Although I am still concerned about the possible lengthy hours I am going to accept the job with hospice home health. My patients will be in skilled and/or unskilled facilities which, I think, is preferable to actually going into private homes. They also provide a laptop which hopefully will enable me to chart from home if need be. My other job option was with the hospital, days, but straight weekends which really troubled my 12 year old. the hospice job will give me weekends, holidays, even some snow days which is more complimentary to the kid's schedule.
If I can ask a couple more questions: I will do call one night a week 5p-8am. Triage nurses are the front line for on call so I'm hoping that will provide a cushion (ie. lessen the times I have to go out). Do you all do call and if so how frequently does it occur and what types of incidents and stress level? My second question: I have 2 years experience in critical care which is the totality of my nursing career. I am somewhat fearful that removing myself from the hospital, especially with limited experience, to do the home health care will make it hard for me to be accepted back into the hospital setting if indeed I find I made the wrong choice and what to go back. Any thoughts?
Again, I truly thank you...your comments are helping me achieve a greater level of peace with my decision!!!!

Facility hospice case mgt from what i hear from my colleagues who have transferred into that role is much less time consuming than the in home. they still have complex situations but these pts also have skilled care so you much less likely to get 'called' in when your on call as well. I have heard from one of the nurses that she actually gets home early once in awhile gl