Hospice LVN vs RN

[moomin, LPN]

Hello,

I am a LVN thinking about entering hospice. Would anyone be able to help me out and let me know what a LVN hospice nurse does vs an RN hospice nurse? Also, would you consider hospice nursing less stressful than working at a LTC facility? How does scheduling typically work for hospice nurses? How much experience would you recommend before entering hospice? I currently have 7 months of experience as a LVN in LTC.

Thank you!

[vampiregirl, BSN, RN]

Where I currently work, we have an amazing LPN who does visits. She works part time, typically 2 days a week. 

At our agency, the RN case managers do the admissions. LPN's can do admits but regulatory requirements stipulate an RN must do an admission assessment within 48 hours of admission. It's just less complicated for everyone if the RN does the admission. Any orders must be co-signed by an RN - that's not a problem for any for us. Our case managers make the initial care plans and update them. Medicare requires that an RN perform an aide supervisory visit every 14 days. Other than that, LPN's can perform anything else allowed by their scope of practice. 

I don't know that I'd say one environment is "less stressful" over another as a general rule. So many factors go into this. I worked SNF/ LTC prior to coming to hospice. I enjoy focusing on one patient at a time. I love education, there's a lot of this in hospice. The schedule is more adjustable. Documentation is still important - depending on the charting system and agency policies, charting can take awhile. I certainly don't miss huge med passes in nursing home life!

Typically I work Monday - Friday 0800-1630 but frequently have charting in the evenings. I have call one night a week and every 4th weekend. Call typically isn't awful but occasionally gets busy. We are all hourly.

As for experience, it just depends. Some agencies have great orientation programs for people with limited experience. Other agencies only accept people with lots of experience. You are typically by yourself in the field so it's important to be proficient in skills (catheters, blood draws, wound care, etc). Great assessment skills and interpersonal skills are two on the most important skills. 

I think I've answered most of your questions, but let us know if you have more!

[PoodleBreath]

I'm an LPN who transferred from SNF to hospice. We work with patients in nursing homes, hospitals, private homes and also have an inpatient unit. We occasionally go to the ER with our patients. People don't stop living just because they're dying and living out in the world carries it's own risks.

For me the plus is that I am working with patients who are much more varied and medically complex than in SNF/LTC, ages range from infancy to elderly. I have a lot more autonomy, and have been able to use and expand on my nursing and critical thinking skills. I am also personally driven to the philosophy of hospice, most of us come in to the profession with a history of our own experiences with death and dying.

Another plus is that the hospice care model is very collaborative and mission driven. I spend a lot of time with my patients, rather than the chaos of the floor of running from one patient to the next. We become deeply connected to our patients and families because we start this journey with them and stay with them to the end. The commitment to their well-being is deeply personal.

The downside is that it can be very lonely. We see patients on our own and don't have that comraderie that we have on the floor. It's hard to go into a crisis and not be able to be with our co-workers while we're dealing with it and debrief in the moment. There is a lot more processing of tragedy that goes on alone. Most hospice agencies typically offer counselling for nurses who have been traumatized because there are some visits that are so awful. Things can be unpredictable.

The other downside is that hospice has become more corporatized. There is a lot of pressure to do as many visits as possible in the shortest amount of time. We never have enough nurses. We often have visits stacked up with no time to break or chart and often work hours over shift to finish visits and charting. At times we're assigned a visit twenty minutes before end of shift because there is no one else to do it.

A lot of visits do turn into crisis situations and we end up having to stay longer than planned. If you are with a patient and family and you are the one who is looking them in the eye and needing to solve that crisis, it is impossible emotionally to leave until the problem is solved, even knowing that you have more visits and other patients are calling triage to find out when you're going to get there. This is the unfortunate effect of for-profit hospice.

So it's a mixed bag. If you love hospice and constantly learning and being present for your patients there is no better job in the world. The team work and is amazing. The emphasis on being good to each other as we do this work is empowering.

In a SNF, we see patients decline and then die as a natural progression of disease. I will say that death does not happen that easily outside of facilities. Sometimes the tragedy is overwhelming. A lot of nurses come into hospice because they think it will be easier than working the floor and they flame out within months. It is hard.

I can't imagine doing anything else with my life. I would love to see more LPNs come in and represent.