is hospice nurse and hospice case manager same thing?

Jensmom7, BSN, RN · Jul 4, 2015

Hospice nurses are called Case Managers because they are the head of the Hospice team. They are NOT the Case Managers you see in the ER or on the floor.

As a Hospice nurse/Case Manager, you have a caseload of patients. I currently carry 16, which may seem like a lot, but all of mine are in one facility, so I have no travel time. I do 5-6 routine visits daily, which includes a physical exam (mainly based on symptoms, not always head to toe, depending on how s/he is feeling), and yes, some physical care. I assist the Wound nurse as needed, assist the CNAs with bathing/cleaning/changing (when they let me lol), and if these patients were in their own homes, I would be putting in Foleys as needed.

Every day, I do a "head count" on the people I don't have scheduled for the day, and talk with their nurses. Helps with staying on top of symptoms. Sometimes it turns into a PRN visit, requiring calls to physicians.

Don't be fooled by the "Case Manager" designation in Hospice. You will NOT be sitting in an office all day, never interacting with patients, families, facility staff, Hospice team members, and physicians.

rearviewmirror, BSN, RN · Jul 5, 2015

Hospice nurses are called Case Managers because they are the head of the Hospice team. They are NOT the Case Managers you see in the ER or on the floor.
As a Hospice nurse/Case Manager, you have a caseload of patients. I currently carry 16, which may seem like a lot, but all of mine are in one facility, so I have no travel time. I do 5-6 routine visits daily, which includes a physical exam (mainly based on symptoms, not always head to toe, depending on how s/he is feeling), and yes, some physical care. I assist the Wound nurse as needed, assist the CNAs with bathing/cleaning/changing (when they let me lol), and if these patients were in their own homes, I would be putting in Foleys as needed.
Every day, I do a "head count" on the people I don't have scheduled for the day, and talk with their nurses. Helps with staying on top of symptoms. Sometimes it turns into a PRN visit, requiring calls to physicians.
Don't be fooled by the "Case Manager" designation in Hospice. You will NOT be sitting in an office all day, never interacting with patients, families, facility staff, Hospice team members, and physicians.

Thanks for your comment. I do understand that some contact with patients will exist, since I do have to assess them and coordinate services such as wound care, social work, chaplain, etc, but I expect to not do much of bedside care, but more of thinking and facilitating the services; that means no more perineal care, no more labs, no more giving meds, no more 7p-7a, no more passing out blankets, standing forever, working on weekends, etc. I know these are absolute necessary part of nursing, but I have done it all and I don't want to do it anymore, so I hope you don't take me wrong way. I want to finally do the thinking part, not the physical labor part, and learn and move onto insurance. I hope this is a good set up for me to learn more about cm.

QuiltDog · Jul 5, 2015

Thanks for your comment. I do understand that some contact with patients will exist, since I do have to assess them and coordinate services such as wound care, social work, chaplain, etc, but I expect to not do much of bedside care, but more of thinking and facilitating the services; that means no more perineal care, no more labs, no more giving meds, no more 7p-7a, no more passing out blankets, standing forever, working on weekends, etc. I know these are absolute necessary part of nursing, but I have done it all and I don't want to do it anymore, so I hope you don't take me wrong way. I want to finally do the thinking part, not the physical labor part, and learn and move onto insurance. I hope this is a good set up for me to learn more about cm.

Please understand, as others have stated, that a hospice "case manager" has nothing to do with what a traditional case manager does. Consider the hospice role as a staff nurse for home hospice patients. You do not "coordinate" other disciplines, you collaborate with them. If you are doing home hospice, prepare for a lot of patient care. As other posters have mentioned, you will stand on your head to place a foley while your patient is on their couch. You will clean up incontinent patients, because the aide isn't due to visit today. You will draw labs, and get to transport said labs to the hospital. Most hospices I am aware of have some on call rotation, which may include evenings or weekends, or both.

I am not trying to dissuade you from taking this job. I have done hospice nursing for 11 years and do not want to do anything else. I think you need to understand what is really involved with the job. Certainly, it is less strenuous than working a hospital floor, but it has it's own stress.

Good luck!

Jensmom7, BSN, RN · Jul 5, 2015

Thanks for your comment. I do understand that some contact with patients will exist, since I do have to assess them and coordinate services such as wound care, social work, chaplain, etc, but I expect to not do much of bedside care, but more of thinking and facilitating the services; that means no more perineal care, no more labs, no more giving meds, no more 7p-7a, no more passing out blankets, standing forever, working on weekends, etc. I know these are absolute necessary part of nursing, but I have done it all and I don't want to do it anymore, so I hope you don't take me wrong way. I want to finally do the thinking part, not the physical labor part, and learn and move onto insurance. I hope this is a good set up for me to learn more about cm.

I don't want to beat a dead horse, but I'm concerned that you are still hung up on the "Case Manager" designation in Hospice.

It is NOT a good set up for you to learn how to do traditional Case Management, and Hospice experience won't win you any Brownie points for your ultimate goal of moving into insurance. For that goal, you would do better to stay with acute care experience, or even Home Care.

Please, don't go into Hospice simply because you hope it will be a stepping stone to what you really want to do. The knowledge you gain doesn't really transfer to other settings.

I'm not trying to be negative, I'm just protective of my speciality and the population we care for. Truthfully, except for nurses who decided that the whole Hospice concept wasn't for them, I've never heard a Hospice nurse talk about moving along to a different specialty.

rearviewmirror, BSN, RN · Jul 5, 2015

Please understand, as others have stated, that a hospice "case manager" has nothing to do with what a traditional case manager does. Consider the hospice role as a staff nurse for home hospice patients. You do not "coordinate" other disciplines, you collaborate with them. If you are doing home hospice, prepare for a lot of patient care. As other posters have mentioned, you will stand on your head to place a foley while your patient is on their couch. You will clean up incontinent patients, because the aide isn't due to visit today. You will draw labs, and get to transport said labs to the hospital. Most hospices I am aware of have some on call rotation, which may include evenings or weekends, or both.
I am not trying to dissuade you from taking this job. I have done hospice nursing for 11 years and do not want to do anything else. I think you need to understand what is really involved with the job. Certainly, it is less strenuous than working a hospital floor, but it has it's own stress.
Good luck!

Thank you quiltdog. I do understand that it is not exactly the kind of case management I am looking for, but at least I am hoping that this experience plus my clinical experience can open doors for me into real case management, and according to one of cm i talk to, the experience does apply towards that desire, so I am hoping to learn a lot from this and possibly move on.

QuiltDog · Jul 5, 2015

Thank you quiltdog. I do understand that it is not exactly the kind of case management I am looking for, but at least I am hoping that this experience plus my clinical experience can open doors for me into real case management, and according to one of cm i talk to, the experience does apply towards that desire, so I am hoping to learn a lot from this and possibly move on.

May I make one suggestion? See if you can shadow a hospice case manager for at least one full day, or even two days. This will give you the real "flavor" of home hospice nursing. Keep us posted and best wishes!

toomuchbaloney · Jul 7, 2015

May I make one suggestion? See if you can shadow a hospice case manager for at least one full day, or even two days. This will give you the real "flavor" of home hospice nursing. Keep us posted and best wishes!

I agree that the OP needs to shadow a hospice RN Case Manager as it seems that there is little appreciation for what they do. It IS REAL CASE MANAGEMENT. It just isn't the nursing case management that you see in the acute care hospital setting.

If one want to work in the insurance industry jump in...you really don't need case management experience to do that. Insurers employ nurses to case manage (without previous CM experience), to provide utilization review, to interact with beneficiaries, etc.

The insurance companies (HealthNet, Humana, and United Health Care) which administer the Tricare benefit are almost always looking for good nurses. That work is generally available in all 50 states or in the form of work at home positions. It can be financially rewarding if one can stomach working in the insurance industry; many nurses cannot.

I have worked for a company in which the RN Case Managers did not actually visit patients. They sat in the office and did the paper work or answered phone calls from patients/family/physician offices. I worked only briefly in that environment as it seemed very disjointed in the provision of care...focus of care seemed to be staff/organization driven rather than patient driven.

rearviewmirror, BSN, RN · Jul 8, 2015

I agree that the OP needs to shadow a hospice RN Case Manager as it seems that there is little appreciation for what they do. It IS REAL CASE MANAGEMENT. It just isn't the nursing case management that you see in the acute care hospital setting.
If one want to work in the insurance industry jump in...you really don't need case management experience to do that. Insurers employ nurses to case manage (without previous CM experience), to provide utilization review, to interact with beneficiaries, etc.
The insurance companies (HealthNet, Humana, and United Health Care) which administer the Tricare benefit are almost always looking for good nurses. That work is generally available in all 50 states or in the form of work at home positions. It can be financially rewarding if one can stomach working in the insurance industry; many nurses cannot.
I have worked for a company in which the RN Case Managers did not actually visit patients. They sat in the office and did the paper work or answered phone calls from patients/family/physician offices. I worked only briefly in that environment as it seemed very disjointed in the provision of care...focus of care seemed to be staff/organization driven rather than patient driven.

hey toomuch, thanks for your comment. Although I interviewed for couple insurance positions, this hospice position was actually the fastest one to offer, so I grabbed it. I believe I can learn tremendously from this position in terms of "managing", which would really help well into getting what I want later, or who knows, I might like hospice cm so much I could grow in it. But at least this position seemed to offer more experience for what I am ultimately seeking (insurance cm) than current bedside role. As one of cm I spoke to said, you can't always start with plan A, but rather start with what you get, and go for what you want. I don't plan to do half-ass job either because that's not who I am, but learn and move on... isn't learning and challenge what we all need to do in this life.

Jensmom7, BSN, RN · Jul 8, 2015

hey toomuch, thanks for your comment. Although I interviewed for couple insurance positions, this hospice position was actually the fastest one to offer, so I grabbed it. I believe I can learn tremendously from this position in terms of "managing", which would really help well into getting what I want later, or who knows, I might like hospice cm so much I could grow in it. But at least this position seemed to offer more experience for what I am ultimately seeking (insurance cm) than current bedside role. As one of cm I spoke to said, you can't always start with plan A, but rather start with what you get, and go for what you want. I don't plan to do half-ass job either because that's not who I am, but learn and move on... isn't learning and challenge what we all need to do in this life.

I wish you luck in your new job, but something still tells me that "Hospice Case Manager" still doesn't mean what you think it means.

Please, keep in touch here and let us know how it goes. I hope my gut instinct is wrong, I really do.

rearviewmirror, BSN, RN · Jul 8, 2015

I wish you luck in your new job, but something still tells me that "Hospice Case Manager" still doesn't mean what you think it means.
Please, keep in touch here and let us know how it goes. I hope my gut instinct is wrong, I really do.

I sure will. I am glad at this point that I can do something different than facility bedside nursing, and you know if this isn't what I was looking for, I will learn and move on :), at least this new role seems to provide a lot of learning experience and autonomy. I'm excited that I will be exposed to some kind of (even minute) managed care.

QuiltDog · Jul 8, 2015

I wish you luck in your new job, but something still tells me that "Hospice Case Manager" still doesn't mean what you think it means.
Please, keep in touch here and let us know how it goes. I hope my gut instinct is wrong, I really do.

I feel the same way!