ER to Hospice

  1. Hello :-) I am hoping to take a job as a hospice RN. I have been an ER nurse for 4 years in an acute care setting with 1 year as a hospital case manager. I have always worked in acute care/hospital setting.

    These are the things I think I will really appreciate about being a hospice RN:

    (1) I get to be out in the field. There are probably pros and cons to this that I haven't yet considered, but NOT being within the walls of the hospital sounds very free to me.

    (2) Working with patients one-to-one. In the ER, I have 4 patients at a time, and it is a treat-and-street model. I look forward to (hopefully) having less interruptions as I care for each patient one-to-one.

    (3) Environment of care. Hospice incorporates alternative therapies and often has a calm, peaceful environment of care. The ER is chaotic, teeming with family member, patients, co-workers, and administration. I feel that hospice will be less stressful with regards to the busyness of the ER versus the home care environment. I can't wait to be out of the acute care setting!

    (4) Day shift hours. In the ER ... I work night shifts or sometimes mid-shifts (3pm to 3am). I am *not* a night owl, so these hours are tiring to me, and seep into my next day. I look forward to having a better, more regular sleep schedule, working Mon-Fri 9am to 5pm.

    Cons:

    (1) I will work 5 days per week instead of just 3.

    (2) Dealing with a patient and family members for a longer amount of time ... very difficult patients and family situations will be an ongoing situation rather than just part of a shift.

    (3) Having to deal with traffic as I use my car to visit patients in their homes or other care settings.

    (4) Having to deal with dirty homes with animals that have lots of hair and bad smell.

    (5) My days off will be shared with everyone else - I won't be able to hit Costco on a Tuesday afternoon, but will have to use my weekends to get everything done.

    (6) May be paid slightly less and have to pay more for healthcare. Benefits package (401K) may not be on par with hospital benefits.

    What else am I missing? What are some of the pros and cons of hospice nursing for you? Have I hit all of the main points?

    I am only comparing this theoretically in my mind right now - with no practical experience as a hospice RN - so I'd love to hear from people who actually do the work - to see if I am being overly optimistic or properly pragmatic on my pros and cons list of being a hospice RN.

    Thx, Anne Marie
  2. Visit anne_marie_oregon profile page

    About anne_marie_oregon, BSN, RN

    Joined: Nov '10; Posts: 130; Likes: 67
    RN; from US
    Specialty: 6 year(s) of experience in Nursing

    8 Comments

  3. by   vampiregirl
    Hospice is a fantastic area of nursing. I don't see myself looking to get out of this area.

    Regarding your question...
    For your pros - keep in mind some residences of hospice patients are not going to be calm. You will sometimes encounter residences that might be a candidate for the TV show "hoarders". Other residences may have multiple animals (sometimes of various species!). And some may have lots and lots of occupants, who may not all be on board with the idea of hospice. Keep in mind, the patients often chose these environments and that is where they are comfortable. When I was out in the field, I had a couple of case that I thought would NEVER work out safely... and they ended up being some of my coolest, most memorable cases in a positive way. There were also a couple that were just interesting the whole way through.

    Also, does the hospice you work for require sharing/ rotation of call? Different hospices do different things. When I worked out in the field, we had to take some evening/ night and weekend call. Also, it was not uncommon for me to have charting that took quite a while in the evenings. We just had to be synced by midnight, so I could take a break and finish it later if I wanted/ needed to.

    For me the positives as I look at them considerably outweigh the cons.

    Even though hospice nursing is very different than ER, your ER experience will be invaluable. Assessment skills, identifying when something "isn't right" (either with the patient or the environment) and dealing with people in crisis are all attributes that I've noticed in the ER nurse transplants I've worked with.

    Good luck with whatever you decide!
  4. by   nurse_flo_marie
    I started to read all your Pro's and winced a few times. I felt much better after seeing you also had a list of Con's. I did a year of hospice. I LOVE the philosphy behind hospice (but the business side can make it not worthwhile). Many people still view hospice as euthanasia compared to care and comfort measures. Educating others will be one of your biggest responsibilities.

    Some suggestions. Find out if the company requires you to do on-call and/or weekend rotations. The company I worked for said no, but somehow I ended up doing it several times in a row. In hospice and community health settings, NEVER give out your personal number. If it's absolutely necessary to use your cell, block your number and remind patients & family to call the office during non-business hours. Commute was a big pain point for me. Ask about your territory. My territory seemed to grow monthly, and I would sit in traffic as my phone buzzed about patient A, B & C needing an urgent visit.

    I can say luckily, I had a great team - the scheduler was my personal secretary sometimes & the aides would comfort patients and let me know any changes. Staffing is always a challenge, so keep that in mind because you will be physically on your own compared to the support in the ER.

    Good Luck! When do you hear back about the job?
  5. by   anne_marie_oregon
    Thank you so much for your replies, vampiregirl and nurse-flo-marie,

    I am really hoping to "land" my career in a field where I can express compassion. I know I can bring compassion to my daily work in the ER, and I certainly do!

    But I also find myself very scattered due to constant interruptions. I also dislike working Fast-Trax in the ER, although I can bring compassion ... it's hard to see THAT many patients. I feel like working OUTSIDE the hospital environment will be a better fit for me - but I also do NOT want to have "grass is greener" syndrome!!!

    I know there will be chaos and interruptions in the hospice environment as well - so i don't want to have my rose-colored glasses on! :-)

    nurse_flo_marie ::: to answer your question, "Good Luck! When do you hear back about the job?"

    I am doing a ride-along this week :-) So ... no job offer yet. But my hope is that I will hear about the job soon! This is for a non-profit hospice ... so I am guessing there are lots of pros and cons to this as well!!! (pro-bono patients).

    Do you think non-profit is a better hospice model than a for-profit model?
  6. by   AtlantaRn1
    I think you will Enjoy hospice. But be prepared that it has moments where you will feel you are working fast track again. I do on call so I'm like the fireman-fix a problem and move to next problem.
  7. by   nurse_flo_marie
    Quote from anne_marie_oregon
    Do you think non-profit is a better hospice model than a for-profit model?
    Hmm... that is a tough question to answer. As nurses we hate to think of what we do as part of a business... but it is. In one of my current positions, I'm able to see how non-profits work & what they need to survive. Funding will determine how the hospice runs. It may have great intentions in the beginning & provide above standard quality of care, but if funding decreases, you may be asked to do the work of 2 or 3 nurses... which is the case for for-profits.

    Do you still have rose-colored glasses on after the ride-along?
  8. by   anne_marie_oregon
    An update from me :-) I started a job with hospice in May, so I am just hitting my 90-days. So far so good! The things that have bothered me the most are:

    1) I am definitely racking up miles on my car. I worry that this is going to be bad for my car and expensive in the long run.

    2) I REALLY miss having a day off during the week!

    3) I'm not making as much money as I could in the hospital. Definitely thinking of doing a Saturday side-hustle for a while to have a little extra cash.

    The good things:

    1) I am on DAY SHIFT!!! OH my goodness!!! No more late nights - up until 4am. This really is a good thing!!!

    2) The team is incredible! Everything from the interdisciplinary members, the social workers, the other nurses I work with ... a great supportive environment.

    3) My patients actually say THANK YOU! In the ER, all it was was a bunch of complaints. This is quite a difference!!!
  9. by   anashenwrath
    Congrats OP! Based on your username, I'm going to assume you're in Oregon, which is a very good state for EOL care!

    Reading through your pros and cons, I noticed a lot of "logistical" factors, so I wanted to chime in as you get started as a hospice nurse. Yes, we get mileage, amazing bedside experiences, and awesome self-management. Yes, I have ended my day at 3 pm sitting on the beach in my scrubs, documenting on my tablet.

    BUT: that's not a reason to be a hospice nurse. I have sat at a patient's home for 6 hours (until 1030 pm), putting all my other visits on hold, while that patient breathed their last breath and their 12yo daughter screamed at me (most of my other families were ok with rescheduling, some made me feel like crap). I have had my phone ring at 8 pm with the on-call nurse trying to figure out how to get symptoms under control. I have had to drive an hour out of my way to change a dressing or have a family meeting because "dad seems depressed." I have had family members--HCPs--who were so in denial that they accused me of lacking compassion bcs I advised against CPR.

    I'm not trying to be dramatic or anything. I just really want to make it clear, hospice isn't all about the mellow hours and "kumbaya" philosophy. We work ourselves to the point of exhaustion caring for people and families at the darkest hour, and our reward is frequently tears, occasionally anger.

    Please prepare yourself for a type of burnout you may have never experienced before. Yes, there are hospice nurses who kind of "coast" through their caseload without ever really investing in the work. The other RNCMs are not fans of these individuals, and usually the families ask for another nurse after a while
  10. by   anne_marie_oregon
    Thank you for the reply ana shen wrath. I think I like this job more than any other job I've ever had :-) It's kind of amazing to say it!!!

    A few more negatives that I have run into:

    - No refrigeration! It's hot out there - and I can't seem to keep my lunch cold, no matter how many ice packs I stuff in there :-)

    - All kinds of stuff in the back of my trunk. I find myself needing different supplies for different scenarios, and my trunk is full of crap.

    - Charting in my car with the A/C running. Am I going to kill my car, with how much I use it? I fear this! And sometimes I crave a big, spacious desk where I could spread out and lay papers.

    But, even with the negatives, this is truly an amazing job. I feel that I am doing some good in the world, and ultimately, it feeds my soul.

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