Hospice case management... is it for me?

  1. Hi. I am looking into a RN case management position with a hospice company. I have strengths in the areas of empathy and listening to people. I really value spending time with patients and their families. But I have weaknesses in the areas of multi-tasking and time management. I tend to have an independent nature and maybe I've tried to do things all on my own too much in the past. I have 7 years experience as an RN; my first 2 years in med-surg and my last 5 in an ICU where I had a lot of experience with patients at the end of life- and their families. I think I would like hospice case management but I really don't know what it's like. My idea of it is that it's meeting with clients and their families, figuring out what sort of equipment, care, and meds they need, arranging for it, and then following up on it, and then helping the family arrange funeral plans in the end. I don't feel like it would be so hard but this need to be organized thing that seems to go with it is making me uncertain. If I've been able to manage things as a med-surg and ICU nurse in spite of these struggles, it shouldn't be a big deal right? Can anyone give me input on what a typical day for a hospice RN case manager might be like? What causes this job to be stressful? Do you think my weaknesses in the areas of time management an multi-tasking might make it a bad fit? I'd appreciate input from anyone who has related experience.
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    About kjpatek

    Joined: Dec '10; Posts: 2


  3. by   JerseyLilly

    Hospice nursing is a very special type of nursing, and feel it is very emotionally draining One has to be the type of a person who leaves their work at work and not bring it home. There is a lot of time management and multitasking involved which you say are your weaknesses--this may be a problem. Also, one must like field work, if it is field based. I would trying doing a forum search on this site to see what others have said about hospice nursing, the caseloads, the ethical principals, paperwork, etc. Also, check under the specialites tab as well. Hope this is helpful.
  4. by   NightNurse,RN
    It is very rewarding. Especially if you like to comfort and spend time with your patients. To find out your case load, and structure of hospice team is critical. Along with if you will be salary or hourly...trust me on this...If you are salary you will not be paid for additional hours over 40 hr per week....it is highly likely that you will be putting in over that...especially with paperwork you will do at home. Also find out about on-call responsibilities...on-call duty maybe after you have already worked your scheduled 8 or 8+ hours and on weekends. Actually I make less and work more in hospice than my other nursing jobs...I can spend more time with my patients and their families than in any other discipline of nursing I have been in. My hospice team is a loving, hardworking, and overall best coworkers I have ever encountered. However, we are understaffed and tensions do run high in EOL care.

    Our team all starts with a morning conference call. The on-call nurse gives report, concerns addressed, updates given, and schedule changes are made. Typically our case managers are scheduled to see 5 to 7 patients a day...this includes facility and home patients. You may get called to do an admission during your scheduled 8 hours or when you are on-call. You have to take care of assigned patient load as needs arise, which involves more than your hour visit a week once or twice a week. Then every two weeks is IDT, this is where you discuss each patient you have (15 to 25), each has specific paperwork needed to report on condition and hospice eligibility. Case managers are responsible for obtaining orders, calling in medications, setting up medications, updating medications (electronically and hard chart), updating care plans, equipment, additional services, admissions, discharges, and attending funeral (not mandated). Typically weekly visits are home patients get one R.N., one L.P.N. and three S.T.N.A....more if needed in all disciplines. Facility patients get one R.N. visit and three S.T.N.A. Visit note include full head to toe assessment, care plans, comfort care given, medications, change in patient status, orders obtained, and must reflect hospice eligibility.

    Organization is needed...to what degree I am uncertain. Find the nurse who is most organized in your discipline...find out how she does it...find the nurse who is least organized...find out how she does it. This way you will see what works and what does not...then adjust it to you.

    Flexibility is essential. Your schedule will change...ALL THE TIME...

    Other life saving essentials... GPS and WATERPROOF MASCARA...these are a must.

    Hope this was helpful.
    Last edit by NightNurse,RN on Jan 2, '11 : Reason: Correction
  5. by   kjpatek
    Thanks for your responses. Your thoughts are helping me with things I need to consider and questions to ask when I interview.
  6. by   PeggiRN12
    Try it!!!
    Hospice is a great calling!!!
    If your heart is saying do it!, then you should!
    Greatest delight I have in hospice is to ensure my patient "dies well" meaning relaxed and in no pain.
    Also rewarding, is supporting the families.
    Especially rewarding is the excitement of meeting awesome new people and being in new environments and advocating for the best care of my patients.
    In the five years I have been an RN, this is, by far, my most favorite type of nursing care!!