Hospice RN in northern VA/ Montgomery county MD.

cardiacfreak, ADN · Apr 11, 2018

I live in the Midwest and am salaried. I do on call which I think is awesome because I get paid even if I dont get called out. I dont have any suggestions on what company to work for as mine is only based in 3 states, but what concerns me is being "worn out emotionally and mentally". Hospice can be very draining emotionally and mentally, but yes you are right it is very rewarding.

It took me a little while to get my head wrapped around hospice after coming from an acute care setting, but I love what I do now and would never want to go back to working in a hospital.

Sarl86 · Apr 12, 2018

I live in the Midwest and am salaried. I do on call which I think is awesome because I get paid even if I dont get called out. I dont have any suggestions on what company to work for as mine is only based in 3 states, but what concerns me is being "worn out emotionally and mentally". Hospice can be very draining emotionally and mentally, but yes you are right it is very rewarding.
It took me a little while to get my head wrapped around hospice after coming from an acute care setting, but I love what I do now and would never want to go back to working in a hospital.

Thanks for the reply!

I'm sure it is wearing as well, just in a different way.

This is what I'm trying to convey....

I feel like working in critical care we so often torture patients and prolong the inevitable. Hourly finger sticks, multiple lines, drips, being constantly woken, extubated, reintubated, sedation holds, run multiple codes on cancer ridden patients put them through CRRT, bronch etc etc etc. no rest for these poor folks. Family withdrawing patients DNR. those are the things that are wearing me out. I'm certainly no stranger to death I just see it in a completely different setting than hospice does.

The change in specialties would no doubt be quite an adjustment. A whole different way of thinking.

I followed a home hospice nurse for a few shifts when I was in nursing school and new then at some point my career would lead there. I always enjoy talking to the hospice nurses that come admit our patients when it does happen.

It seems like hospice nurses get the chance to do a lot of good. I Appreciate all that you do!

Katillac, RN · Apr 14, 2018

Lovely to see your interest in hospice. I couldn't agree more that hospice is a different kind of stressful but demanding all the same. But your experience, perspective and desire to move away from futile interventions will hold you in good stead. I don't have specific knowledge of your area to offer, but you may want to consider these general thoughts.

I haven't noticed roles for RNs in hospice to vary all that much. The most common is Case Manager/Primary Nurse, similar in many respects to that of a home care case manager. You'll also see RNs in on call roles, specialized liaison/admissions nurses in large hospices, quality assurance, and bedside nurses at hospice inpatient units. However, case manager is by far the most common, and I would say it would behoove anyone interested in hospice to start there. It's unusual for hospices to offer part time case management roles.

As a rule of thumb I think you can expect to start at 3/4 to 2/3 the salary that nurses in acute care start at in the area you're looking at, others may see it differently of course. Be very, very wary of a salaried position.

Consider whether the hospice you are looking it is for profit or not. It tends to make a big difference.

Ask about case loads, size of your "territory", length of orientation, and on call expectations. You will be learning a completely different approach to care, regulations and most importantly documentation protocol and software. For some hospice nurses, it's the finishing your day and needing to relax and decompress only to be on call - which can mean phone triage all night, visits, or both - that is the hardest to manage, and you certainly aren't advised to do it when you are first starting in the specialty.

Especially if the agency has a liberal PTO policy (which sounds lovely from the outside), try to find out how absences are managed. In a smaller hospice on more than half your scheduled days, you might be taking on half or more of the caseload from one of your absent peers on top of an already demanding assignment of your own.

By no means am I a naysayer here. Hospice has been for me more fulfilling than I could have possibly imagined. But the organization you choose to go with makes all the difference in the world. But I think you know that, and that's why you're asking!

Very best to you.

nuangel1, BSN, RN · Apr 14, 2018

Well said Kadillac .After being a nurse 30 years in hospital last 15 years in ED.Hospice is stressful to me in a very different way .I worked busy Level 2"s with our shares of trauma.I have been Hospice Casemanager now for 3 months and this was a real tough week for me.I got an 8 week orientation and I have a great team I work with .But the pts family and purpose of Hospice I totally get.I lost my Husband last year.The Hospice Team was awesome then and still are .But my Hospice uses HCHB the orderering system I find difficult .I took a pay loss to do this job.It is the correct step for me .I have only done 1 oncall shift with another nurse showing me the ropes.

Sarl86 · Apr 15, 2018

Thanks so much for your thoughtful reply. Very informative!

Sarl86 · Apr 15, 2018

I will say being a new kid is never fun. Wouldn't it be nice if we could just become instantly proficient in a new specialty?! 8 weeks sounds like a nice orientTion. I would need all they'd give me I'm sure.