Hospital vs. Hospice career

[C. T.]

Hello all,

I am seeking your expert and experienced advice on a dilemma I have been having.

Background: I am in my first year of CNS school. I have been a bedside RN in various hospitals, of different specialties, for seven years now. I feel pretty burnt out from bedside nursing, hence starting CNS school. I am not entirely sure what I want to do with this degree. I chose CNS because I wanted to have more options. NP does not interest me at all, nor does Midwifery or CRNA. What interests me is education and educating patients and families. I do have an interest in becoming a clinical instructor or adjunct teacher. But, like previously stated, I am burnt out of being a bedside nurse. I most enjoyed taking care of end of life patients during my seven years at the bedside. I always had an interest in hospice nursing, but felt I needed more experience and knowledge. I now feel like I have nearly mastered the stress of acute care hospital nursing, and am ready for a change.

Dilemma: I have been offered a hospice admissions/patient care resource (prn/per diem) RN position. Pay is not an issue. The issue is, do I leave my hospital job to go to a hospice job knowing that I am graduating in two years? The hospital I currently work for is a very big, productive, well known and amazing hospital. They treat their employees wonderfully. I really like the hospital itself. I just don't like how ANY hospital is run. I don't agree with some politics and some regulations, among other things. And being I will graduate with my CNS in two years, do I stay at this big hospital that probably has more opportunities for a CNS? Or do I change it up and do hospice for two years, then figure out how to apply my CNS education in the hospice company? If I chose to stay in the hospital, I am not sure I want to contribute to all of the hospitals regulations and policies if I can't really agree with them now. (I hope this is making sense to you guys.) Or do I say screw it, do hospice for two years, then try clinical instructing/teaching when I graduate and NEVER return to bedside?

What do all you CNS's think would be the best move? What would you do? I have no one who is unbiased that I can bounce ideas off of, and listen to experience from. I do plan on talking to my professors too.

Thanks for reading this.

[traumaRUs, MSN, APRN]

Hi and welcome. I will preface my remarks that I practice in IL and my scope of practice=NP. I'm an adult and peds CNS and practice in a medical APRN role.

My take on your situation:

1. Does this hospice company have CNSs already? Most hospice companies in my area are RN dominated and they do not have hospice APRNs.

2. The big hospital system in my area is expanding their paliative care care program which offers a lot of opportunities for CNSs as to handlling symptoms of chronic, life-limiting diseases. Its Medicare reimburseable and quite lucrative.

3. Is your hospital helping with your tuition? Will you owe them some time?

Personally I would stick with the hospital and try to move into their hospice program as an RN while you finish school. Is that an option?

Best wishes on your decision

[C. T.]

Hello! Thank you for your response. The Hospice company does not have CNSs already. Hospital is not helping with my tuition due to the fact that i am per diem at 32 hours a month. I owe them nothing. I was very interested in maybe creating a CNS role as a patient liaison with palliative care and hospice but i haven’t gotten that far in school yet to know exactly how to propose this idea to my hospital. My gut is telling me the hospital is probably the best idea, but i keep second guessing that. I’m very thankful that this is the biggest issue in my life at the moment.

[traumaRUs, MSN, APRN]

It sounds more like you are wanting a navigator position and most of the time, they are held by an RN. In order to develop a CNS position (and thus the greater salary) you will need the metrics to prove what you can add to the hospital and also reduce costs to the hospital. You might want to consider using this as a research project - to explore the feasibility of this position at your hospital. You might also want to contact the Palliative and Hospice Nurses Association to talk with actual APRNs and decide what they do.

I will be totally honest here and say that our medical system is all about the ability to bill for your services and if you stick to a "true" CNS role, you might find you are expendable since you can't bill for your services. This is something I considered as I am an APRN who sees, treats, Rx's, etc and of course BILL for my services.