How to get into hospice

NickiTeleRN, ADN · Feb 26, 2021

Two more things I forgot to include

1. I keep reading about shadowing a hospice nurse. I would love to do that but I don't know any hospice nurses. Is that something a potential employer would allow me to do?

2. Scheduling. I love working 3 nights a week and can't imagine going back to 9-5. Are all the longer shifts "on call"? I work nights now and can handle weird hours, I just don't want to do 5 days a week.

Kat Mandu, BSN, RN · Feb 27, 2021

Congratulations on your interest in one of the most rewarding [for some of us] areas of nursing! It differs from hospital nursing as you usually have frequent and extended interactions with the patient's family. You'll find yourself being nurse, counselor, mother, friend, psych nurse, and educator, usually all during the same shift. You'll serve all types of patients with a myriad of conditions and see things you would never see in a hospital setting. You need to be able to separate your work life from your personal life (as it's not uncommon to become attached to certain patients when you've cared for them for a long time). A sense of humor is a must (for me, anyway), as if you can't laugh at some things (not at the patient), all you'd do is cry. Hospice nursing can be very emotionally and physically draining and you must learn to take extra special care of yourself.

That being said, first decide if you want to work at an inpatient hospice where you have lots of support or home care hospice where you still have support but not as close by. With HC you have to shoot from the hip more often and nurses whom I've known in HC have found this to be most attractive as no one is hanging over your shoulder micro managing. Some hospices provide a car and some don't. Those that don't usually reimburse you for gas and mileage. If you choose this route, be sure the reimbursement is enough to cover more frequent oil changes, wear and tear on your vehicle, and eventually enough to replace your entire vehicle because you'll be putting a ton of miles on it. Depending on the terrain, a 4-wheel drive, while not absolutely necessary, is a good choice.

Your experience should make you marketable right now. Does oncology experience help? Yes, somewhat, but not essential. Remember, you're not there to cure anyone, but to make what remains of their life more tolerable. Understanding a patient's disease process can be learned on a case-by-case basis so you'll know what to expect and what to watch out for.

For instance, any type of cancer can spread to the bones of the spine, which may lead to spinal cord compression which is a true emergency. But some of this should be covered in your orientation, along with educational materials your employer should provide, in-service sessions and you can always study on your own. The interesting thing about hospice nursing is every time you think you've seen it all, you'll see something new! Other areas of nursing besides oncology that are helpful (as not all patients have cancer) are LTC, sub-acute care, psych, wound care, med-surg, pulmonary, home care, to name a few.

Certification is great after you have hospice and palliative nursing practice of 500 hours in the most recent 12 months or 1,000 hours in the most recent 24 months prior to applying for the examination. But it’s not necessary to obtain a job in hospice. It actually only increased my pay scale by $1/hr back around 2007. Since I worked at least 2000 hours a year, it was like a $2000/year raise before taxes.

A potential employer might allow you to shadow one of their nurses. The only way you’ll know is to call every hospice near you, ask for the DON and find out. Worst that can happen is they’ll say no. You could try volunteering at a hospice, which can be really time-consuming, given the orientation and extra hours you’ll be away from home. But this would give you an inside look at what goes on in a hospice. I wouldn’t volunteer as a nurse (don’t know if that’s possible anyway) but just as an extra set of hands. At an inpatient hospice you might pass water, distribute floral arrangements, read to and visit lonely patients. You’d get to cover more territory, see more things than a nurse assigned certain patients.

I understand many hospices are going to the 3 day 12 shifts. You can always be contingent and let them know when you’re available.

One final piece of advice…when you find a hospice that wants to hire you, make sure YOU interview THEM and do a bit of research online about employee satisfaction. Back in the day, when hospice was a grass roots, nurse run proposition, most of us felt we had a calling, a ministry, if you will. But all that’s changed in the last 10-12 years, IMHO. The profession is going more towards palliative care, rather than the bulk being end-of-life. Many of the diseases….breast and lung cancer, for instance….certain kinds are not immediate death sentences and just require pain and symptom control. Hospitals and LTC, realizing what a cash cow end-of-life care was, began opening their own “mini” hospices, taking business away from small hospice organizations. The smaller hospices started advertising in order to capture an audience not quite at death’s door, so you have more active and complicated patients. At the same time, like the other facilities, they’ve cut back on staff but expect you to function at the same pace.

You can also expect to deal with the same stuff you’d experience in a hospital. Incompetent administration, back biting colleagues, dictator style lower management (who might have even less experience than you!), favoritism, unrealistic patient loads, etc. Not saying they’re all like this, but some red flags to watch out for. Remember, it is a business. When taking a poll among my nurse friends in other specialties, I found the pay scale was lower and the benefits shoddier in hospice. This may just be my part of the country, however, several years ago, I took a break from hospice to work in drug rehab and was stunned when my starting pay was a full $7 an hour more! But as I said, might just be where I am.

A blogger once did an interview with me which is pretty dated, actually, the website appears abandoned, but in it, I described what a typical hospice position is like. You may find it useful. https://www.careerocean.com/hospice-nurse-career-guide

Good luck with your noble pursuit. If you have more questions, you can always message me and I’ll do my best to answer if I can.

NickiTeleRN, ADN · Feb 28, 2021

@kittyboxers

Thank you! your comment was really helpful. The autonomy of home hospice is really appealing to me. That's part of the reason I enjoy night shift in the hospital. I'm a little worried that since I've been on nights so long that it will be a lot for me to have to manage so many ancillary groups like social work, MDs, suppliers and everyone involved when the patient passes but I guess you get used to it like anything else.

I can handle a little bit of a pay cut (I assumed there would be one) but 12 hour shifts are important to me. I am happy to hear that it's not impossible to get 12's in home hospice, that was my major sticking point. I really do feel like this is my calling and I want to learn as much as I can before I jump into it. I am relieved to hear that oncoloogy or palliative care isn't as neccessary as I assumed. I feel a lot more optimistic about my options ?

vampiregirl, BSN, RN · Mar 5, 2021

On 2/28/2021 at 1:32 PM, NickiTeleRN said:

I'm a little worried that since I've been on nights so long that it will be a lot for me to have to manage so many ancillary groups like social work, MDs, suppliers and everyone involved when the patient passes but I guess you get used to it like anything else.

This typically sounds like a lot but hasn't been in my experience. I have a "checklist" that I use that simplifies this for me. My checklist lists all the typical follow-ups required after a patient death and I just contact (and document) the contacts appropriate for each patient. If there is a unusual contact that will need to be made post-death for a patient, I typically ensure I have all the contact info ahead of time and make a note in the EHR.

Part of the challenge of hospice case management is establishing good systems for yourself that keep you organized. Once you get this in place, it makes that aspect smoother. But like anything else, it takes time to get these in place.