I'm leaving floor nursing...

Published

Specializes in Telemetry/Stepdown, Med/Surg.

I am starting a home hospice fulltime position in Cali. Im excited and nervous. During my rotation in nursing school i told myself i will never go into home health/hospice caus it was not exciting but....... I have been a bedside nurse for 2.5 years. mostly in tele/stepdown in NC and 3 months in Cali in med/surg. I got offered a position as a fulltime medsurg rn at this hospital and have worked there almost 3 months. But those months

/nights that ive worked there, I have been coming home crying my eyes out almost daily, have lost alot of weight and just dread going into work and a lot more stuff and being dissed and humiliated by charge nurse in public . Some nights we dont have charge nurses, or even cna's. pay and benefits are great. But what is that all good for if your sanity and health are going down the toilet?? I am completely draind out and I feel if i dont stop bdside now that i will leave nursing for good. And i am not the person to quit anything. During this whole past time ive been praying and looking and a few job opportunities came up. But the one I really was interested was home hospice. I liked the team when I interviewed with them and everything they stood for. I ended up accepting the offer for a fulltime admissions nurse.m-f 9-5:30. weekends and holidays off. great group of ppl/team. Ive worked with end of life pts before at the hospital in nc cause we had a palliative team in the hospital, but this will be new to me. I put in my 2 weeks notice at the med-surg unit and talked to my manager for a while. she is one amazing person. she offered me other positions/floors including per diem. i took some time to think about it and turned the offers down. I know ppl will think im crazy and insane and so have the nurses on the floor told me i will not be able to do it and will come begging back for my hospital job but Ive made that decision. I am happy and nervous to be finally going into a speciality which has been an interest to me for quite some time. I believe it will be stressful,but I will not give up yet. I really enjoyed taking care of my end of life pts and their families on the floor. Ive been reading these forums and others experiences about going from floor rn to home hospice and have read mixed reviews. Let me know what yall think and what your experiences have been.

Up Vote Up Vote ×
Specializes in critical care, ER,ICU, CVSURG, CCU.

Hospice is amazing, and truly the last gift,, we get to give......

and I LOVE your new hours.......welcome to sanity :geek:

best wishes, keep us posted

Up Vote Up Vote ×
Specializes in Hospice.

Yes, Hospice is wonderful, but don't get lulled into thinking that there's no stress at all. It's just a different stress than hospital nursing.

Those hours are wonderful, but they aren't ground in stone.

Not every visit is going to be 30 minutes long. Sometimes you will spend over an hour (sometimes 2 or more) with one patient. Most agencies have productivity expectations. That means generally around 25 visits total per week.

If you're lucky and your patients are clustered together, drive time will be minimal. If you have the average type of caseload, you'll spend 3-4 hours a day driving. That's half your day right there.

You may have your day all neatly planned, but patients have a pesky way of throwing monkey wrenches into your schedule. They die, they develop new or more severe symptoms, etc. So you may do more than 5 visits in a day. If someone dies at home, you go to pronounce them. If no one from PsychSoc is available to stay with the family until the funeral home shows up, guess who gets to stay? Yep, you. And it can take hours for them to get there.

What about on call? While most agencies have dedicated on call staff, there is usually some on call for the field staff, even if it's just as back up and you rarely have to go out. Also, when someone on the after hours team leaves (and they do, frequently-it can be brutal), guess who gets to cover their shifts until someone else gets hired and up and running. Bingo.

If you do have to go out after hours, you still have to work the next day. Doesn't matter if you attended 2 deaths and got about 3 hours of sleep.

Plus, there's a mountain of paper or computer work. If you're lucky, your agency has dedicated admissions nurses, but you may still be called to do one occasionally. That's a good 3 hours in the home, plus another 3-4 hours of paper and phone calls, especially if you aren't used to doing it.

And, last but not least, there's a Team meeting every 2 weeks, and those last for hours. Seriously. Also staff meetings, peer review chart audits, inservices, etc. All time suckers.

So, your 8 hour day can easily become 12-14 hours. And if you're salaried or fee for visit, there is no overtime.

I'm not trying to discourage you, but the reality of Hospice is completely different than the myth. Yes, in many ways, there's less stress, but it has its moments. Too many nurses come in thinking that Hospice is one of those easy jobs we all aspire to.

I'm here to tell you that you are going to work your butt off. If it's truly for you, you'll love it and never want to do anything else. If it isn't you won't last more than a few months.

Up Vote Up Vote ×
Specializes in Hospice.

I can't edit for some reason. I just noticed you're going to be an admission nurse. So, my advice still stands for someone considering becoming a Case Manager (which is really just a field nurse) lol.

What is the expectation for productivity when admissions are low, which happens. Will you be doing visits?

Up Vote Up Vote ×
Specializes in Telemetry/Stepdown, Med/Surg.
I can't edit for some reason. I just noticed you're going to be an admission nurse. So, my advice still stands for someone considering becoming a Case Manager (which is really just a field nurse) lol.

What is the expectation for productivity when admissions are low, which happens. Will you be doing visits?

yes visits/ in office work/ chart checks

Up Vote Up Vote ×
Specializes in Hospice.
yes visits/ in office work/ chart checks

When we lost a few field nurses, the admit nurse had to take a light (5 patient) case load for awhile. Don't be surprised if you get tapped for that at some point.

Up Vote Up Vote ×
Specializes in School Nursing, Hospice,Med-Surg.

The visits, travel, paper/computer work, stress described above...all true. But if hospice is in your bones, you'll love every single bit of it.

And your case managers will love you if you're an awesome admissions nurse. And if you have a great team and are a great team member you'll absolutely love this job. I've never met a hospice team that wasn't incredible. There's been the occasional individual team member I could live without but, as a whole, every hospice team has been fantastic. A hospice heart is an amazing heart.

I left 3 years of med-surg, went to hospice and did either inpatient or home for 12 years. It was fantastic. My only challenge was becoming emotionally involved with my home hospice patients. Those patients who didn't have family members who cared became like family to me and, after some time, emotionally wore on my heart. Otherwise, I valued my drive time as a time for myself to unwind and "get away" from everything and prepare for my next visit. I loved meetings where I could get valuable input from more experienced team members when I had issues I needed to tackle with my patients. I didn't mind the paperwork because I loved what I was doing.

It was a very, very positive experience for me and sometimes I really miss those strong emotional connections with my patients.

Up Vote Up Vote ×
Specializes in hospice, ortho,clinical review.

I have a difference experience than described above. I worked LTC and in the hospital, also did 2.5 years of review work and I absolutely LOVE my job with the exception of on call but I believe we're working on that as we're growing.

I couldn't stand the hospital for the politics and the crabby nurses that loved nothing more than making people feel small and there are plenty of those unfortunately as NanaPoo pointed out, the hospice team is generally awesome that makes all the rest of it bearable and for me, even enjoyable.

I blessed to be a Case Manager in my back yard for the most part (average 30 miles per day) but I have been called out for over hour long drives for pronouncements and admissions, but when you meet that family...all your grumblings will melt away in what that family needs and what they give you and what you get out of it, far exceeds what you do. It is absolutely the most humbling rewarding job I know of. And most days I feel privileged to be a part of someone's most intimate last days on earth.

Like NanaPoo I don't mind the driving that much as I'm getting paid to unwind and listen to music for the most part instead of listening to above said "crabby nurses"

For pronouncements, once we call the funeral home, if family doesn't need us, we can leave. It's up to family but again I find I generally stay because there's a reason greater than I understand why I was called there and I generally leave with a "wow that was amazing" feeling.

Up Vote Up Vote ×

A lot will depend on how understanding your employer is and how well your team works when it's crunch time.

This has been a harder then normal week for me, but I still love what I do and the amazing group of people who are in it with me.

I hope it works out well for you.

Welcome.

Up Vote Up Vote ×

Best wishes in your new position. I think it might be just the spot for you. Let me recommend a fabulous book: 'Midwife for Souls: Spiritual Care for the Dying', by Kathy Kalina.

Good luck!

Up Vote Up Vote ×
Specializes in Management.

I loved working home health. I did minimal hospice but did love the home health aspect and wound care. I have since transitioned into working from home as a disease management nurse for the last 4 years. I love that even more than home health. I hope you enjoy your new line of work!

Up Vote Up Vote ×

The hospital is not the be all and end all. Leaving was the very best move I could have ever made. I love being a nurse, and now I can use my other talents to the advantage of patients without being a wreck.

Best wishes!

Up Vote Up Vote ×
+ Join the Discussion