I'm leaving floor nursing...

[newbieRN2012]

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.

[brandy1017, ASN, RN]

Thanks for everyone sharing their experiences in hospice/home health. I still do bedside which as we all know is very stressful, but am curious about other jobs out there. We had a coworker who was having health problems due to stress and went to hospice/home health. I emailed her about how it was going hoping to learn more about the good and the bad, but she never replied. Apparently it was not that good, because she left less than a year for another hospice job and has been working maybe a couple years at that when I heard she has now quit that job without any nursing job lined up. I wonder what lead her to that choice, I would be afraid to quit a job without another lined up. They even had her picture on billboards on the highway by the agency she worked for.

The problems with home health that I see is I've been told you are paid by the vist, so it is piecemeal and you are not compensated for your experience. I don't like the idea of taking a pay cut, not to mention all the wear and tear on your car. I knew about the long hours already as I had a friend who did it for several years and she was paid by the hour but took a huge paycut and she said if she had not been paid by the hour she would have been salary and overworked. As it was she had hours of paperwork every night. She eventually returned to floor nursing at a good union hospital with great pay and benefits.

[Kitty Hawk, ADN, RN]

To Brandy:

I guess it depends on where you work. I'm paid hourly, no pay cut (but I didn't have years of hospital experience so I was starting from the base tier at the hospital) and sometimes too much overtime right now, but that's at time and a half. It's def not about the money, but if we ever went ppv I along with most of my co-workers would find another job because we would not be compensated appropriately for our work. Same thing with salary, the office employees are salary and are often there until 9p or 10p

On the flip side for the overtime, even though I'm not crazy about it as I work to live not live to work, if it's an admission after hours we can just gather the info we need from the patient's home and come back home to finish up which I think we're pretty blessed. As long as no one abuses that, but I write everything I'm doing and phone calls and computer work all has time stamps. If it's an admission during the day, we can again gather up the info and go somewhere else to finish up. If we're close to one of our affiliated facilities, we can go there, if not we can go to a Panera or even a park as we have hotspot connection to the internet as long as we're not too far in the boondocks! So those perks def outweigh being in a tense hospital atmosphere working OT.

That's a huge benefit of hospice vs hospital. In hospice if you have a tense or crazy situation, you only have to deal with it in small doses and you can leave. Fix the problem and leave. In a hospital, you are stuck with said situation for 8 or 12 or more hours. No thanks. I thank God when I'm in a facility seeing patients or at a hospital doing an eval....that I get to leave and go back to the sanctuary of my car! And then there are the situations that I mentioned are a privilege to be a part of from start to finish, so I can't even believe I'm getting paid for those experiences.

[Kitty Hawk, ADN, RN]

Oh, and another huge benefit, is the doctors actually respect and listen to us because we are the ones there. IME in the hospital I was not able to question or suggest things to the MD only report s/s as all but 2 of the surgeons (ortho) thought they were gods including residents and one even ordered enough dilaudid to kill the patient and didn't appreciate it when I questioned him!

I got to suggest prednisone for a patient who had encephalitis when I explained to the MD at IDT meeting pt lost his appetite but "wanted" to eat and the s/e of the med was increased appetite and maybe with the brain swelling it could help...well it did and the family has the best remembrance of the holidays and 40 family members traveling in to have one last holiday like the old times....that was a priceless privilege to have been able to suggest an intervention that gave a family back their loved one for just a short while (prior he would just nap in a chair and barely eat) They got 3 mos of quality time with him.

So it's being able to actually use your critical thinking skills and make suggestions that is pretty cool. Again not to insult hospital nurses because maybe some really do have respectful relationships with their MD's. I was treated like a robot to carry out orders and now I'm a respected team member. BIG difference. IMO

[blaaveispiken]

I was a floor nurse too and had to leave. Initially went into Home Health and for the past 4 years have been in Hospice -- and I have loved both! Good luck to you. I doubt you will be going home crying any longer.

[Conqueror+, BSN, RN]

I was a floor nurse too and had to leave. Initially went into Home Health and for the past 4 years have been in Hospice -- and I have loved both! Good luck to you. I doubt you will be going home crying any longer.

Not being a downer but you just might for different reasons. When you see an eight year old lose BOTH parents to cancer over two years it can be almost unbearable. When your patients are 98 with 14 great grandchildren you can put it in perspective. Not as easy when they are 6 months old. The stress is different but it IS there.