inpatient hospice facility question

debbers · May 5, 2007

Our unit is small, with a small pt load. On day shift each nurse has apprx 4 pts. On night shift we have apprx 6-8 pts. It is wonderful, as there is time for family along with time to adequately meet the needs of the pt.

HospicePalliativeRN, RN · May 6, 2007

In my area, there is currently one inpatient hospice unit with 12 beds. Because the census fluctuates often, it only employs a small core of FT & PT staff members and relies on a larger pool of per diem nurses to help fill the holes. The unit is staffed according to census and acuity, but there are typically 2 RNs and 2 CNAs on each shift. If the census is low (

Please don't be mislead by thinking that having a small patient assignment of 4-6 patients is an easy tasks. The acuity of inpatient hospice units is usually quite high, as many of the admits are d/t pain and other symptoms that are unable to be controlled/managed at home. These patients arrive in a crisis state, and family members are often having many issues themselves, so there is a lot of work involved medically, psychologically, emotionally, & spiritually. In fact, the manager of the inpatient hospice unit in most cases will not hire RNs to full-time positions on the unit because she has found that 40 hrs/wk has often led to staff nurse burnout (mostly mentally/emotionally) in a short period of time, which then results in increased turnover.

My best advice would be to get in contact with the nurse managers of the two inpatient facilities in your area and find out more about the units. I would also suggest asking if you could "shadow" one of the more seasoned staff nurses for a few hours on each unit to get a better idea of what an inpatient hospice unit is like. I think this is important, because nurses may find out the duties, patient/family issues, etc. are not what they imagine them to be in their minds. It is better to know what the work is going to be like before being accepting a position.

ginger58, ASN, RN · May 6, 2007

I think this (shadowing) is important, because nurses may find out the duties, patient/family issues, etc. are not what they imagine them to be in their minds. It is better to know what the work is going to be like before being accepting a position.

Very good point. I worked in a Palliative Care/acute medical floor in CA. Although I could have five patients max, the end of life patient took most of my time (and gladly spent time). I had to be sure of their comfort, help the family cope--there's more to their care than one thinks. Anyone who thinks an end of life patient is easy hasn't done it.

MT RN · May 6, 2007

thanks for the info hospicepalliativern. and the reasons that you state are exactly why i am interested in hospice to begin with. working med-surg i never feel that i have enough time to give the patients all of the care that they deserve, and i am looking for a nursing specialty that might answer that need.

i have seen the wonderful work that hospice does many times over the years with various family and friends that were under the care of hospice. i also spent a few days shadowing a visiting hospice nurse while in nursing school.

i really don't feel that i want to do the visiting nurse aspect, but the inpatient facility sounds interesting. the reason behind my original question was to get an idea as to where these units stand regarding nurse-patient ratios. don't get me wrong, i'm a very hard worker and i love being busy at work, it helps the time go faster. i am just tired of being so overwhelmingly busy that i seem to never have time to stop, and going home every day with the feeling that my patients didn't get all of the care that they deserved because i simply didn't have the time to provide it.

all of the hospice nurses that i have encountered over the years seem to always have the extra time to answer questions and provide comfort to both patients and family members, and i would love to be able to do just that, but never seem to have adequate time in my present position.

i know i'm rambling so i'll close, but thanks again for the info...

ginger58, ASN, RN · May 7, 2007

MT RN, You sound like you'll be an asset to hospice. I'm not sure I'd like the in home hospice as much as a facility either. You're right, med-surg is grueling and it is overwhelming in terms of work, feeling like you haven't spent as much time as you'd like with patients and then the paperwork! I wish we had an inpt hospice here.

ayellowbyrd · May 13, 2007

HI, I would guess that each hospice is different on how they staff their PCU's. Ours is staffed with one RN, myself , one LPN, one CNA, and a housemom that functions as a cook and part time CNA. We take care of up to 11 patients and the average stay per patient is 2 weeks. Our PCU's are used for management of accute stages during the patients disease prossess. Such as uncontroled pain, nausea, care giver breakdown, etc. Clients come in we work with our team to get there indiviual chalenges under control and then they are transfered back to homecare.Hope this helps

IMAHospiceRN · Sep 20, 2008

Your post is a couple of years old, so hopefully you've already settled on an area that works for you. I will say, though, that in response to what other hospice nurses wrote, do not always expect such an easy nurse/patient ratio. I work in a 30 bed facility and both first and second shift RNs often have 7 or 8 patients with only one care partner. Night shift can have from 10 to 15, depending on whether someone calls out. It a very rewarding job, but can also be terribly demanding and difficult if you want to do it well---and you should. I cried often during my first year of work and can't say that I was a really proficient end of life caregiver until I'd been doing it for at least two years. Too many nurses come in thinking it will be a cakewalk because there's often no CPR, etc., but we have trachs, respirators, wound vacs, rectal tubes, lots of PCA pumps, and a huge number of spiritual and emotional issues to help patients and families through. We get addicted patients who constantly demand increasingly greater amounts of narcotics, infants who look perfect, but have congenital defects that are inconsistent with life, angry family members who take their grief out on staff, COPD patients with panic brought on by air hunger combined with fear of death, patients who are brain dead on respirators with family who can't let go, patients with AIDS who are often younger than the staff, parents trying to figure out how to live life without their children who are dying.... In other words, it's demanding work that takes a willingness to open your arms to whoever comes through the doors, giving your best to every one of them no matter what's going on in the next room. They're all at a huge crisis point in life and they all need and deserve the best that nursing has to offer them. If you're able and willing to give that, hospice work is a great career!

Allow Mystery · Nov 23, 2008

Hi all,

I'm contemplating working in-patient as opposed to out-patient

case management. I've been advised that working in-patient may entail

up to an 8 patient load with a CNA, and acuity will not factor in.

Pros for in-patient include (1)less travel (2)more patient care (3) no

on-call responsibility (4) set schedule (5) less IDT (6) less stress with

recertification process

Cons for in-patient (1) Acuity may make an 8 patient load a nightmare

(2) Institutional setting, and a belief that a good death would be in one's

own home surrounded by loving family

I'm sure they're many more pros and cons, please help me out! Thanks!

Becky8 · Jan 1, 2010

Since I feel very certain that I would like to be a hospice nurse, (I work as a hospice lna now and love it), I thought it would be helpful for me to start in an inpatient hospice unit and eventually work as a home care hospice nurse. It seems the only sane path to where I want to go. My only other alternative seems to be med surge or a nursing home, both of which are fine, but not where I would want to end up. I want to get the experience, but not working where I would rather not. Any words of wisdom? Of course, in this economy, I will do what I need to do.............Thank you

lovesthejob · Aug 21, 2010

Ina I am glad to hear you like being a hospice nurse. I worked for Vitas in Ohio as a massage therapist. I am also a RN and when I called to see if their was a need no one called me back. They did hire me as a contract massage therapist but that came to an end. They just never gave me any more patients. I really loved the experience and would have considered working as a nurse but they were not in the least interested. Can you believe it a RN and massage therapist and the hospice just blew me off I was really hurt and extremely insulted and never given an explanation. Vitas has good workers but the management people and staff who work in the office have no idea who you are. I coud never get in to meet the right people. I have heard Vitas is having serious financial difficulties but just not to tell you anything just stop giving you patients no reason nothing but I loved the experience and if anyone in the greater Cinti or Dayton area knows where is nurse massage therapist is needed please email [email protected]. I would love to do it again but not Vitas they were horrible to me.