Interview questions and Red Flags for Hospice

wonderbee, BSN, RN · Aug 9, 2007

Average case load, how many. It is difficult to case manage more than 12.

Call. How often? If it's more than what you want, that's a red flag.

"hospice is a lifestyle". Translation: you will have an interrupted personal life and expect to be working from one degree to another in your "off" time. If your career comes before anything else, this might be a plus.

Do you use LPNs? LPNs cannot case manage in most states but are an asset in the field to handle overflow visits.

a21chdchic · Aug 12, 2007

You will want to know what is expected when you are on call. Are you responsible for just taking calls and dealing with issues that arise from the call and deaths. Or are you also required to do scheduled visits in addition to that? And are you also expected to do referrals and admissions in addition to all of that. If you are expected to do all of this, it makes for a brutal and miserable time. I have all of this to do and last w/e worked from 0715 to 2300 and was back up at 0530 for another death and a few more calls. This was a 24 hour call on a Saturday. It sucked. You will also want to know how call time is compensated. per visit, or per hour, and how much per hour. Is your time worth what they are offering?

Ana

Fiesta Red · Aug 12, 2007

I know call is one weekend shift a month -- don't know if it 24 hours or 8 hours -- I'll have to ask. We are hourly employees, not paid per visit. I'll definitely have to ask about caseload and overtime. Not sure if there is an evening/nights RN or if that is covered with on-call nurses.

Thanks for the replies thus far!

Interview is tomorrow.

-Mark

paulh61 · Sep 1, 2007

Hey Fiesta,

How did yer interview go???

Fiesta Red · Sep 8, 2007

Hey Fiesta,
How did yer interview go???

Score!

Case load is no more than 12. Only 4 home visits per day. Weekends are one a month, and there are different nurses who do after hours call. The nurse manager is also a former ER RN, so she understood exactly where I was coming from. Sutter VNA & Hospice is an affiliate of Sutter Health, so I keep all my benefits, seniority, pension, etc.

I interviewed for a per diem job and wound up with a full time position. I start on Monday. Once I get to where I am comfortable on my own, I will keep my skills up with a per diem ER position.

Thanks!

-Mark

Trauma Columnist · Sep 8, 2007

Congrats on the job.

aimeee, BSN, RN · Sep 9, 2007

Great news. Congratulations!

uahrn915 · Sep 12, 2007

I know this is late, but someone else may be looking for help on their upcoming interview and I just finished responding to a similar private message. Copied my reply and thought I would copy/paste them over. Maybe someone will benefit.

The most important things to look for in a hospice company:

1. The company's owners and management must be in the business for the right reason....and I feel the only right reason is to provide the best patient care (that will be the common thread throughout this note) without greed. It ain't about the money or what it can buy, it is to provide a service that is sacred because of the sensitive nature of the services. You are going into the homes and lives of people getting ready to send someone off on that glorious final journey.

2. If the words "God" or "faith" aren't mentioned by you in the interview, they may not be mentioned at all as to "not offend someone or show descrimination". Bring up the subject if you are a Christian and if they don't offer any back, go to the next interview. If God is not in the heart of your hospice organization, the life expectancy is greatly decreased.

3. You can not work alone in a hospice so be ready to be a team player. Ask about the teamwork in the organization. It must be strong. If you don't see cooperation during your tour of the facility (and you can ask for one), then you don't want to be there. If you get held up with a dying patient, you want to be able to call a fellow nurse and say HELP! and hear there concern for you when they say "how can I help?"

4. If you don't feel comfortable with your first contact inside the office, chances are the public will be just as dissappointed as you are. If you go in and ask for an application or ask if you can drop off a resume', they should be falling over themselves to get it to you. If they act rude or inconvenienced, just say never mind and walk.

5. If you are an RN or LPN with a year or more experience, you have a ticket to the world, but you have to ask for what you want or feel you deserve. I have never hired on at the company's "starting rate" of pay. After a couple of interviews, you can usually determine about what you can get. Hello, there is a nursing shortage. Ask for it!

6. Have a list of questions for the interviewer. This blows them away... I pull out a list of questions that is 2 pages (with spaces for notes). I ask all those questions that they "forgot to tell you" in the initial interview:

What is the rate of pay? is overtime allowed? what is the OT rate? what is the mileage rate? is there any bonuses (sign on, christmas, end-of-yr profit share)?

Do you provide cell phone? company car?

Will I have to take call? what is the rate on call? does on-call time start with travel time from my home?

How is vacation earned?

Do I get Medical, Dental, Eye Insurance? if so, do I pay for it? how much? how much does the company pay?

When was the last state survey? How many deficiencies were out? How many standards were out? {If you would like the whole Word doc let me know or do a internet search for "questions to ask during a hospice interview".}

As far as companies to look at, take a resume' to all of them knowing what you now know from this note. Every area is different. One of the Oncologists in Birmingham, AL had a patient in my territory around the Huntsville area. He recommended Odyssey Hospice because they were so strong and took great care of their patients in B'ham. Two weeks later, the patient's husband called me and switched because the nurse had not drawn labs for 5 days post-hospitilization for hypoxia r/t PE. Patient had been on coumadin. When the nurse finally got the lab done, her PT was 65 and the INR was over 8. When I contacted the MD he couldn't believe that the level of care was that different from the same company in two different cities. Two weeks later Odyssey in Huntsville sold their patient load to AlaCare and Wiregrass. The point here is that I can't tell you which hospice will fit your needs or meet the criteria mentioned in the 6 points above. You make that decision, and it starts when you walk in the door with your resume'.

Hope that helps.

Nana1206 · Sep 29, 2007

I know this is late, but someone else may be looking for help on their upcoming interview and I just finished responding to a similar private message. Copied my reply and thought I would copy/paste them over. Maybe someone will benefit.
The most important things to look for in a hospice company:
1. The company's owners and management must be in the business for the right reason....and I feel the only right reason is to provide the best patient care (that will be the common thread throughout this note) without greed. It ain't about the money or what it can buy, it is to provide a service that is sacred because of the sensitive nature of the services. You are going into the homes and lives of people getting ready to send someone off on that glorious final journey.
2. If the words "God" or "faith" aren't mentioned by you in the interview, they may not be mentioned at all as to "not offend someone or show descrimination". Bring up the subject if you are a Christian and if they don't offer any back, go to the next interview. If God is not in the heart of your hospice organization, the life expectancy is greatly decreased.
3. You can not work alone in a hospice so be ready to be a team player. Ask about the teamwork in the organization. It must be strong. If you don't see cooperation during your tour of the facility (and you can ask for one), then you don't want to be there. If you get held up with a dying patient, you want to be able to call a fellow nurse and say HELP! and hear there concern for you when they say "how can I help?"
4. If you don't feel comfortable with your first contact inside the office, chances are the public will be just as dissappointed as you are. If you go in and ask for an application or ask if you can drop off a resume', they should be falling over themselves to get it to you. If they act rude or inconvenienced, just say never mind and walk.
5. If you are an RN or LPN with a year or more experience, you have a ticket to the world, but you have to ask for what you want or feel you deserve. I have never hired on at the company's "starting rate" of pay. After a couple of interviews, you can usually determine about what you can get. Hello, there is a nursing shortage. Ask for it!
6. Have a list of questions for the interviewer. This blows them away... I pull out a list of questions that is 2 pages (with spaces for notes). I ask all those questions that they "forgot to tell you" in the initial interview:
What is the rate of pay? is overtime allowed? what is the OT rate? what is the mileage rate? is there any bonuses (sign on, christmas, end-of-yr profit share)?
Do you provide cell phone? company car?
Will I have to take call? what is the rate on call? does on-call time start with travel time from my home?
How is vacation earned?
Do I get Medical, Dental, Eye Insurance? if so, do I pay for it? how much? how much does the company pay?
When was the last state survey? How many deficiencies were out? How many standards were out? {If you would like the whole Word doc let me know or do a internet search for "questions to ask during a hospice interview".}
As far as companies to look at, take a resume' to all of them knowing what you now know from this note. Every area is different. One of the Oncologists in Birmingham, AL had a patient in my territory around the Huntsville area. He recommended Odyssey Hospice because they were so strong and took great care of their patients in B'ham. Two weeks later, the patient's husband called me and switched because the nurse had not drawn labs for 5 days post-hospitilization for hypoxia r/t PE. Patient had been on coumadin. When the nurse finally got the lab done, her PT was 65 and the INR was over 8. When I contacted the MD he couldn't believe that the level of care was that different from the same company in two different cities. Two weeks later Odyssey in Huntsville sold their patient load to AlaCare and Wiregrass. The point here is that I can't tell you which hospice will fit your needs or meet the criteria mentioned in the 6 points above. You make that decision, and it starts when you walk in the door with your resume'.
Hope that helps.

Thanks! I am a new RN (6 months in Med-Surg) wanting to go into hospice or oncology. This info helps me greatly!

introspectiveRN · Nov 8, 2007

In addition to case load I would also suggest asking about average acuity. At one of my former hospices we were "open access". Sounds great on paper but it was awful to work with. Very high acuity patients who are not on board with a palliative care philosophy will make for emotional exhaustion on your part, as well as physical. If they expect you to take care of pts on vents, TPN, fluids etc. this will make for much work for you. And family members who are far from letting go.

Also, ask how much experience your social worker has in working hospice. Although the social worker was a great person, she had very little hospice experience and was slow to learn. This created alot of work for me. I ended up being the social work side of the house in many cases. Ditto for spiritual care- the chaplain that we have now is awesome. He is very gifted and I have seen the difference that his visits make in giving pts hope and comfort.

Also, ask questions about CNA's. Any hospice manager/PCC that does not value their CNAs will ultimately not value you either. CNA's are the bedrock of hospice...moreso than case managers. You want to know that the culture of your hospice supports open communication between CNA's and case managers (you must promote it too!)...they will work more closely with you than anyone else on the team. They will also keep you informed of the most important aspects of your patients overall health.

that's all for now....good luck!

doodlemom · Nov 8, 2007

Quote from uahrn915 "1. The company's owners and management must be in the business for the right reason....and I feel the only right reason is to provide the best patient care (that will be the common thread throughout this note) without greed. It ain't about the money or what it can buy, it is to provide a service that is sacred because of the sensitive nature of the services. You are going into the homes and lives of people getting ready to send someone off on that glorious final journey.

2. If the words "God" or "faith" aren't mentioned by you in the interview, they may not be mentioned at all as to "not offend someone or show descrimination". Bring up the subject if you are a Christian and if they don't offer any back, go to the next interview. If God is not in the heart of your hospice organization, the life expectancy is greatly decreased. "

I personally would not work for a hospice agency that had a religious slant to it and I take my faith pretty seriously. BTW, Christians are not the only people that believe in God. Our hospice has about 10 % charity patients and I would say the majority of the staff feels that serving these folks who have nothing is a spiritual journey. Are you talking about the life expectancy of the employees or the patients? Do you have any data to back this up?

You say the company must be in it for the right reason, but the company you work for was fined over 13 million last year because of it's unethical practices. Do you think Odyssey really cares about the patients - or do they really care about lining the pockets of their corporate stock holders?