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Med/Surg, offered position in Hospice

Laicia Laicia (New) New

Okay. So I started out working LTC/LTAC for a year to get that magical year of experience before I got into a hospital. I now work nights on a med/tele floor.

I like/love the technical aspects of my job (depending on the night) - I'm learning a lot about different disease processes, medications, etc. I love the people I work with *on my shift*.... And that is about all I have to say about my good experiences.

I ALWAYS have to drag myself out of bed to go to work internally screaming that I cannot possibly make it through another shift. I dread giving report to day shift because there is a tremendous amount of bullying that goes on at shift change. I have reported it to my manager who has stated it is "unacceptable" and has addressed it in meetings, but her interventions have only cut down on the bullying slightly. I understand this is the unfortunate nature of nursing and I can let quite a bit roll off my back... But when I'm staying hours past my shift because the next shift refuses to accept reasonable endorsements, it's maddening.

Of course there are the patients. The sense of entitlement and the hourly rounding and lying through your teeth saying "I.have.the.time."

The CNO has often instructed the clinical supervisor to make all the med surg RNs take 8 patients to keep ER flow going.... Which I feel extremely uncomfortable with on med/tele. The majority of our patients are MI or CVA (sometimes with major deficits) and our floor also accepts stable vent/trach patients. It's scary at 8. Our policy as I was told when I was hired is that days get "5, sometimes 6" and nights get "6, sometimes 7" which of course means anything less than 7 at night is like a vacation.

To top it all off, management has begun writing people up for anything and everything. A CNA showed up for her scheduled shift, was told she wasn't on the board for the day and needed to wait for the manager. She waited an hour and a half for the manager to come in and see her, and left with her last check in hand. Everyone is on edge about losing their job seemingly out of nowhere and are either leaving or establishing per diem employment just in case.

So to the point. Of course I have been nervous too given the culture of the floor and management's behavior, and I have been applying for other positions just like everyone else - just in case. Well, today I was actually offered one as a hospice case manager. I feel as if the autonomy and hours would suit me and my personal needs at this time in my life. I think I would enjoy the work. I am, however, worried that as I only have about 6 months of acute care experience, that it would be a huge hindrance in my career path as a whole.

I am an ADN nurse and am preparing to obtain a BSN. My hope would be that I could use some time in hospice for fresh scenery, some autonomy, and some different challenges that I'm not as burned out on yet while obtaining my BSN online. But when I'm ready... Will there be a hospital willing to accept me? I know taking a break and keeping my license and sanity is ultimately better, but I don't want to regret a career choice either. Any experience or opinions would be greatly appreciated!

klone, MSN, RN

Specializes in Women's Health/OB Leadership. Has 15 years experience.

My husband took a hospice case manager position immediately out of nursing school. He has been doing hospice and home health for the past 10 years - 5 years as a case manager, several years as a clinical manager, and now as a director of nursing for a large company for which he has over 100 direct reports. As you can see, lack of clinical experience has never hindered him in doing his job, and he LOVES hospice.

Good luck to you, whatever you decide!


Has 3 years experience.

This sounds like a wonderful opportunity given your current situation on your unit. When making your decision, keep in mind that many hospitals want at least 1 year of acute care experience (which obviously you won't get as a case manager). So leaving now may or may not become an issue for you in the future when trying to get a hospital job. The other thing to consider is that, at least here in NY, most hospitals are only hiring BSN's. So since you have your foot in the door already at a hospital, it may be worthwhile to stay and just transfer to a different unit if possible.

Been there,done that, ASN, RN

Has 33 years experience.

Run... to that new position. You will be learning much more valuable skills, that will look excellent on your resume.

Good luck! Let us know how it's going.

firstinfamily, RN

Has 33 years experience.

I have left the hospital environment three times during my career. I am just getting ready to return. You should have at least a year of experience for it to count for anything in the future. However, I don't believe in trying to stay afloat when the ship is sinking. It is very difficult to maintain a positive attitude in a negative environment. Having 8 patients on a med/tele unit is just about impossible. There is no way you can give those patients any undivided attention, or you most likely feel you have time to rollar skate in, give them their meds and rollar skate onto the next patient. Nursing is about so much more than that. Not having time to talk to your patient to see how they are dealing with their illness, how you can help them etc. Being a case manager involves more patient contact, working with the various facilities and families to make the best match for that particular patient or assisting them with home health environment and the impending death. It would be very rewarding and also is a different type of stress. I don't think that there is such a thing as a stress-free nursing environment. Returning to an acute environment may be something you might want to do later down the road. It is harder to get back in the longer you are out. I don't think you will be bored or get restless with hospice case management. Perhaps it is time for you to get into another area of nursing, you can learn a lot and maybe it will be the aspect of nursing you have been longing for. I would recommend you try it. It will be up to you whether or not you want to wait until you have a full year of acute care experience which would make you more marketable later, in case you want to try it again. Finishing your BSN should be a high priority and you should stay the course to complete it in a timely manner. If the new position will help you do this then that should help you decide. Good Luck, change is always a sign you are growing!!!

I would agree with all the posters above - you need a change of scenery, and fast! whether it's to hospice or a different specialty. I'm just a little partial to the former ;)