Need help making a decision

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Specializes in ICU.

I'll try to keep this as brief and to the point as possible 😊

I've been an ICU Nurse for @13 years. Have been in different units and hospitals. I am totally done! Burned out beyond belief. I've decided to leave the hospital environment and go into Home Health or Home Hospice. I am not expecting it to be easy or less stressful.... Just different, and I need/want that.

I've been offered a case manager position with both.

I've always liked my palliative /comfort care patients the best. I feel like I'm truly helping instead of just prolonging a painful death or extending a life with no real quality of life.

Both positions have there pros and cons. I'm hoping someone here has done both or decided between the two and can help me through the thought process so I make the best decision.

I'll gladly answer any questions. Thank you in advance for your help.

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Specializes in Cardiac (adult), CC, Peds, MH/Substance.

Very closely consider on-call responsibilities for companies under consideration.

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Specializes in ICU.

The Hospice on call is Mon-Thurs nights split between 3 RN's. There is a full time weekend on call nurse. Weekends required when nurse is sick or on vacation.

The HH was told to me to be 2-3 nights a month and one of those being a weekend. Not sure if day or night, or both.

The Hospice territory is bigger than the HH territory.

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Specializes in Urology, HH, med/Surg.

I've done HH & am currently doing hospice. I enjoy the actual work of hospice so much more than I ever did HH.

With HH I ended up having to chart at home every night and stayed stressed out all the time!! It does depend greatly on how many pts you're expected to see per day and how many of those are admits and/or recerts (those require sooo much more computer time!)

Hospice charting isn't as much as HH. Also, the hospice I work for has an admit nurse & on call nurses (which is so fabulous I can't even describe it!!)

But at the end of the day, I just feel like I've done good things and hardly ever felt that way when I did HH.

Good luck with whatever you decide!

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Specializes in ICU.

Thank you for your input!

The caseload of Hospice they said is ideally 12-14, but currently it's more like 16-18.

There is no Admission or weekday night call nurse, only a weekend nurse. So, really, the call is the biggest drawback to me. They would be split b/w 3 RN's. It comes out to 6-7 nights a month on call :-(

I know either is going to be a huge learning curve.

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Specializes in Urology, HH, med/Surg.

Wow- that's a big pt load for hospice! Especially when you're seeing them more than once a week!! My pt load varies from about 11-13 pt; which is usually around 20-24 visits/week. And yes, call, especially during the week makes a big difference.

If the HH is a better fit for you- less pt load & call- I would probably go with that. If you decide later you want to try hospice you can always change!

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Specializes in ICU.

HH is minimum of 5.5 points per day. Average 30-35 visits /week

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I have worked both hospice and HH..if call is a deal breaker for you then HH would be the way to go because unlike hospice, most HH calls were not something you would go out for - in HH if there is an emergency the patient goes to the ER,calls 9-1-1 etc. As far as hospice..calls come for pain management, deaths, admissions, etc at any time. Hospice too is more emotionally taxing but was also, for me, more rewarding in many ways. There is tons more documentation in HH or was where I worked but if you are organized most of the time you can keep it controlled.

With either position, there will be a LOT of driving, keep supplies in your car & being on the phone as well as going into houses that are so nasty you won't sit down to houses that are so over the top extravagant. In HH you are looking to resolve the problem/illness/disease & chart to the positive, in hospice, you are looking for comfort and chart to the negative. Many times nurses who are leaving the hospital setting underestimate this and the documentation thinking either hospice or HH will be a "breeze" but it comes w/its own stresses..like miles on your car, filling your tank up more and going from 12 hours shifts to 5 days/wk is also an adjustment. Also, wages were less in these areas than the hospital. Make sure you are paid a salary or hourly NOT "per visit" because that can create a whole other stress. Your experience lends itself to either one & if you don't like one you can go into the other, if neither work you can always go back to the hospital setting. But again, if call or being called out is a huge deal to you, don't go the hospice path.

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I worked both HH and Hospice. I am still PRN with the Hospice agency I worked for, for the past 4 years. It is really a personal preference. When I was with HH, we took call for a week at a time, Tues-Tues and we were off the Monday before and the Friday after our call. HH call can mainly be dealt with over the phone for the most part. I did it when everything was pen and paper, so even though there is more paperwork, I would assume that its easier now that most agency used tablets or laptops. With HH you have to call the Dr for any kind of order. Our agency had no standing orders.

With Hospice, I worked as a case manager for 2 years and the weekend call nurse for 2 years. I enjoyed both positions. As case manager we took call 1 night a week. The weekend call nurse worked from Fri 5:30 to Mon 8:30. Hospice tends to be more miles on your car in my experience, but I loved it so much better. We had standing orders so you didn't have to call the Dr for every little thing. It was just more rewarding as well with the pts. Many ppl say that you lose you skills, but I did not find this to be correct. I inserted foleys, drew labs, did wound care and drained pluer-a-vacs. It just different that being in the hospital. You have to get creative with your sterile field at times. You definelty want to keep a box of supplies in your care also. I always had basic wound care supplies, a couple of foleys with bags, mouth swabs, lab supplies and a few other odds and ends that were specific to my pts. I live in a large rural area, so it was no big deal for me to drive 500-750 miles a week but I did get reimbursed mileage.

Hope this helps!

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i've been doing hospice since 2012 and i feel it's a humbling experience but i always felt i've always wanted to be a hospice nurse since graduating nursing school in 2010. i have seen some hospital nurses struggle in the home health field, mostly with the charting and adjusting to the 'hospice way.' of course you're aware that these patients are super fragile as they go along their journey but it's bitter sweet to walk along side them during this vulnerable part in life, it's very rewarding. i will say if you don't like family dynamics, it might not be for you because you will deal with some off the wall families, maybe need to call APS, ombudsman, etc. but for the most part, i've been blessed that the good outweighed the bad but if **** hits the fan, everyone's going to look to the case manager to fix it. go for a nonprofit company if you can, i worked for a for profit hospice and it's like working in a SNF and it's really hard to be part of a start up hospice as they work out the kinks. i did start as a revisit nurse and then took on the case manager job because i liked being about to do my own schedule and got tired of fixing lazy nurse's medlists. a good case manager hardly turfs off patients for another nurse to see, especially critical cases, unfortunately there's those case mgrs that don't care and would rather see their easy ppl and give away their problem cases, which just pisses everyone off. but i

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