New grad asks if they should leave ED after 6 months for hospice

[Nurse Beth, MSN]

It sounds like you have a big decision to make! Both paths offer pros and cons, and it is understandable that you are considering the long-term career impact and the personal adjustments, especially regarding family life and work-life balance.

Here's a breakdown that might help guide you. At the end, I will give you my personal opinion.

ED (Emergency Department) Pros

• Work-life balance. With 3-day shifts, you get 4 days off, which gives you significant time with your kids, and the ability to schedule yourself allows flexibility.
• High-acuity, fast-paced environment. This could be an advantage if you enjoy being constantly challenged, working with diverse cases, and developing your critical care skills.

ED (Emergency Department) Cons

• Staffing issues. As you mentioned, the short staffing can lead to burnout and stress. This is a big concern, especially if it's chronic and could jeopardize your license. It's important to work in a safe environment where you feel supported.
• Shift type. Mids might be tough for family life, even though the 4 days off are a perk. The emotional and physical toll from high-stress shifts can also wear on you over time.
• Pay: If the compensation isn't great, it could motivate a change, especially if you can earn more elsewhere without compromising your values or quality of life.

Hospice Admissions Pros

• Better pay. The higher salary could be a big plus, especially if financial stability is your key concern.
• Slower pace. Hospice might provide a more predictable schedule and a less stressful environment. You'd likely have more time to devote to your kids and yourself.
• Consistent hours. The structure of a five-day workweek with set hours may be more predictable for family planning. Another advantage is that on-call shifts are limited to holidays.

Hospice Admissions Cons

• Longer workweek. Five days a week (plus on-call shifts every other week) is a bigger commitment than the 3 days in the ED. This could be harder with young kids, especially when considering childcare needs.
• Salary vs. flexibility. The salary is higher, but being salaried means that overtime isn't compensated like hourly work. You might feel "locked in" if the work increases in volume or complexity.
• Look at the whole benefit package-vacation, insurance, etc.
• Sometimes, higher pay can be a red flag, meaning the agency has difficulty retaining employees.
• Career progression. While valuable, the experience in hospice care is quite different from ED experience. If you're thinking long-term about advancing in nursing, the skills you develop in the ED (critical care, rapid decision-making) are more versatile for other roles down the line.

Considerations for Returning to the ED After Hospice

• Skill transferability. The skills you're building in hospice (empathy, symptom management, patient education) are extremely valuable but different from the clinical, fast-paced skills you'd make in the ED. 
• Difficulty transitioning back. Returning to bedside nursing after time in hospice is possible, but the longer you are away from acute care, the more difficult it is to return. Having only 6 months of experience on your resume is less than the 1-2 years expected by an employer.

Career Growth

• ED. Staying in the ED, even for another 6 months, will deepen your experience in acute care, trauma, and high-pressure decision-making, which is a strong foundation for future roles in critical care, advanced practice, or even management. Plus, the experience is highly transferable to many other areas of nursing (including specialties like ICU, flight nursing, or nurse practitioner roles).
• Hospice. Hospice nursing, while emotionally rewarding, has fewer opportunities for the rapid skill development that the ED offers. It could be a great choice if you're drawn to end-of-life care, case management, or palliative care, but I don't hear that in your letter.

You asked if it would help advance your career to stay in the ED. I don't know your career goals, and maybe a good start for you is to identify where you want to be in 5 years. Try a vision board that includes financial goals, career goals, and includes family time.

Final point. Staying in the ED will advance your career while going to hospice admissions could derail it.

My Thoughts

You are thinking about leaving the ED for some reason. What is it? Looking at job advertisements when you are still new at your job indicates something is not right.

However, it could just indicate that the honeymoon phase is over. You are still on the learning curve in the ED.

Stick it out in the ED for a few more months. In the meantime, make a list of your priorities. Job opportunities such as hospice admissions will still be there, trust me.

Ultimately, whether to proceed with the change depends on what you value most right now—whether it's family time, a smoother job pace, higher pay, or continuing to build on critical care skills for future opportunities. Both paths offer unique rewards and challenges, so it's about finding the right balance for your life.

Very best wishes, my friend

Nurse Beth

 

[JKL33]

If you will need to pay child care and do not have that expense with your ED job, that amount needs to be subtracted from the amazing salary hospice is offering; don't even think in terms of what they are offering but rather what you are left with after paying for childcare. Next, using that 2nd amount, consider that just being salaried is its own issue many times. Since you will do "whatever [amount of] work that needs to be done...all for the same salary (the one already adjusted for childcare), this is a situation that can easily/frequently math out to mean that you are making less per hour than hourly-paid roles, depending on the demands of the salaried position.