New hospice nurse: Burned out!!!

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I HAVE BEEN A HOSPICE NURSE NOW FOR 10 MONTHS NOW AND IM FEELING COMPLETELY BURNED OUT. I HAVE CONSIDERED LEAVING MY JOB FOR THE LAST 2 MONTHS. THE PROBLEM WITH THIS IS THAT I LOVE HOSPICE. I LOVE THE FACT THAT I GET TO BE THE NURSE THAT I ALWAYS PICTURED IN MY HEAD. THE ONE THAT IS MORE THAN A DOER BUT ONE WHO IS A CRITICAL THINKER. I CONSIDER MYSELF A NEW NURSE AS I HAVE BEEN IN THE FIELD FOR 3 YEARS. I PREVIOUSLY WORKED ON An ONCOLOGY/MED-SURG FLOOR THAT WAS EXTREMELY SHORT-HANDED FOR OUR AREA, AND IT WOULD BE NOTHING TO COME IN AND HAVE 7 CANCER PATIENTS. WE ALL KNOW HOW MUCH ATTENTION A CANCER PATIENT NEEDS SO THIS LOAD WAS CRAZY TO ME. I LIKED WORKING IN THE HOSPITAL, BUT I FELT LIKE ALL I DID WAS FOLLOW ORDERS. I WAS NOT ACTIVELY BEING A NURSE I FELT. WITH HOSPICE I AM ALLOWED TO REALLY USE MY CRITICAL THINKING SKILLS. ANOTHER REASON WHY I WOULD HATE TO LEAVE IS THE AMOUNT OF KNOWLEDGE THAT I HAVE OBTAINED WHILE BEING ON MY JOB. I HAVE BECOME A MUCH BETER NURSE BECAUSE OF THE DAY TO DAY LEARNING THAT I RECIEVE ON MY JOB. I HAVE LEARNED MORE IN HOSPICE WITHIN 10 MONTHS THEN I DID IN 2 YEARS ON MY ONCOLOGY FLOOR. MY PROBLEM IS THAT I AM CONSTANTLY WORKING. I WAKEUP AND WORK AND I WORK WHEN I GET HOME. AS SOMEONE WHO HAS NEVER WORKED IN THE HOMECARE SETTING I FELT THAT I NEEDED ALOT OF ORIENTATION TO THE JOB ALTHOUGH THIS DID NOT HAPPEN. I SPENT 4 DAYS WITH A NURSE WHOS POSITION I WAS TAKING AS SHE WAS LEAVING TO TAKE ANOTHER JOB. I FELT MY ORIENTATION WAS RUSHED AND MY WORKLOAD WAS TO HEAVY TO FAST. I STARTED OFF WITH A FULL TEAM OF PATIENT AT 13. I KNOW IN HOSPICE NO ONE HAS THE TIME TO MICROMANAGE YOU BUT I DID NEED TO BE MANAGED. THE MANAGER WHO I HAD AT THE TIME WHO I ADORED WAS UNABLE TO HELP ME DUE TO THE FACT THAT SHE WAS OVERWORKED. I RELIED HEAVILY ON MY SISTER WHO WORKED FOR THE COMPANY AS A PATIENT CARE MANAGER AND A CASE MANAGER FOR 10 YEARS. SHE LEFT AFTER 2 MONTHS OF ME BEING AT THE COMPANY BUT SHE WAS BASICALLY MY MANAGER WHO I COULD CALL ON WHILE OUT IN THE FEILD IF I HAD QUESTIONS WHICH I HAD ALOT OF. I WAS GIVEN NO RESOURSES WHICH MADE A DIFFICULT JOB EVEN MORE DIFFICULT. TO TOP IT OFF AFTER BEING THERE FOR ABOUT 4 MONTHS STATE CAME!!!!! DURING THIS VISIT MY COMPANY WAS CHEWED UP AND SPIT OUT ON THERE DOCUMENTATION AND WAS LEFT WITH 30 DAYS TO GET IT TOGETHER BEFORE THEY CAME BACK. WELL THIS SET OFF A CHAIN OF EVENTS WHICH INCLUDED 2-3 MEETINGS REGARDING CHANGES A WEEK(ALONG WITH IDG), DAILY AUDITS, POLICY CHANGES, AND INSERVICES. DURING THIS TIME I STILL HAD TO FIND A WAY TO SEE ALL MY PATIENT HAS PRN HELP WAS UNAVAILABLE. NOW THAT STATE HAS COME BACK AND EVERYTHING TURNED OUT FINE I AM STILL LEFT IN THE SAME WORE OUT CONDITION. I DONT KNOW WHAT TO DO. I DEAL DAILY WITH ATTITUDES WHEN YOU HAVE QUESTIONS. I DEAL WITH MANAGERS WHO TALK TO YOU LIKE IN THERE MIND THEY ARE SAYING " OH WHY DONT YOU KNOW HOW TO DO THAT YOU BEEN HERE FOR 10 MONTHS". I WAS NEVER EVEN TAUGHT HOW TO DO AN ADMIT BUT WAS SENT OUT TO DO AN ADMIT AND WHEN QUESTIONS AROSE FROM ME I WAS TOLD THAT ITS PRETTY SELF EXPLAINATORY. AS ALL HOSPICE NURSES SHOULD KNOW, WHEN YOU ARE A NEW HOSPICE NURSE NOTHING IS SELF EXPLAINITORY. I REALLY JUST DONT KNOWN WHAT TO DO AS I LOVE THE JOB AND MY PATIENTS AND FAMILIES DEARLY AS I HAVE GONE THROUGH MUCH WITH THEM AND THEY HAVE HUNG IN THERE WITH ME WITH NO COMPLAINTS AS I LEARNED AS I GO. I HAVE DISCUSSED THESE ISSUES WITH MY DOC AFTER SHE CAME TO ME TO ASK WHY I WAS SO BEHIND. I LET HER KNOW THAT I HAVE EXPRESSED THAT I NEEDED HELP SEVERAL TIMES WHILE OUT IN THE FEILD AND HAVE BEEN TOLD THAT THIS PERSON IS OFF AND THAT THIS PERSON IS OFF AND THAT YOUR PRETTY MUCH JUST ARE GOING TO HAVE TO HANDLE IT. I KNOW THAT TIME MANAGEMENT HAS BEEN AN ISSUE WITH ME AND I AM RESOLVING THAT WITH MANY TIPS THAT I HAVE LEARNED FROM THIS SITE AND COWORKERS. BUT I FEEL THAT IT IS SO MUCH MORE TO IT THEN THAT. I FEEL LIKE I HAVENT BEEN GIVEN THE TOOLS TO SUCCEED AND IM STRUGGLING TO STAY IN A JOB THAT LOVE. IF ANYONE HAS ANY SUGGESTION ON HOW TO PROCEED PLEASE LET ME KNOW. I AM SO ON THE FENCE BECAUSE I KNOW THAT MY RUSHING AND SITUATION CAN POTENTIALLY PUT MY PATIENTS IN A BAD SITUATION WHICH I REFUSED TO DO. SO PLEASE HELP A STRUGGLING HOSPICE NURSE IF YOU CAN. THANK YOU!!!!

Our hospice was always trying to get us to chart at the bedside. I was very uncomfortable doing that. I once had a COPD patient tell me "I need you to look at me when I talk, because it takes absolutely all my strength just to say a few words, and I don't want to do that if you are looking into the computer." the computer closed and I never opened it again, ever, at a patient's house.

There are too many studies showing that patients believe that providers are distracted and i'm interested computer. I think that probably has changed somewhat in the last few years because it is becoming much more common.

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Our hospice was always trying to get us to chart at the bedside. I was very uncomfortable doing that. I once had a COPD patient tell me "I need you to look at me when I talk, because it takes absolutely all my strength just to say a few words, and I don't want to do that if you are looking into the computer." the computer closed and I never opened it again, ever, at a patient's house.

There are too many studies showing that patients believe that providers are distracted and i'm interested computer. I think that probably has changed somewhat in the last few years because it is becoming much more common.

I had many reservations about bedside nursing but to be honest - if you want to survive and get your job done in a timely manner, it is a must nowadays. And patients get used to it, a lot of providers input data while they are assessing in doctor's offices and also in the hospital.

Granted, in hospice there are situations when you do not want to pull out the laptop but starting bedside charting did improve my time management and the timeliness of charting. I would open the laptop and fill in vitalsigns and check off boxes for the assessment with the visit. After the visit I would usually sit in the car for another 10 minutes or so and complete the comprehensive note or other items. Sometimes you have waiting time while you wait to hear back from the hospice medical director for example and I would just wait at the pat house and complete my note while waiting for the call for recommendations.

I stick to timely documentation with my job in the hospital as well. After I meet with a patient or family I sit down and write the note. That has the advantage that by the end of the day I am usually done with documentation and can still remember enough details.

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I have just switched from hospital nursing to hospice nursing for about a month, thinking I would give it a try. Although the OP typed in all caps, I interpret it as a big crying out for help (cause I feel the same now !). When I read the OP's posting, I felt like someone can completely read my mind! I have been off the so call *orientation* and on my own for 2 weeks. But I already feeling burn out. Most of time I feel alone in the field without resources and also not knowing what to do (in the hospice system). Our company still charts on all paper and the med list is a mess. In the past few days, I have doubts if I made a wrong choice. I got burn out in the hospitals and thinking hospice will let me stick to the purest form (or close to) of nursing. But in a new case I'm handling past 2 days, nobody cares except me and the SW. I'm giving some it some thinking over the weekend and then decide if this is the right place for me.

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Specializes in Hospice,LTC,Pacu,Regulatory,Operating room.

Since Medicare has created the hospice benefit many hospices have opened and they don't have the best training programs in place. I've worked for 5 hospices none of which trained me.i also want you to know that 10 mos in this business will burn you out a bit and it's a cycle that we go through. If you want to stay with this hospice company I'd start speaking up and asking for some additional training, on policies and procedures and ect. Believe it or not it's a state requirement that they do hospice inservices with the staff. If they don't respond start looking elsewhere but also set up a set of questions on your next interview that let you know if these things are provided..

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Honestly, people. You can't read with caps? The device I have to document with ONLY uses caps. Give this poor girl a break.

I too love my job as an RN Case Manager for the same reasons this writer does. I'very been doing it over 10 years and identify completely with what she is going through. When we were a small company, I had all the support in the world, but as we've grown, documentation has quadrupled and caseloads are higher than we've ever had. Working between 50-60 hours every week, and getting paid for 40 (salaried) is the norm.

Orientation is slipshod at best. Sadly, we are hiring new nurses and they burn out so fast, especially if they have a baby or young children at home.

IDG meetings are a joke. I used to love them because it was a time to collaborate and I learned so much. Now all of it is about the physician making sure the client is eligible, nothing more. Chaplains and social workers don't even bother to try to contribute anymore.

The worst part is, management feigns concern at the staff turnover (which we never used to have) but nothing changes. Any raises are swallowed up by rising cost of our insurance premiums. Chritmas or any kind of bonuses are nonexistant. We get only constant urging to take on more visits , more on call, and more add-ons to our documentation.

Why don't I leave? Because if you read the reviews of different hospices from employees, these issues are industry wide. Ideas anyone? I am getting too old for this pace.

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Specializes in currently, hospice.

I genuinely feel your pain. My personal solution is going back to school, in spare time I don't really have, to get a MSN in education. So maybe I can transition to working from home in my comfortable clothes, teaching online, or mentoring online. You are right, the hospice industry of pretty much what you describe. To me, it's a better fit than the hospital, and it's the patient relationships that make it worthwhile, but it's not a lucrative profession, and it can tear you down physically, emotionally, and spiritually unless you can find a "why" that keeps you mostly grounded and mostly contented. I'm sorry for what you are laboring under.

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Specializes in Long term care.

I agree I do not chart at my visit...I don't have time anyway....Im fortunate that the hospice I work employs Lpns and HHA's ....I'm a Lpn....I'm assigned to two Rn case managers and we work as a team...I visit up to 8 patients a day...mostly in assisted living facilities so it's doable because I just walk down the hall to my next patient...I am the hands on nurse...and the eyes and ears for my Rn case manager...I do the personal care and or wounds tx as needed and order the supplies for each pt...my Rn case manager makes 4 visits a day and just 2 visits a day on idg team meeting days....we usually always have at least 13 to 15 patients....it only becomes difficult if more the one patient at a time begins transitioning to actively dying status...our hospice lets us Lpns manage our time and schedule our day...so I can make shorter visits to my other patients while I spend more time with my dying pt and their family. From what I read it sounds like the your hospice needs Lpns and Hha to assist you.

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Annlewis, I like the team concept your hospice uses. Thanks for your response.

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Specializes in IMC, school nursing.
I'm trying to think of CRITICAL skills needed for hospice. Pain and anxiety management is all; patients are not being medically treated.

Seems a bit :sarcastic: myopic.

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I am sad that I keep hearing the same things over and over again from hospice nurses. My company is the same…case loads in the upper 20's….by the time the new hire gets trained a seasoned one quits. Or the new realizes that you can't make any connection at all when you see 6 people with 30 minutes of driving between each, 30 minutes of charting..plus whatever is wrong. Complex dressing changes, pleurex, pumps and whatever else you can think of. Doctor's that may take 45 minutes to call you back but you can't leave the bedside always and circle back around….(mine always call me back when I am doing 70mph on the highway…usually while they are doing 70mph in the other direction between the 6 people they are seeing)

Oh, another big use of our time that management doesn't know how to put on a spread sheet….time spent talking to patients and families…There are days you go into a families homes and the clients and families just want someone to talk to…not about the disease or treatments….just a GD human connection for 10 minutes because so many of these families all the do is eat, sleep and breath the death of someone they love. You may be the 79 year old woman who takes care of her demented husbands only rationale conversation for a few days while she is with him day and night.

Well hell, I rewrote that a few times and that is the tame version of that paragraph…..I'm thinking I might be getting burned…I have been seriously looking at new careers (outside of nursing, same BS everywhere)….

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Agree with every word. All sad but true. We are losing the heart of what hospice is all about. I want to tell you to hang in there, it's all worth it, but I can't. Good luck with whatever you decide.

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OP I'm wondering how you ended up faring? I am currently in the same position, about 7 months into a hospice case management job that I spent the year previous trying to get into. I am realizing that while I love hospice I don't like the office environment, and agree with all the other posters who are telling you that the added stress is the poorly managed company and not the job!

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