On-call hospice nurse

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How are after hour and weekend responsibilities structured in the hospice agency you work in?

Specializes in Hospice.

I just accepted a new job offer and after reading these posts about salary and per hour pay, I'm a bit tense.  It is a nice salary with a bonus (but of course that bonus will be diminished quite a bit through taxation).  My hours will be 5pm-8am on call 7 days on/7 days off. I will get reimbursed for mileage, yet I'm not quite sure what I have gotten myself into yet.  I start next week; my Very Thorough background check finally came back without any issues...it was just much more intense than I remember from previous jobs.  Times have changed, of course.  Are there any hospice nurses out there who can offer me advice, tips, things to watch out for going forward?  This is my first hospice job, and I have been an RN/BSN for quite a while. I still would Really Appreciate advice and/or encouragement from other hospice workers, in any capacity.  Thank You very much.  As I said, I will start training on Monday; they haven't even asked me to do a drug test yet. I'm not worried about it , since I have nothing to hide, but thought that all nursing jobs required a drug screen/test before hiring, or at least somewhere during the process.  My own mother was in hospice care prior to her death about four years ago, which sparked my interest in palliative and hospice nursing. A new perspective, deeper, with more meaning to me personally.  Thank You again in advance for any and all responses.  

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Specializes in Hospice, Palliative Care.

Salary has pros and cons.  When I worked for-profit their for-profit took advantage and I worked more hours without the benefit of overtime.  On-call can be just phone, phone + PRN visits or phone + PRN visits + scheduled visits.  The latter can be horrendous, especially if salary.  By the way, I'm not stating or intending to communicate run.

I write mainly hospice stories at https://pmabraham.medium.com/ which may be beneficial to you especially admissions, recognizing terminal restlessness, end of lifek, et al.

 

 

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Specializes in Hospice.

Thank You Very much for the comments and the link; I have checked out some of the articles which I am sure will be helpful for me in the upcoming days/weeks/months of my new job.  It was so confusing getting hired as I had three different recruiters calling me from the same company. One said she would send me an email with details of my start day/time/place to be, then she said actually someone else from your home office will be emailing you that information.  It feels a bit off-putting to not have clear instructions from one source here in the beginning. I'm hoping this is not the way the company usually runs.

Of course I realize that a bit of handing off takes place between the recruiter and the hiring manager.  It is a for-profit hospice/palliative care company, and they have stated clearly that it is a Salary Position, no overtime, and XYZ this is your salary, and this is your bonus structure, and your on-call hours are 5pm-8am Monday through Sunday/Seven days on, seven days off.   Half bonus after a few months, then the other half at one year. I do have a lot of questions, yet it seems that I'll need to wait until I get started to ask the questions. 

I have been told that I do not have a set number of patients to see, nor will I have a list of "regulars" or appointments.  I was hired to be a go-between for families and patients who already have scheduled visits during the day, but feel/know that the scheduled visit cannot wait, which probably means change in status, death, need for additional comfort/pain measures, guidance/advice on falls, possibly family dynamics becoming confused.  I have seen all this happen and dealt with such situations in regular hospital settings when the patient is Not expected to pass soon.   I guess I'm just anxious and excited to get started and see what this position is all about!! Thank you again for your guidance and helpful information!  

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Specializes in Hospice, Palliative Care.

"I have been told that I do not have a set number of patients to see, nor will I have a list of "regulars" or appointments.  I was hired to be a go-between for families and patients who already have scheduled visits during the day, but feel/know that the scheduled visit cannot wait, which probably means change in status, death, need for additional comfort/pain measures, guidance/advice on falls, possibly family dynamics becoming confused. "

This is a huge plus as this is the best type of on-call.  You'll learn over time which types of calls require (sometimes it is more beneficial for the family than the patient) in-person visits vs. handling it over the phone.  Usually, I go by pain crisis, respiratory distress, and other changes that may indicate possible end of life (I.e. <= 2 weeks to live) as major reasons to visit in person; and from there, go by the emotions in the voice on the other end.  Based on what you've shared you will bloom.

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Specializes in Hospice.

Thank You Very much for the helpful information and encouragement!  I actually did receive the email from my new employer with all the information I need to get started. I know where to go, when to be there, and what to bring. What a relief!  Sometimes, it's just the little things that ease my mind the most.  Some of my nursing friends are curious about me branching off in this direction, but it just feels comfortable and natural to me. When I look at myself in the mirror, I see a confident and secure lady.  I'll continue to read as much as I can absorb about hospice and palliative care.   I'm truly fortunate and blessed to be provided this opportunity in my career.  Best Wishes to you!!

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Specializes in Hospice.

Welcome to hospice and palliative nursing! It's truly an amazing area of nursing. I found it to be a bit of a learning curve as some of the philosophy/ teaching is so different compared to other settings - it's a huge transition from aggressive treatment to comfort care. Palliative care can be the best of both worlds when done right. Hospice/ palliative care is truly patient centered and also addresses caregiver needs.

I joined the HPNA and found they have great resources for learning about hospice. You may want to see if there is a local chapter near you as well.

My favorite resource that use almost daily is https://learn.aahpm.org/content/primer-palliative-care-7th-edition. 

Opioid conversions are something you will probably want to learn about if you are not already familiar with them. 

I'm always finding new resources - I wasn't aware of pmabraham's writings until this thread. 

Good luck! And let us know if you have more questions!

 

Rachel

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Specializes in Hospice.

Rachel, Thank you very much for the information!  I really appreciate it!  I am also a night owl, by the way.  

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Specializes in LVN.

Hello, I am LVN, I would like some assistance on LVN scope in a hospice agency. 

what are pre admit evals, tuck ins? IS RN supposed to do it. can I get into trouble with my license. 

 

Thanks!

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Specializes in Hospice, Palliative Care.

Hi:
Tuck-in calls and visits should be doable by LPN/LVN/RN et al as it is just a routine visit or call to check in on the patient.  Pre-admission evals typically require a good understanding of LCD's and what makes a patient terminal from a nursing perspective.  I would think the latter would be better done by an RN, but that's just my opinion.

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On 2/15/2022 at 11:01 AM, gemswanson90 said:

I just accepted a new job offer and after reading these posts about salary and per hour pay, I'm a bit tense.  It is a nice salary with a bonus (but of course that bonus will be diminished quite a bit through taxation).  My hours will be 5pm-8am on call 7 days on/7 days off. I will get reimbursed for mileage, yet I'm not quite sure what I have gotten myself into yet.  I start next week; my Very Thorough background check finally came back without any issues...it was just much more intense than I remember from previous jobs.  Times have changed, of course.  Are there any hospice nurses out there who can offer me advice, tips, things to watch out for going forward?  This is my first hospice job, and I have been an RN/BSN for quite a while. I still would Really Appreciate advice and/or encouragement from other hospice workers, in any capacity.  Thank You very much.  As I said, I will start training on Monday; they haven't even asked me to do a drug test yet. I'm not worried about it , since I have nothing to hide, but thought that all nursing jobs required a drug screen/test before hiring, or at least somewhere during the process.  My own mother was in hospice care prior to her death about four years ago, which sparked my interest in palliative and hospice nursing. A new perspective, deeper, with more meaning to me personally.  Thank You again in advance for any and all responses.  

Hey there. I have worked hospice in the past, but also just came back to hospice in an on call, 7 on-7 off position. I have finished the day time training, and now have three nights where I will be the primary on call nurse with a back up experienced nurse. Our hours are 5pm - 9am. The hospice I work for has an after hours triage contract, so there is a service from basically 6pm-6am that answers the phone and tries to trouble shoot. If they cannot or a visit is needed, the call gets passed on to me. There are high percentage of visits that are pronouncing deaths in homes, or board and cares. One hospice I worked for had a nurse go to every one of these. This hospice for some reason seems to have a 1/4-1/3 of patient families who decline this visit and just want the mortuary called. 

The goal for the patient census is around 100-110. We have been in the 90's lately. As Night nurse we do not do admissions, though 15 years ago the Night nurse here did. We don't have scheduled routine or comprehensive nursing visits. We do have visits for calls from patients that come in near the end of the day shift that need in person follow up right as we punch in. The number of visits per night can be highly variable in our set-up. There can be no calls, or there can be 3-4 death visits on a busy night. Sometimes symptom management calls can be handled over the phone because we have good progressive orders in place for this (so we don't have to call the doctor for every change). Sometimes it requires a visit. Putting in catheters, irrigating catheters, etc. is common.

It is a rural area, so driving different directions can happen. 300 miles would be a lot, not completely unheard of for one night. Driving 100 miles a night between the 5 main communities we serve is not uncommon. 

The day shift needs to really focus on having the needed meds in the house for symptom management crises. Getting new meds at night from a pharmacy is time the patient and family suffer in the waiting. And it means a lot more driving because of where the pharmacy is in relation to where the patients live. 

I feel honored to serve families at this time. I am looking forward to starting on nights full time. It is requiring a shift in thinking for our managers, seeing 3-4 days off in a row in one week tempts them into thinking I could be working a lot extra for them. I am not saying it won't happen, but I am going to be mindful to avoid burnout and compassion fatigue. 

I also had to get a different vehicle. I live in a place where people build in remote areas and the dirt tracks can become muddy in the rain, plus there are some crazy steep roads. I went from FWD to AWD. I may suffer as gas prices start to go up, but I need to know I have the best possible vehicle for doing my job. I don't want to be stuck in the mud at 2am in a place with no cell service! 

Good luck!

 

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Specializes in retired LTC.

Question - what are 'tuck-ins'?

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Specializes in Hospice, Palliative Care.

"Tuck-ins" are calls or visits to see if the patient is OK, needs supplies, etc.  More often they are phone calls but can be a visit if a change in physical location such as nursing home discharged to home or home going to a nursing home (respite or longer).

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