On-call hospice nurse

vampiregirl, BSN, RN · Mar 6, 2022

25 minutes ago, amoLucia said:

Question - what are 'tuck-ins'?

I'll be interested to see what other agencies do for "tuck-ins"...

My experience with "tuck-ins" has been a brief initial visit to admissions (or change in location) especially if it's late in the day as patient/ family may be exhausted and a full admission visit can be several hours long. Consents are signed and immediate symptom management needs/ education are addressed during a tuck in visit. Medicare does not require that the full comprehensive admission assessment be completed at time of admission - agencies have 5 days to complete this. I always feel like the most important thing for families to understand is how to contact hospice if needs/ questions during the night.

Typically another visit time for the "rest" of the admission is scheduled the next day. An effective tuck-in visit can be helpful to make a good first impression for the patient/ family and decrease stress. Symptoms can be addressed which is often what patient/ family are most concerned about. A full admission visit can be exhausting for patients/ caregivers and if the admission visit is rushed then important information will not be addressed.

amoLucia · Mar 6, 2022

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Annw · Jun 3, 2022

On 8/5/2013 at 10:43 AM, HillieRN said:

I realize this is an older post, but is there anyone who works without any backup at all? This is my current situation and I am very concerned.

I am an on call Hospice nurse for a hospice with a census between 45 and 50. I am the only weekend call nurse, and I am responsible for all triage and visits. Before they hired me, the case managers took turns covering the weekend. For the most part, I do not feel overwhelmed because the case managers are excellent and I am not expected to do any regular visits--only PRN's and the (very) occasional admit. However, sometimes it does all go south at once and it can be bad. I have a supervisor I can call for help, but she is sometimes sleeping or away from her phone. It can be frustrating when there is an admit (because I rarely do them, and am not really proficient ), along with some pts not doing well, plus trying to answer the phone. Those weekends make me start thinking about doing something else.

SunDazed, BSN, RN · Jul 1, 2022

On 6/3/2022 at 2:40 PM, Annw said:

sometimes it does all go south at once and it can be bad

I started my first shifts on call at the beginning of March this year. This past weekend was the first time I had a night with so many calls I could not get to them, and it would have been nice to have back-up. I had two pain crisis calls I could not return until after I had finished up with an actively seizing patient and his family. I was able to handle them all by phone, but between the calls to the MD and the AOD and the family, the seizing patient took well over an hour. I felt bad calling the pain crisis families back 90+ minutes later to try to help, but it was all I could do.

I do get frustrated when one or two of the case managers don't seem to follow up on the night triage information. I know we all have our own way to make assessments, but when they don't even call the family? Or indicate they have reviewed the medication regime? And don't update the med list, which is the only thing the triage service has access to besides a face sheet. Sigh.

Heading into the July 4th weekend... I don't mind working holidays... but the fact that the day shift is so thinly staffed, is sure to mean (based on all the other holidays I have already worked) I will be getting calls that could have been avoided if day shift had enough staff to reach out first. Fingers crossed no one is going into the holiday weekend without all their meds!

TiffanyDev · Feb 24, 2023

I have an interview on Tuesday for a weekend on call hospice case manager position and this thread has definitely given me a list of questions I need to ask before agreeing to the starting salary. When I first heard about the position I was thinking it would be very easy money. However, after reading that my average caseload will be 10-15 patients and some being admissions, I'm a little concerned that those weekends are going to be torture. It's from fridays 5pm until Monday 8am. I know there will be an on call chaplain and social worker that I can utilize but not sure if there is a backup nurse. I don't mind being crazy busy but the pay needs to be worth the burnout. For those that are paid hourly would you mind disclosing the amount you are paid? This company does not have any bonuses for appointment types either. When I break the salary down to hourly it falls well below my hourly rate I'm currently making as an RN Supervisor.

sulfam · Feb 24, 2023

Case load 10 to 15 may be fine, busyness is fine, but I would run from that weekend stuff...its ridiculous and its beyond burnout. If you absolutely need the job I would make sure they have a backup nurse because weekends are full of visits all hours of the night, med management, bowel care, and death. I have moved on from hospice and have been working as an ICU nurse for the last 5 years. It fits me way better and I get the support I need. It's nice to have a team around you. Anyway I hope this helps.

SunDazed, BSN, RN · Feb 24, 2023

I am not sure what it means to have a caseload if you are an on call nurse? A caseload is held by Case Managers in the hospices I have worked at. Sometimes when the census was high, they would have me "hold" a small caseload of 3-5 patients that were either new on service and likely already imminent, or fairly stable but still hospice eligible.

Admissions take forever. If you have to do admission assessments, that is a long visit. If you have to do all the pre-admit chart reviews and consent signing it is an even longer process. Our admission nurses do two admissions in a day including signing consents, or one admission with consents plus other chart reviews for future admissions. So imagine adding that to a full case load?

You can't predict death, so you can't plan how many death visits there will be. And my current agency has worked hard to make sure 'emergency' bowel care visits are minimized. I mean, seriously. If the day shift visit nurse and case manager call the people 5 days in a row and they refuse bowel care visits, why do they need it at 10pm on a Friday? Give me a break.

There is a skill in being able to triage on the phone to make the family an/or patient feel like they can do something if you can't come right NOW. Do you have to take all the calls or does the hospice use a triage service like CareXM? If the use a service, it can take a lot of routine symptom management questions your plate.

One issue can be getting medications for new admits. Does the hospice use comfort kits? Are you somewhere that has 24 hour pharmacies that you work well with. If they use a pharmacy benefit manager it adds layers (aka hours) to being able to get meds out to people, especially if they don't use comfort kits.

Can't say how much pay... I would say on average the pay I have taken for hospice jobs is around 60-70% of what I would get if I worked the 12 hour shifts at the local union hospitals.

Peachpit · Mar 2, 2023

Just saw this thread after posting something similar about on call and triage LOL. I won't reiterate what my other post said but ..I'm going to pass on the offer I received. Like a few other posters said here, don't mind being busy but flying through 5p Fri to 9 a Monday w/o dedicated back up and the addition responsibility of triage on top is just burnout and liability issues waiting to happen.

Hats off to those of you who can do this.

Ann Weindel · Mar 2, 2023

I do this, and have for several years. It only works with the right company. If you have a company that respects you as a human being, and offers backup when you get busy, it's doable. I like it because it frees up my weekdays. I have tried to work for companies who were simply too busy for one human to do the job. It was awful, and I no longer work there. I am NOT a glutton for punishment. The hardest part is being on call at night, but if it's the right company, you very rarely go out at night, and it's only for true emergencies.