westieluv

I do phone triage for hospices/home health agencies all over the country and many of them employ LVNs, both in their inpatient units and out in the field.

I don't think that waiting two weeks would be doing anyone any favors. You have already made up your mind to leave so sticking around is just going to prolong your misery and your new employer needs to know this ASAP so that they can make other arrangements. I am in the exact same situation, except that I have been at my new job much longer than three weeks. My previous employer is in the process of working out a schedule just for me so that I can come back and as soon as this is confirmed, I am going to either go per diem at my current job or just leave altogether. Life is too short and my employer needs as much notice as possible to replace me, even though I am only part-time.

Three weeks in a sub-acute rehab facility that was woefully understaffed, under equipped, and just plain dangerous. I feared for my license. Is it just in my area, or are all of these beautiful new facilities with fireplaces, fieldstone exteriors, and lavish interior design just facades for an unacceptably unsafe working environment? It's like they spent all the money that should have gone for hiring more staff to make the place look stylish and impressive. We had one thermometer, dynomap, glucometer, and pulse oximeter for 70 residents, several of whom required daily AC + HS blood glucose checks and daily BP checks before getting their BP meds, not to mention only three computer work stations for four nurses, meaning that one of us would have to wait to do all documentation until someone else was finished for the day. Whaaaattt???

I agree with the others, before you accept a position with low nurse to patient ratios, ask a LOT of questions. I work in an inpatient hospice unit with eight beds, rarely all of which are filled, that always staffs two nurses no matter the patient census. Sounds like a dream come true on the surface, but when you have six patients between two nurses and 3-4 of them have terminal agitation or dementia behaviors and really require 1:1 staffing to be safe but the facility does not staff for 1:1 care, it can go south very quickly. We have a lot of falls for this reason, which I don't find acceptable. My supervisor assures me that this is "just going to happen because this is hospice" but I can't reconcile myself to that explanation, it sounds like an excuse.

I think I have taken job hopping to a new level. I am an RN of 27 years who has had ten jobs in the past eight years, some for as briefly as a few months. Seriously. The longest I have stayed at any of them was 2.5 years and that was a job doing phone triage from home that I also came to hate. I can honestly say that I haven't liked any of these jobs; the responsibility of having people's lives in my hands, the emotional stress, the ridiculous workload (I had an acute dialysis position where I was sometimes required to work 20 hour days!) and feeling incompetent because I took several years off of nursing before jumping back into the pool eight years ago...and on and on and on. I am currently working at a hospice inpatient unit which I also don't like, although I am, and always have been, very kind to my patients and their families because I don't blame them that I hate what I do. My employers have all liked me and were unhappy when I quit, but I just couldn't stand what I was doing. So here is the same old million dollar question: I feel like I can't go on anymore in nursing but I can't find anything else that I'm qualified to do that would pay even close to what I'm making now and provide benefits, and I don't have the option of working somewhere that pays much less because my husband is currently laid off and finding it hard to find a job due to his age. My job requires doing some laundry and dishes and these are actually my favorite part of the job because there's no stress and I don't have to be a nurse to do them. Help! Am I stuck? I am getting really depressed and I don't know what to do. It is 7 am and I am already feeling depressed and anxious because I have to work tomorrow evening, not even today! I feel like I can't quit another job (and I really can't because of my husband not working) but I hate nursing so much that it is taking a huge toll on me in every way and making me difficult to live with.

Honestly, hospice patients and families are usually pretty preoccupied and probably won't even notice what you're driving or care. The only thing I would caution you about is if you ever have to go into a bad neighborhood you may want to rethink driving a sharp looking sports car, especially if it's after dark. No need to draw unwanted attention to yourself. I once had to do a visit at night in a very rough area and I didn't have a sports car but I did have a brand new Ford Fusion and I was worried that it might be gone when I came out of the patient's home (it was still there).

I just renewed my certification in 2016 and they specifically requested to know how long I've worked in hospice/palliative, how many hours I have worked in hospice/palliative in the past few years, if I'm still working in hospice/palliative, and contact information for my employer so they could verify. Honestly, I think there should be an experience requirement for any kind of nursing specialty certification. If it becomes something that just anyone can get by rote learning and memorization without actually having worked in that specialty, what good is it, really? I probably could have passed the exam by studying hard and memorizing content before I worked in hospice but the knowledge that I've gained from working in hospice before I took the exam and since is what has made me a valuable hospice nurse, not an exam. BTW, they have really changed things up since I first got certified in 2012. I'm not sure if initial certification still consists of taking an exam, but to get recertified you have to provide evidence from a combination of areas such as working in hospice/palliative, having an allotted number of continuing ed hours in hospice/palliative, and any teaching and/or management experience in hospice/palliative. I think the fourth area involves having done writing or any other kind of media production related to hospice/palliative nursing, but I could be wrong on that one because I just used a combination of the first three. You have to accrue so many points in at least three out of those four areas, if I remember correctly. It is not easy, an exam would have been much easier.

I second hospice. I have been an RN for 27 years and I cannot tell you how burned out I was on acute care. The constant stress of worrying if that borderline critical care patient on the progessive unit was going to crash, having to deal with drug seeking patients and the physicians who enabled them, dealing with nasty families always looking for something to be unhappy with, dealing with lazy co-workers who walked off the floor to smoke (when the campuses were non-smoking indoors and out), and etc., etc., etc. I am someone who has always loved the people side of nursing but not so much the technical side. I probably would have made a good social worker. I love hospice because I get to comfort dying people and their families and feel like I really made a difference. I have had grieving families that I'd never met before hug me and cry and thank me over and over. I don't remember getting a lot of thanks for anything in acute care. It is so satisfying to see someone who was suffering with end of life and terminal illness symptoms get relief and fall into a peaceful sleep after I spent time with them and advised the correct medications and you cannot even believe how thankful families are when they see their loved one's suffering stop. You have autonomy in hospice if you work out in the field and you can set up your day how you want to unless you are an after hours nurse who goes out for emergent situations and death visits. I know a lot of nurses who were so done with nursing and then switched to hospice and can't imagine themselves doing anything else, myself included.

The previous posts are spot on. The only thing I would add is that in some cases, the RN case managers who have a team of patients that they see during the day also have to rotate taking call during the night and weekend hours, meaning that they may get called out during the night or on the weekend to see patients other than their own. They usually get days off during the week to compensate for this. Other hospices have dedicated on call nurses instead who take over at 5 pm or whenever the office closes and are available for after hours admissions and emergent visits and don't case manage during the day. Sometimes the on call nurses do the phone triage as well and sometimes they work with a dedicated telephone triage nurse who takes the incoming phone calls and relays the information to them if the situation cannot be handled over the phone. I have a job where I work with several hospices every time I work and I see a lot of burnout in the cases where the case managers are also expected to rotate taking after hours call. It is so much better when there are dedicated on call nurses to cover the nights and weekends.

I've worked for two different hospices and currently have a job where I have daily contact with several hospices. BEWARE any hospice job that is on call and salary. What they are telling your wife about not getting called out that often is nice, but the reality is that if there is an admission (2-6 hours, depending on the patient and situation) that gets pushed to after hours or any other "leftover" work from the day shift, e.g. scheduled visits that the day shift case managers couldn't get to during their shifts, it will probably get dumped onto her and she will have nights where she is swamped with work, even if she doesn't get called out for an emergent need. Hospices don't like to pay people to sit around and twiddle their thumbs, believe me, they will likely find her plenty to do aside from the visits that she has to do. The whole on call thing sounds good in theory but unfortunately, it really is too good to be true in many cases. I accepted a 7 days on/7 days off on call job with a hospice a few years ago and was told that during my off week I wouldn't have to do anything and during my on week I would have days off and be on call all night, similar to what your wife is considering. The reality after I had gotten through most of my orientation was that I was expected to be available during the days on my off week because I didn't have to go out at night (so no off week at all, go figure!), and that I would be available during the days on my on week because the supervisor decided that there weren't enough visits on average to warrant my salary. So on my on weeks, I was literally expected to be available 24/7 for seven days in a row. No, thanks, I quit as soon as all of this was presented to me. Tell your wife to be very, very careful and ask a LOT of questions about job expectations. Will she be expected to do anything above and beyond the emergent visits? Will she have to do admissions, clean up after a slow case manager who consistently doesn't get her work done during the day? If possible, she needs to get it in writing. That was my mistake. Best to both of you!

I currently work from home doing telephone triage nursing but find that I am bored and lonely at home and feel the need to work around people again, even just a few days a week. I interviewed at a lovely hospice inpatient center today for a part-time night shift position which I think I would really love. The interview went very well and it sounds like they will offer me the job as soon as I send them the names of a few references to check. The management at my current company loves my work and are very happy with me so I would like to ask a couple of them for a reference. I don't plan to quit that job, just cut back to per diem, which helps, but still...I don't know any way to approach them about wanting to take on this other job and needing a reference from them. I figure I'll just be honest and tell them that I am bored and lonely working from home and still want to stay on per diem, but we are always short staffed so I think they will still be upset with me. They've been very good to me in the past and this is hard but I feel like I need to do it. How would you handle this? I need to send the references in the next day or so so that I know if I have the other job or not ASAP.

As someone who has worked in hospice for the past several years, BEWARE a salaried hospice RN job. I have never been a hospice case manager, always after hours, triage, or inpatient which were all paid hourly, but I know from seeing what my current salaried co-workers go through, as well a past co-workers at other companies, that there is a reason why they want to pay salary instead of hourly. In one case, the hospice expected the salaried nurse to make visits all day long and then be on call all night, every night for a week at a time. In other words, be available 24/7 every other week. Who would take that on, especially on a salary? It probably worked out to about $10/hour. Hospices don't usually have huge budgets and they tend to squeeze every last penny and then some out of their RN case managers with long hours and crazy demands. Maybe the company you are considering isn't like that, I hope they aren't, but just be careful since you said that you aren't that familiar with hospice nursing vs. being a hospice CNA. I would stick with what you love and build up some seniority and clout there. While I love hospice (not case managing, though, won't do that ever) I agree that if you are just starting out in your nursing career the ED job will do more for you in the long run. I am at the opposite end of the spectrum, hoping to retire early in a few years.

Actually, the working from home position aggravates my chronic pain issue a lot! I would not have ever thought that this would be the case, but sitting in a chair at a computer for nine hours straight and getting slammed with phone calls and having to type, type, type during and after each one leaves me with a lot of pain from my shoulders down to my hips after every shift. I have tried four different desk chairs and several orthopedic seat cushions and lumbar support devices, all to no avail. I ache more after a shift at this job than I did after a shift at other jobs that were much more physical. Not being able to get up and move around really takes a toll on the body.

Thanks for all of your helpful replies! I don't think I would have to take call with this job, it is an inpatient hospice unit within a hospital. However, I don't know that for sure so I would need to ask at the interview. I'm really on the fence here. I keep thinking "no way" then I turn around and think, "But I want to do this and it's only three days a week". Part of the problem is that my husband is pretty much against it because he looks at the wear and tear on my car. Right now my car sits in the garage a good part o the time and I only buy gas every few weeks at the most. He likes that a lot! He's a wonderful guy but practical to a fault. I do think this job would include a pay increase (it would almost have to, another reason why I'm looking), so it may balance out the extra usage of my car.

I sometimes wish, but my DH's job is here and we are closer to our families and generally pretty happy here so moving isn't an option right now. The same company offered me an interview for a job closer to where I live only working in the field as a case manager instead of in the inpatient unit (it's a hospice company) but that would defeat the purpose because I would be doing even more driving doing a job where I go to people's homes all day long.