goldberryRN

I've taken a sabbatical of sorts from hospice, but when I was working we had a CM or two who really knew how to " work it" and dawdle with certain tasks to get themselves up in hours. No one was allowed to go overtime so they would have to be given a partial or even full day off which typically was Friday. And so as you are experiencing, other nurses would have to see their patients. Certain nurses seemed to get away with it. It wasn't fair and morale was low.

Our hospice would tell pt's/families that they could revoke in order to seek aggressive treatment for the hospice diagnosis, and as far as I know they always complied.

Recently left but it was: RN Missouri 20/hr 2.50/hr on call Regular pay if I had to go out Mileage at IRS rate

After 2.5 years in hospice, I'm out, at least for now. I love hospice work, the patients, the families. But the management was so bad I couldn't do it anymore. There was a mass exodus of the core of the team a while back, due to the new manager of our hospice (hospital based), which pretty much decimated it in my opinion, and it never recovered. Why? So many reasons. The call schedule is harsh. Politics. Favoritism. Lower pay than other hospice agencies. I don't know how it is with other hospice agencies, but at ours, the CMs take ( theoretically) one night of call per week and one weekend day per month ( either Sat or Sun, 24 hours). There is no back up. If you have the night from hell you're on your own. Late admissions are done by whoever is on call. There is no triage. Weekends tend to be heavy with admissions and visits of one kind or another. When nurses quit, which has been often, the CM s have to divvy up that person's call until new people are hired, trained, etc. which takes several weeks. the CM s do get time off if their hours get to the point of overtime. This can be problematic though because then PRN s are seeing their patients a lot, so less continuity of care. Plus the CMs are still tired and stressed, and they just never really have enough scheduled, predictable time off because the schedule is always in flux. Being on call is difficult in itself because it's semi rural. We would routinely get sent out well beyond our stated mileage boundaries. Terrain can be rough, and meth production is rampant so you have that demographic. cell service is spotty. so going out alone at night on call can be harrowing. On call does seem to get called quite a bit. I love hospice, I feel I'm good at it, received excellent reviews. I hope someday I can go back. But work conditions for the nurses will have to improve. It's just WAY not enough money for the toll it takes. Just thought I'd share that; ventilating I guess. Thanks for listening.

That's it right there in a nutshell. Nice and concise, I love this.

Where I work the pay is 2.50 per hour to be on call. Regular pay and mileage if you have to go out. Small rural-ish hospice, the CMs take turns taking call. No admissions nurse, no triage nurse, no back-up. It's not working particularly well. Several excellent nurses recently quit.

See, here's the thing, I thought they'd be nice because they (the administration) really wanted this to work.....we didn't have anyone doing "just call" before I tried this. All the CMs had to share it, and that was causing much overtime, so this was supposed to alleviate it for the full-time CMs, make their lives easier, etc. Most, if not all, of them voiced enthusiasm for the plan. Anyway, one would think they'd (the bosses) try to make the workload reasonable so that I could survive this over the long term, but it hasn't happened that way. I was naive, I freely admit it. ugh, you'd think I'm old enough to know better than that!!

Update: I plan on throwing in the towel on my life of being the weeknight on-call nurse. Started out doing five nights a week. Too much. Cut it to four. Still too much. 62 hours of call a week. Many times having an admission or a late routine visit (or two...or three). It's just too much. I can't deal with starting out the evening saddled with a bunch of stuff to get done and then having calls as well. It's good we have a lot going on and a lot of admissions but there need to be more staff to deal with it. It was good experience, and I'll still have to take my turn at being on call but it will be more like once a week instead of four times a week. I'm supposed to be part-time.....setting boundaries and sticking to them.....not so easy.

Hi! I'm pretty new to hospice also. I've been doing weeknight call four nights a week for several weeks now. We have a voice mail system and all the CMs report off at the end of each day so I, or whoever is on call, has some idea of what 's going on. I do have a laptop to refer to but don't use it that much. I have a binder with a face sheet on each patient. If I get stumped I can usually text or call the CM for advice on what to do with their patient, or I can call the team leader. They've been really good about helping me learn and answering questions. So I think yeah, you're on the right track if you can get them all to report off to you what's going on with their patients and potential hot spots. I make sure I have everything under the sun packed in my vehicle in case I'm out for a long time. Supplies, forms. Cat litter for disposing of narcotics. Phone and laptop chargers. Flashlight, extra jacket, etc. I was so nervous my first few times I could hardly sleep. It's still nerve-racking! but getting easier with time... Hope it all goes well for you!!

We don't have a triage nurse, and I agree, so often families just want to hear some reassurance. The calls aren't that many, usually, what's making me tired is that I'm doing the late admissions too, which is ok, it's just been a busier-than-normal week for admissions. Oh well it's Friday, my work week is almost over! :)

They'll back me up, but there is no set plan that I know of. Halfway through the first week of it and it's been ok, but I'm tired. Thanks for your advice! :)

HI! I am new to hospice, have almost five months under my belt (and love it) I've been an RN for 24 years, had worked mostly in acute care medicine before taking many years off raising children. I took a refresher before re-entering the workforce. That's my background, here is my question: I have recently volunteered to switch from case managing to being on-call Monday thru Friday nights from 1630-0800. I will do any late admissions or visits that fall in that time period as well. We have a census of about 50 in a semi-rural area. It seems like it should be a tolerable schedule, but some, more experienced people have said I won't be able to do it for very long, that I will burn out on it, etc. That makes me nervous. I've been on call before but not this much of it. Am I being overly optimistic that this can work well for me and my family?

I don't mind color coding, it beats having to wear all white all the time like when I first got out of nursing school. When I did refresher course clinicals earlier this year, the floor I worked on had no uniform policy, it was a free for all and it looked sloppy.

I took a 10 week refresher earlier this year. I'm in the Midwest and they are hard programs to find around here. I gather though, that the content and the structure vary widely from one program to the next. Ours was weighted heavier on clinical experience. We had 120 hours clinical and 80 hours of classroom and skills lab. For clinicals we were assigned to an area based on our past experience, and each had our own preceptor. There were several optional things one could sign up for, like following a respiratory therapist around for a day or hanging out in interventional radiology, things like that. I've heard that some programs are primarily online with little clinical time. And some programs provide the classroom time but you have to procure your own clinical setting and preceptor. Our program was awesome but unfortunately the medical center almost closed it and then decided to cut the available spots in half.....I guess it's not a money maker.

I was a SAHM for 17 years, recently took a 10 week refresher and now work hospice. I'm at a point now where I don't know if it was the right thing to stay out so long. There are days I've (mentally) really kicked myself for not keeping a hand in it because coming back has been so hard. Not because bedside nursing has changed, the fundamentals are the same. But the amount of computer documentation is huge now, it was nearly nonexistent when I left....and the new meds and other technology have taken a lot of work and study to learn. I don't know. I can't regret the wonderful time I spent home with my children, and it's impossible to know how our lives would be now if I had kept working. It is what it is at this point! :) Anyway, I wish you all the best as you discern what is right for you and yours.