"Called" to hospice nursing?

aimeee, BSN, RN · Jun 17, 2008

i have a lot of questions, though. can anyone help me out?
1. what is your typical work schedule? i'm really curious as to how they schedule hospice nurses. is it a regular m-f, 9-5 type of job? what about when one of your patients declines and/or passes in the middle of the night? how is call rotation handled? or do you just go when one of your cases starts going bad? if you work in a hospital-based program, do you do 12s like on other floors?
see the thread at the top of the page with the sticky "day in the life of a hospice nurse" which will tell you much about the typical day of a hospice nurse doing home visits. call rotation depends on the individual hospice. some take turns, some have dedicated on call staff. when you are doing case management your day usually ends when you finish your visits. some days this might be early, some days this might go considerably beyond 5 pm. in almost all hospices there will be someone "on call" who will take care of your patient when they are in distress in the middle of the night.
2. what's different about working in a hospital-based hospice/palliative care unit vs. doing home visits?
everything! i'll let others delve in this.
3. what kinds of challenges do you meet most often in your work?
where do i start? misconceptions about hospice, about drugs, patients/families in denial...the list is long.
4. what do you love most about the work that you do?
being able to truly focus on the patient and family, dealing with what really matters.
5. is the pay rate comparable to that of other nursing specialties?
this will depend on your geographic area somewhat and vary from hospice to hospice but in general, this is not a high paying speciality area.
6. i'm thinking it's probably a good idea to get some years of general experience under my belt before going into the autonomy of hospice nursing. would you agree or disagree?
the more the better because we operate with a lot of autonomy so the more experience you have to draw upon, the more effective you will be in the field and the more confidence you will have to deal with whatever comes your way.
7. do you think a hospice company would allow a student nurse to shadow a hospice nurse for a couple of days?
many will.
thanks in advance for any insights you can offer. i'm looking forward to your responses!

please see responses above in red. good luck to you in finding your niche!

Cree8ive1 · Jun 17, 2008

Thanks so much for your insights, Aimee! I had read a bunch on the sticky "A Day in the Life..." but was wondering if hospice jobs tended to be more M-F 8-5ish type thing or if there were companies doing like a firefighter's type of schedule (several days on in a row, as in 24 hr. on call, then several days off in a row, etc.). I guess it's different from hospice company to hospice company.

Anyway, thanks for finding this post and responding!

aimeee, BSN, RN · Jun 17, 2008

Thanks so much for your insights, Aimee! I had read a bunch on the sticky "A Day in the Life..." but was wondering if hospice jobs tended to be more M-F 8-5ish type thing or if there were companies doing like a firefighter's type of schedule (several days on in a row, as in 24 hr. on call, then several days off in a row, etc.).

Ah, your "firefighter's type of schedule" might be more likely if you are working in a hospice inpatient unit in a hospital setting or a hospice house. If you are doing home hospice case management then probably you will only work that kind of a schedule if you are On call staff. Our oncall weekend staff works Saturday and Sunday round the clock and that is a full time position. We also have weeknight positions where they are oncall M-F from 5p through 8a.

Case management tends to be more 8-5 M-F ish because you need to be working when the doctor's offices are open and the more days the case manager works, the better the continuity.

IMAHospiceRN · Nov 12, 2008

Yes, I absolutely see beauty in the last days/moments of life. I've often said that watching someone pass out of life can only be compared to watching a newborn come into it. There is enormous reward to be found in hospice nursing. I work an 8 hour shift (includes every other weekend) at a 30 bed inpatient hospice facility. We care for pediatric as well as adult patients, and do sometimes admit newborns, which is always quite emotional. I care for anywhere from 5 to 8 patients per shift, and they are the same patients from admission through death. We generally care for those patients who could not be managed by the home team, either because of symptoms or because of caregiver burnout or lack of a capable caregiver in the home. Once stabilized, some of these patients stay with us for weeks or months (a few do return home), so we build quite a relationship with them and their loved ones. I personally prefer the inpatient environment, but there are many hospice nurses who would not do anything other than home care. Most hospice facilities work 12 hour shifts because it is easier to staff this way and it saves the facility money. My co-workers and I feel that burnout would be higher if we worked 12s, and there's also the fact that you'd be with your patients less days, so have less continuity of care.

As for experience prior to doing this work, I do think that at least one year on a med-surg or oncology floor is important. I agree with a previous response that given the significant autonomy we have, it's important for each nurse to have the ability to make quick decisions, based on her own experience. That's not to say that you need to know hospice care before doing the job, because God knows I didn't. I was told when I started that it would take a year before I was really confident acting alone---and it did. But when that time finally arrived, I found myself to be at total peace with my choice of careers. As a young nurse, I felt, as you do; I was incredibly drawn to end of life care. I did, though work for a number of years in acute care before starting hospice work, and that experience has been invaluable.

As for your other questions, I agree totally with Aimee's responses. Best wishes to you as you start your new career---and if you feel called to EOL (end of life) care, follow your heart. It's wonderful work for those of us who really want to do it.

LivinginDelaware · Nov 13, 2008

Hi

I'm reading this post in November and I'm curious? Did you go for it?

I hire for a Hospice and we actually require all of RNs to do a "Realistic Job Preview". I'm shocked at the number of hospices that do not require this. By requiring it, we have cut down significantly on turnover. The TWO times I 'waived it' the person quit the day after day one of orientation. Many people feel 'called' and are reluctant to jump right in. This is normal. This is a passion and an effort that you have to learn about.

You really need to do exactly what you are doing. ASK questions. In my experience (and i'm anxious to see any hospice RNs respond) few people wake up saying, "Hey! I want to be a hospice RN"! They have an experience and are impressed and realize that we are not about dying. We are about living and making the most of the time left. Certainly we want folks to be pain free, and to have 'a good death' but we want them and their families to be free to make the most of the time they have. Hospice treats the patient and the family as a unit of care which for many is what they had hoped for when attending school for nursing.

We have been on a mission to hire one "newbie" RN in each county a year. That took a couple of years to institute because there was a prevailing feeling that you had to have a year or two clinical experience for confidence. We have been able to have 'older' new RNs who have had some life experience or been LPNS who break in relatively fast. And, to their credit, we have some younger newbies who asked us to give them a shot and everyone has been thrilled with the results. Thanks for your post and for taking the time to read this. Best to you.