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Thinking of career change to hospice - HELP!

I know there have been similar posts about this, but didn't see what I was looking for. I'm an RN w/ almost 5 yrs experience in med/surg/tele, recently moved to Palliative care, but am burned out by the "hospital" environment. I am new to the unit ( I like it, but it's kinda med-surg), and have just started my learning on end of life care. I was curious about hospice, and chatted w/ the hospice RN tonight who visited one of my patients.

I am curious about what the hospice RN does- how many families in the caseload, typical duties, job satisfaction? Should I shadow/volunteer w/hospice? I am noticing a real satisfaction in caring for my "dying" patients in particular.But I worry it's more paperwork and less human interaction. I LIKE bedside nursing & human interaction. I like the social/spiritual aspect, in addition to the medical side. Can anyone recommend another thread or website? I am wondering if I should explore hospice more....Thanks.

renerian, BSN, RN

Specializes in MS Home Health.

I have been a hospice volunteer over 10 years. here is my speel. I love it. I am not paid so I can comment for sure on what I know. I know my husband runs a rural hospice in Ohio. Sometimes admissions are very long. Sometimes they see 4 people a day sometimes more sometimes less. They work and I mean work, all three shifts. Alot of people die in the night. It is very rewarding. I know others here work in hospice so I would like to hear what they have to say.

renerian

I would like to reply to this, but short on time this am and have a BIG day ahead. But I'll be back, tomorrow hopefully, to reply.

I am a Hospice nurse. (five years). I love it. You can spend as much time as needed with your pt. As with all jobs there is paper work. But the work is sooooo rewarding that is doesnt matter. I see any were from two to six pts. a day depending on the need. I have an the average eight pts. as primary nurse. I can choose whether to see them 1, 2, or 5 x wk. depending on need. Taking care of the pts. pain is easy. It is the psychosocial aspect, mostly with the family that is the challange. Ask any Hospice Nurse if you can shadow a day and you will see.

A typical day starts with about an hour in the office getting organized for the day, finishing up paperwork, conferencing with others on the team about patients, etc. Then its off to visit usually 4 to 6 patients. Length of visit depends greatly on what is going on. Some might be as short as 20 minutes if they are stable and no symptoms are out of control. Or it might be as long as two hours if there are lots of problems to be addressed. Then back to the office to finish off paperwork and return phone calls etc. for about an hour.

There is a LOT of education involved. Pain management, skin care, signs and symptoms of death, medications and side effects, etc. We are providing the framework and the support for families to take care of their loved ones by themselves.

Paperwork is pretty minimal (aside from admissions). We use a check off system so it doesn't take long to document the routine. Care plans are updated every two weeks and also use a check off system for goals and for interventions so they don't take too very long either. This should go even faster after we get our new laptops and software implemented.

Caseload is pretty manageable at 10 patients per full-time RN. This is assuming there is a good mix of stable vs. rapidly declining patients. If they were all in their final days then that would be very taxing.

I just started with a Hospice and I love it. I went off orientation and went on my own this week. Went to one private residence and to a facility to see three. Just about filled up my day, with driving and paperwork. I will treat myself to some new CDs to listen to in the car to chill to and I love the emotional support we give. Don't do Hospice if you don't like to give hugs. I get hugs everyday from the other nurses, bosses to the patients and their families. Love it, as I need the hugs!

renerian, BSN, RN

Specializes in MS Home Health.

CArgal I am glad you love your new job!

renerian

Part of the reason I went in to home hospice nursing was the realization that I yearned to spend more time with the dying patient when working in hospitals/nursing facilities. With a heavy patient load, I was constantly torn between providing spiritual and emotional support to the dying patient and loved ones, and doing the hundreds of tasks for others that keep nurses sooooo busy. When I finally went to hospice care, so much stress fell away that the menial tasks became a joy to provide. It is amazing how quickly one becomes part of a family's inner circle, and how fast trust is acheived in the home setting. I have had a chance to truly see how important and significant each individual patient is, and to affirm their life's significance. I have had the privilage to walk away with a little piece of each person's life, whether it be a patient or a loved one. I'm aware of how long this reply is getting, but I feel compelled to convey this to anyone considering hospice work. It changed my life and made me a better and more "whole" person. The death process is not just the end of a persons life, it is the most important. You have the honor to be one of the last friends, last listener, last student, etc. WOW! I keep a hospice scrapbook of all the patients I have comforted, loved, and then lost. I let them know before their passing that they have touched one more life and will be leaving behind one more person who will never forget them. When I near my own end, I'll be hoping for that also.

Just a little addendum to my big speech above....I took a break from Hospice work in October, and have really missed it. Been doing Agency work and am currently doing a school-nurse kind of position for a day camp for medically fragile children. After I replied to your inquiry, it really struck home how much I missed doing hospice. After I left, I kept thinking about my patients, meaning to stop by and see them, especially one who had been assigned to me for over a year. The day after Christmas, I got a call from a former co-worker, and that long-term patient had passed away. It's time to get back to where I belong. Any nurse thinking about entering Hospice work should be prepared to have a life-changing experience, and be prepared to follow that path. As for me, I jumped right into the classifieds and now have a new hospice job! YEAHHHHH! LOL........JulieBean2U:roll :roll

Julie-

Congrats on the new job! Your dedication and compassion is truly admirable... I have just started my journey to nursing and haven't made up my mind about what area of nursing I want to go into. But you have peaked my interest. I chose nursing because I want to make a difference, and I can tell hospice nursing allows a nurse to have an impact on a person's life as well as be changed herself(himself). Thanks for sharing!

Sharon

DIPLOMATICRN4HIRE, MSN, RN

Specializes in CVOR,CNOR,NEURO,TRAUMA,TRANSPLANTS. Has 18 years experience.

I worked Hospice when I was a LPN going to RN school I took call and did baylor weekends with them. I loved it , loved every minute of it. It broke my heart daily but I learned more being with the patients, thier family and learning how to make things as you go. I can honestly say that was the best job I ever did, it taught me so much its hard to say it in words. If your a nurse that deals straight from the heart you will love it. There is nothing like knowing , that you truly helped another with thier wishes.

Zoe

Hello all!

I was recently given the opportunity to work with hospice nurses two days in a row, as two of our month long critically ill pts' DR's decided there was nothing more that could be done for the pts and called in hospice.

The hospice RN who came in was so helpful! She wrote a few orders (which I carried out) and spoke with the family, and even took a few minutes to help me (a new nurse in an ICU dealing with my first deaths) feel a little better. She seemed to intuitively pick up on my pain, even as she was dealing with the much more urgent needs of the family, and offered words of support and encouragement.

Over the past weekend, I have been thinking about Hospice nursing as a possible career down the road. (I dont want to give up the awesome ICU job I have now!)

But I have some questions.

1) What is a typical day like for a hospice nurse?

2) How many hours are you on call?

3) Is there a difference in the "types" of hospice nurses? For example, some go to the hospital and offer "In-House" services, some go to the pt's homes, and some work at the beautiful and peaceful hospice houses. What kind of place would someone trained in the CVICU (no oncology) be best suited for?

4) Are traveling opportunities available for the Hospice RN?

5) Would any Hospice program accept a PRN RN for 1 day a week (while working another job, not needing benes) to help ease someone into the position down the road?

Thanks you wonderful people! :)

Hi Caroline I have been a Hospice Nurse for 5 years, and this is the very best job I have ever had! I am a home care nurse, which means that I see the pt's at home and in the hospitals. I must see everyone once a week, and then prn for any problems. I currently have 14 pt's. At our hospice we have a on-call nurse that does every night and weekends- I work 5 days a week, 8-10 hrs a depending on what crisis there is that day! Our hospice serves 3 counties in New York- and we have grown alot since I started- I have at least 2 admissions a week- and I find that people are being referred earlier which makes a big difference- I hope that this helps! Feel free to PM me if you have any other questions!! Have a great night :kiss

Lucy

1) What is a typical day like for a hospice nurse?

2) How many hours are you on call?

3) Is there a difference in the "types" of hospice nurses? For example, some go to the hospital and offer "In-House" services, some go to the pt's homes, and some work at the beautiful and peaceful hospice houses. What kind of place would someone trained in the CVICU (no oncology) be best suited for?

4) Are traveling opportunities available for the Hospice RN?

5) Would any Hospice program accept a PRN RN for 1 day a week (while working another job, not needing benes) to help ease someone into the position down the road?

I imagine every Hospice is a little different.

1) I start my day by organizing what I plan to accomplish. I finish up any paperwork that was left undone. I get errands done (pick up prescriptions--get them filled at the pharmacy). I usually see between 2 and six pt's in a day, depending on my pt load (which is anywhere from 5 to 14-- 6 right now)

2) I am on-call one day a week and one weekend per month. I get $3 per hour on-call, with time and a half over 40 hours.

3) We don't have a live-in facility. All of our nurses see pts in their homes.

4) I travel every day. Just not very far (I'd insert a smiley here, but the last time I tried all of my text was deleted)

5) A lot of places hire PRN.

Hello all!

I was recently given the opportunity to work with hospice nurses two days in a row, as two of our month long critically ill pts' DR's decided there was nothing more that could be done for the pts and called in hospice.

The hospice RN who came in was so helpful! She wrote a few orders (which I carried out) and spoke with the family, and even took a few minutes to help me (a new nurse in an ICU dealing with my first deaths) feel a little better. She seemed to intuitively pick up on my pain, even as she was dealing with the much more urgent needs of the family, and offered words of support and encouragement.

Over the past weekend, I have been thinking about Hospice nursing as a possible career down the road. (I dont want to give up the awesome ICU job I have now!)

But I have some questions.

1) What is a typical day like for a hospice nurse?

2) How many hours are you on call?

3) Is there a difference in the "types" of hospice nurses? For example, some go to the hospital and offer "In-House" services, some go to the pt's homes, and some work at the beautiful and peaceful hospice houses. What kind of place would someone trained in the CVICU (no oncology) be best suited for?

4) Are traveling opportunities available for the Hospice RN?

5) Would any Hospice program accept a PRN RN for 1 day a week (while working another job, not needing benes) to help ease someone into the position down the road?

Thanks you wonderful people! :)

Caroline,

I am a Hospice nurse in Idaho. I have been in practice off and on for 10 years. I also practice in the patient's home making 4-6 visits a day. Work hours, pay, and on-call responsibilities differ from agency to agency and state to state. I work full-time Monday thru Friday 8-5. I am on call one night a week and every 6th weekend. Sometimes I feel like working part-time, 32 hours a week, would be better considering the intensity of what we do each and every day, but we are not compensated as well as some other specialities so need to work more hours.

I agree with some of the other nurses here that Hospice is a true calling. You need to have a firm spiritual base and be open to just about anything. The work we do definately gives as much as it takes. I can't imagine doing anything else with the rest of my life!

HospiceTess :)

Hello Caroline!

I live in rural IL and work for a non-profit hospital-owned agency which is joined with home health and a DME. Start looking around in your area and see what is available as the set-up and structure may be a factor for you.

1) What is a typical day like for a hospice nurse? RN's and LPN's see between 3-6 patients a day for regular visits, less with an admission as the paperwork takes forever.

2) How many hours are you on call? RN's are on call a couple of nights a month and one weekend every 2-3 months.

3) Is there a difference in the "types" of hospice nurses? For example, some go to the hospital and offer "In-House" services, some go to the pt's homes, and some work at the beautiful and peaceful hospice houses. There are no hospice houses in our rural area, so the vast majority of our patients are in their own home. Some live with family and some are in LTCF's.

What kind of place would someone trained in the CVICU (no oncology) be best suited for? I don't think your background dictates what you would be best for - I think that comes more from your personality. We are out on our own but have help available by phone. I sometimes see the CNA during a visit. Staff see each other mornings, evenings, but most often at staff meetings.

4) Are traveling opportunities available for the Hospice RN? Can't say - haven't checked into it myself.

5) Would any Hospice program accept a PRN RN for 1 day a week (while working another job, not needing benes) to help ease someone into the position down the road? Yes, and I think it's an excellent idea. Research your choices and be sure you are comfortable with the way things will work for you as a PRN and a full-timer down the road.

Good luck to you!

I could really use everyone's help. I think I'm burned out on med/surg nursing after almost 5 years and I've been thinking a lot about hospice nursing. Can anyone tell me what your average day is like? What do you love about it? What gets you frustrated about it? I would really appreciate any advice or insight. Thank you!

TxPeach, I merged your thread with two older ones that had some responses pertinent to your questions. Unfortunately, that means the responses appear previous to YOUR post.

Wow, JulieBean, my jaw dropped after reading your post. I'm just starting nursing school, and already know I want nothing to do with ICU/CCU/ED and really, hospitals! I know I'll have to do my time, but hospice has an inner appeal to me...it's a pretty damn important time of life and I would love to share that with folks. Thank you for that inspiration :yeah:

Hello all!

1) What is a typical day like for a hospice nurse?

2) How many hours are you on call?

3) Is there a difference in the "types" of hospice nurses? For example, some go to the hospital and offer "In-House" services, some go to the pt's homes, and some work at the beautiful and peaceful hospice houses. What kind of place would someone trained in the CVICU (no oncology) be best suited for?

4) Are traveling opportunities available for the Hospice RN?

5) Would any Hospice program accept a PRN RN for 1 day a week (while working another job, not needing benes) to help ease someone into the position down the road?

Thanks you wonderful people! :)

Hi Caroline,

Ditto on a lot of the answers you have already received! I usually work directly from my home, so I don't go into the office except to get supplies and for team meetings. Most of the time I spend some time at home in the morning finishing up stuff from the day before and make calls to pt's and families. I so anywhere from 2-6 visits a day, depending on the day.

Our hospice does not make the full time case managers take call, so that part is a breeze. We have a lot of patients on service, so the agency can afford this. I did a lot of on-call with the previous agency that I worked for in another state and got a little burnt out.

We have a hospital/inpatient team, a facility team that goes to long term care facilities, and we have several home teams. We also have an inpatient facility - so there are lots of choices. If you like working at one place all day then inpatient might be nice. The one good thing about that is that the staff there are not alone in their cars all day and they have support from other workers. The facility team has that benefit too. I used to be on that team and liked it a lot because I was able to have other nurses and other staff to talk to about the patients and be able to get ideas from them.

I don't know about travel opportunities either...I tried looking when I wanted to move to another state but all that wa available was hospital work.

We hire lot's of prns that work when they can - I would encourage you to check it out. You would not be a case manager, but you could do prn visits.

Good luck

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