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To those that left critical care for this

Hospice   (2,849 Views 6 Comments)
by buddiage buddiage (Member)

buddiage has 10 years experience and specializes in critical care transport.

6,371 Visitors; 378 Posts

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I've been in the hospital in a CCU, CVICU, and have been a transport nurse (on an ambulance) for 10 years.

I've really enjoyed the 'nerdy' aspect of critical care, but I feel especially connected on a more spiritual/human level with hospice patients and families, which I think speaks to me more. Ultimately to me, the reality of dying is the moment of all truth- an opportunity for a death bed and reflection of your relationships.

One of the things I don't like about my job (I think nursing can say this generally), is I'm annoyed with trying to make people live that should be allowed to say good-bye. I see the view of death as something feared and scary. I feel like I want to do my part in changing it.

For whatever reason, I feel comfortable (and privileged) to be a part of someone's world when they are in a crisis. Critical care has definitely given me a sometimes salty and gritty view of things and the state of the human race sometimes :banghead: but I don't get this way with the dying.

I want the opinion and view of people that left critical care to do hospice. What made you like it more/less? Did you have friends that challenged the choice of hospice, as if you were "downgrading" the value of your nursing care you provide? (My husband, an ICU nurse, says, "Ew, why would you want to do that?")

I've only dealt with hospice through transporting them home or to hospice facilities (as well as caring for them in the hospital).

Any words of advice? Did you get bored? Feel more fulfilled in your job (perhaps you felt your purpose in life was this, and feel content)?

I work a ton of hours in transport and haven't picked up in the hospital in almost six months (per diem). The thought of going there turns my stomach. I'm thinking of just axing that altogether.

Sorry for the wordiness, but I don't know hospice nurses and I want your input please. I've been thinking about this for about 2 years and now I'm burning with it practically.

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222 Visitors; 10 Posts

I did not leave critical care, but a step-down unit with moderate care patients. I found no shortage of being bored. It is a very different setting though. My typical day as a hospice case manager looks something like this: Arrive at the office at the start of my day, call my 4-6 patients that I'm visiting with an ETA. Gather any paperwork from my mailbox, turn in paperwork from admits/etc, and get on the road. Visits last anywhere from 30-90mins on average, sometimes you'll arrive and a patient is symptomatic (uncontrolled pain, dyspnea, etc) and those visits will take longer. Visits will also take longer if you have a lot of tasks to complete such as wound care, cath changes, etc. Inbetween visits, I might be returning phone calls from other patients, calling in refills of medications, calling the doc, calling my HHA/MSW/chaplain, and general coordination of care tasks. I might get a call that another patient has a concern and needs a visit, so I'll make a PRN visit in addition to my scheduled visits for the day. Our company also has dedicated on call staff for nights and weekends, and those nurses make PRN visits if needed after hours. We also have dedicated admissions staff that do the majority of our admits, so there are different job opportunities just within hospice.

I remember the first time I told some of my nursing buddies that I switched to hospice and I got a lot of "Good for you, but I wouldn't want to lose my skills" and other similar comments. What I tell people is that I don't lose my skills. Sure, I don't often put in IVs or titrate drips on a regular basis, but I do PICC/mediport maintenance, PCA pumps, manage drains, draw my own labs (if needed, its rare) among other things. So sure, it isn't the same as the hospital but I do utilize my nursing skills. I actually think hospice requires a very solid handle on assessment and pathophysiology. My patients look to me to explain what is happening to their loved one, but I don't often have scans or labs to give me a clue as to what is going on, I just have my assessment.

My advice? Go for it. The beauty of nursing is that if you don't like what you're doing, there are many other options out there. Good luck, and sorry for my wordiness as well!

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nrcnurse has 13 years experience and specializes in hospice.

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For me, the most striking thing about leaving the hospital to work in Hospice, is that I don't have to worry about killing anyone. It was a huge black cloud that lifted off my head! Most of the patients have a DNRO/POLST, but that does not mean I treat them with less respect that someone without the DNR. I love being able to spend more time with patients and families than they would get at the MD office or in the hospital. They appreciate it as well. I am attending to their needs/concerns during the last phase of life and helping them to go on to their next great adventure. I love my job.

That being said, I would never work as a Staff RN Case Manager on salary. They are worked to death. Forget the 40 hr work week. It's more like 50-60. I have worked, full time, per diem and am paid for every hour I put in. Also, I don't have to ask permission to take time off. No PTO or insurance, but that's not a problem for me.

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1 Article; 1,377 Visitors; 4 Posts

I was an ICU nurse for 7 years before I switched to hospice. As much as I loved a fabulous "save," what I seemed to see more frequently was the prolongation of dying...and the horrors it brought. The elderly with multiple comorbidities have very little reserve for recovery to even their baseline. I was very hospice naïve and we didn't see hospice until literally the patient was 24 hours or less from death, often related to a terminal weaning (removing the vent). Had no idea that hospice could help many of these patients manage their symptoms at home and not be caught in the revolving spin of monthly admissions because they were in a crisis. I love, let me repeat LOVE, the support hospice provides the patient and their caregivers. Yes, I'm not titrating drips or managing a vent anymore, but I still use many of my nursing skills. With abnormal lung sounds, I need to determine if the patient is having problems such as atelectasis, chf or pneumonia. I use my assessment skills all the time. We do a TON of education...not only on the dying process but how to manage symptoms. Wound care is pretty frequent, because as the skin is the largest organ, wounds are not unexpected as the body shuts down. Just because a patient goes on hospice doesn't mean that we only deal with morphine and Ativan. Many of their meds are continued as long as they can help with comfort. For example, a cardiac patient would have their cardiac meds continued. Do I still dream of my ICU days...yes! There were some great times! But I feel like I'm making such a bigger difference as a hospice nurse. 

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JacAn001 has 1 years experience.

5,077 Visitors; 136 Posts

On ‎6‎/‎27‎/‎2018 at 1:59 PM, nrcnurse said:

That being said, I would never work as a Staff RN Case Manager on salary. They are worked to death. Forget the 40 hr work week. It's more like 50-60. I have worked, full time, per diem and am paid for every hour I put in. Also, I don't have to ask permission to take time off. No PTO or insurance, but that's not a problem for me.

I'm a Salaried Case Manager, not the case for me, maybe at the beginning but now. I work 40 per week or less

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nrcnurse has 13 years experience and specializes in hospice.

6,527 Visitors; 194 Posts

Good for you!  I have worked for five different hospices, four as a traveler, and my experience has been as I described.  However, my current employer (where I began my hospice career... back with my beloved dysfunctional family) has recently hired a new CEO and he has made some profound changes toward lightening the case load numbers.  There is hope!!

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