Torn between the two

[nursemoma35]

I have been offered two jobs with hospice. One is with a company in currently employed with. (I would be transferring from home health to hospice) this is would be in field position with productivity of 20-25. No on call really except 2nd backup call rotation once in a while. Salary position. The company Covers 8 counties.

The other offer is with a hospital. I would essentially be the nurse "making rounds" doing regular visits, admissions. From what I gather no real hands on nursing. The acute care bedside nurse would perform care. This productivity is 30. Regular visit and admit of course are weighted differently. If I go over productivity I would get paid per visit or bonus pay. This is less paying job but potential for more money.

One of my big concerns, one reason leaving home health for hospice is I'm so done bringing work or charting home after working all day. I have to separate work from home. I tend to spend more time with my patient when I'm at their home and chart later. I've tried all kinds of methods but always manage to get behind on my charting.

Another dilemma I have is I just found out I'm pregnant!!! So I know if I go with new hospital position I won't qualify for FMLA. Both jobs know, as I told them. I'm only 2 months. And i have a toddler.

I'm wondering with hospice work, are you finding yourself bringing work home? What is your normal day in a field or hospital setting (not hospice house). What is your productivity? What areas do you struggle with?

Any advice or input greatly appreciated. Thanks ahead. :)

[toomuchbaloney]

I would recommend that you practice POS charting until you can complete 90% or more of your documentation before you begin your next visit. Taking your documentation home is a really bad idea for a couple of reasons but the first one is that it abuses YOU and your time.

[softrbreeze]

Productivity expectations vary hospice to hospice. A previous nation-wide hospice I worked with required at least 20 visits per week but there was SO much other stuff expected that I was working 55-78 hours/wk. The current small hospice I work with requires at least 16 visits per week but even when I do 20 or more, I only get 40-45 hrs (Hallelujah!). Congratulations, btw, on your new little one!

[nutella, MSN, RN]

Congrats for the job offers!

There are a couple of things to think about.

First of all you are pregnant. This is a huge factor because you do not know yet how well you will be feeling, how many doctor's visits and so on. Granted everybody thinks things will be ok and hopefully they will be good for you. But I was pregnant 2 times and to be honest starting a new position when pregnant can be rough. I had to transfer from anesthesia because in Germany you can not work while pregnant with all the gas around you... It was not an easy transfer because my new coworkers knew I would be out in a couple of months plus turned out that my pregnancy was complicated and I was out a lot.

You definitely want some FMLA !

Plus it sounds like the other place mostly offers hospice in the facility. It is a great job (I go to nursing homes and hospitals as well) but it really requires you to be an expert in order to provide great care and meet expectations. Perhaps getting initial hospice experience with a general home hospice agency where you are able to learn all the ins and outs is a better option.

When you provide home hospice in a traditional agency you will also learn to provide hospice in a assisted living and nursing home setting, perhaps also GIP in a local hospital. But because you learn to provide in different settings you get to be an all rounder with a broad variety of skills/problem solving, which will be a great foundation. The question is also if the agency also includes palliative care for hospice nurses, which is great because it further broadens your skills.

To be super honest here - starting a new job when you will be pregnant and out in the future is something that is really rough. Not impossible but also not easy. There are days where you just do not feel well and those are the days you are glad you have a job you can do with your eyes closed and do not have to worry about orientation, doing something wrong, worrying about support, new charting and so on......

[Jensmom7, BSN, RN]

I've been a Hospice nurse for awhile, and I completely understand how it can leech over into your private life if allowed to. It's insidious that way; you don't want it to, it just happens.

I've driven 150 miles in a day, in addition to having productivity of 5 visits/day. So much time wasted with travel, that it was physically exhausting.

In my current position, I work for a company that has several LTC facilities. Initially, I worked out of one facility (about 5 patients), and had some home patients. Then, because of productivity, I had to go to a second facility, maintaining the first one and a few home patients.

Not the best situation, but sometimes God smiles. I did my job, kept the kvetching to a minimum. Things happened with staff, and now I am exclusively in one facility, just a few miles from home.

I have 16-18 patients, which is very doable since the only traveling I do is up and down in the elevator. The facility staff likes it, I like it, families like it since they see me all the time. ALL my documentation is done bedside, and finished up at the Nurse's station if I conference with the facility nurse.

I average 5-6 visits/day, and do a "head count" of my other patients during the day-makes it easier to stay on top of symptoms and potential problems.

Minimal irritations, management pretty much leaves me alone to do my job (especially since I'm really good at giving them a heads up if something's brewing), a great Hospice team, facility staff trusting us more and more. It's about as close to a dream job as I've come in 36 years.

For the first time in forever, I can actually eat lunch, pee, and have time with my family in the evening.