What makes you love hospice?

[Jo Dirt]

I'm feeling really stressed out at my home health job. Part of it is the endless driving (over 10,000 miles in a few months), part of it is the hectic office atmosphere when I am there, part of it is the ingrateful patients/families who act like you are imposing when you come out to do your job, part of it is being expected to be "creative" and find ways to milk every drop we can from Medicaid/Medicare, being expected to go out and do procedures I am not comfortable with, running like a chicken with its head cut off...I'm just tired and burned out.

I wonder how different hospice is from home health? I would like less pressure and a more laid back atmosphere. I thought this would be the case in home health, maybe it is just the agency I work for, I don't know.

What are the visits like? How often do you visit?

Do you have to go out in the middle of the night a lot?

Are you expected to come pronounce the patient when they die?

[river1951]

Hi, Yes, I've found hospice much different from home health. Yes, in our area, nurses go out to pronounce patients, do night on-call. Families are either very grateful or not so much (after all- huge losses!)

I love hospice, but it requires a lot from nurses, including independence- need to be comfy with yourself and your practice.

[doodlemom]

I think it really depends on where you work. Hospice can be laid back at times but then really intense at other times. When you have a laid back period, it's time to take care of yourself. You are the case manager so patients/family's are very dependent on you and your expertise - it can be stressful. I don't know if we'll ever have OASIS or anything like that, but right now I can tell you that our paperwork is minimal compared to HH. Hospice is more time and patient/familyoriented rather than task oriented - I think of home health as being more task oriented. At our hospice the case managers do not do on call but we do go out during the day to pronounce our patients. This varies at different hospices.

[RNDYN2CU]

response to motorcycle mama: the visits are about an hour long for a stable home pt, and the snf pt takes 1/2 to 1&1/2 hours depending on what they need; they are seen 2-3 times/week between my LVN and myself and there is per diem rn and lvn support. I am expected to be available from 8am to 5 pm mon thru fri, I am on call as backup RN 1 weeknight and b/u RN one weekend a month... it seems we are always short an RN so all of us pick up the admits in rotation, it varies. I do go out night for a death if the o/c LVN is already on one, and I have always found the family or facility grateful and the time spent with the family quite a privilaged blessing. If i have a lot of admits, my case gets behind and my company is always working toward fixing this... like doodlemom said, you take advantage of the laid back periods. I do a one page skilled nursing assessment, so after Ive completed that I have a clear picture of what the pt. needs addressed... call MD for increase pain med, write the verbal order on our orders and the SNFS, call the pharmacy, do teaching on o2 in the home, arranging for spiritual support, wound tx orders, creating careplans, communicating, signing the SNFs careplans, doing the treatment, remembering to list the supplies to bring back, and on &on & on.....A BIG KEY!!! is taking the info I've gathered in the field BACK to the office, in the IDT book, updating a LOT in the med sheets, gathering supplies, investigating my re-certs, making sure the pt. is qualified and that I am addressing the issues medical is looking for...Getting the schedules for RN/ lvn and home health aids, My LVN does the schedule, she doesn't mind and she's quicker than me... communication with the home health aids, finding out when the facilities pt care conferences are and being there, creating and presenting in-services for the SNFs. communication with your DON your facilities DON, taking new employees out for orientation, initiate continuous care, continue continuous care.

Did I forget anything? You get in a groove and learn to squeeze in the emergencys, delegate, re-schedule, remember what it was you were doing when you got interupted.

Sometines I have to remind myself to just take one patient at a time, one step at a time. Beleive it or not, it still feels like independence to me. I can start my day at 9, end at 6, shcedule a day off (wiht approval) or a 2 hour block to see my child i n a school play. It is real important that I keep track AS I GO ALONG or I have a mess the next pay period when I turn in time sheets with activity log. Thats how I roll, I'm only 8 months into Hospice, my company is only 3 years old but we already have a pretty good reputation in our community for being quick and helpful and compassionate and PRESENT.

I spend a lot of time just me and the patient, me and the chart, me in the car, in my cubicle, I love that I am never anywhere long enough be bothered with the politics, coos, personalities and hen-house BS. Pretty much wherever I end up, someone is pretty happy to see me and I feel sooooooo useful!!! I tend to want to do more on a voluteer basis, "Sure I'll take the orientee.... sure I'll start that admisson... yes i will do this or that for you! Very rewarding. I love the autonomy, ego gratification, and the leadership I get to abuse GOTCHA!!! JK Hope I didn't over do it, can you imagine my careplans? yikes!! bablah bablah

[doodlemom]

Randy - you said in your post that the on-call LVN may already be out on a death, therefore you would have to go out on the next one. Are your LVN's allowed to pronounce? I didn't think it was legal for an LVN to pronounce - or maybe that;s just been the case in the states I've lived in. It would be interesting to see if other hospices are doing this.

[saribeth]

In NJ LPN's cannot do pronouncements...I agree too with the others...Hospice can be calm at times but it can get really wild and crazy too...there is a lot of nursing besides pain management, emotional support yada yada...we are now on laptops (Clinical Novius) and it is great but many bugs...our "paper work is so much less than HC...no OASIS but I hear that it will be coming in the future for hospice also...I better be retired by then:)

[doodlemom]

We have laptops, as well - hate em. They take more time than old paperwork ever did.

[skemergirl]

It sounds like Randy & I work for the same hospice Co. Yes, I do all that he listed and somehow do have down times when you can help out your fellow coworker who is having a busy day. I make out my own schedule and can "at times" push someone to the next day if I need to. We do not have our laptops yet (coming this spring) and it will cut down on alot of paperwork. I think overall Hospice is more laid back than HH however, every day is different. I couts down on time when you have more than 1 pt in 1 facility (no driving time between pts). Alot of miles though. I bought a new car last Dec and already have 19,000 miles! I love the automomy though.

[skemergirl]

By the way, LPN's in NE are not really allowed to pronounce but they do. If it's during business hours M-F 8-5 the case manager will pronounce (RN) if after hours, who ever is on call (LPN or RN) will go. Families are always grateful.

[RNDYN2CU]

Gee golly i sure hope our LVN's can pronunce death!!! Or We is in a whole lotta trouble out here in Southern California!!! Yeah guys, it's legal. By the by, take a close look at my call letters, and read them like a license plate, It's cute that you all call me Randy, but i'm a chick named Leslie...(tee hee) see if any one gets my macabre play on letters...I'm dying to find out! (hint hint)

[doodlemom]

RN dyin' to see you? That's good! I've known girls named Randy, so I wasn't making any assumptions that you were a guy. So, the LVN thing must be state by state?

[hospicemom]

RN dying to see you....hehehehe....awesome!