Which job is better?

[moonunit1130]

So I’m new to hospice, with nearly 8 years of acute care experience. I have gotten one job offer, and expect to hear one way or the other from another job later in the week. Since I’ve never done hospice before, I’d like to know the pros and cons of both, from the perspective of experience hospice nurses. At one job, I would get a caseload of approximately 10 patients, aiming for 4-5 visits/day, Monday through Friday, with 1 night of call every 2 weeks. Eventually it would be no call, but until then, they have 13 nurses and a census of 100+. They only have RNs and CNAs, so you do all of your admissions and routine visits, with help as needed. At the other hospice, they have a census of approximately 20 patients. I would be the only full time RN case manager, but they have a team of 3 LPNs. I would do admissions and supervisory visits on approximately 14 of those patients. I would take more call, but be backing an LPN except for 1 night/week and 1 weekend/month when I’d take primary call. It seems like I would have fewer routine visits. What do you all think? Would you rather have a slightly smaller caseload and be totally responsible for all their visits, with less call, or a higher number of patients but work with a team of LPNs? I appreciate any advice!

[Katillac, RN]

I'd take the caseload of 10. The other situation sounds really ripe for the list of "other duties as assigned" to grow by the week, and you have no idea how effective as team members the LPNs are. Additionally, with a staff of 13 RNs there's more room to spread the wealth around when the stuff gets deep. But there are a lot of crazy hospices out there, it all hinges on whether leadership is sane.

[happyRN29]

Take the caseload of 10 and less call. "On call" can cause major burnout in hospice. The less of it you have to do, the better. A caseload of 10 for a full time monday through friday nurse is very reasonable and doable. The hospice I worked with before told full time nurses that 12 was what the full time caseload would be but most of the time they had anywhere from 14 to 18 which is way too much especially with one day a week call and every 4th weekend call. I often had 10 to 13 pts as a part time 3 day a week case manager in addition to one day a week call and every 4th weekend. I loved hospice but the 'on call' burned me out completely after 2 1/2 years. That and excessive charting. Hospice can be great if you have bosses and a company that really cares about the welfare of their nurses. Good luck to you in your hospice career.

[moonunit1130]

Thank you both so much! I got the other offer, and ended up taking the job with less call and more RNs. Glad to know my instincts were pulling me in the same direction as you guys recommended ? For what it’s worth, both offices seemed to have really supportive management, but I just didn’t feel comfortable going into a job as the only full-time RN without any prior hospice experience.