Are you a nurse considering a career in Hospice care? Well, I’m here to tell you that it’s more involved that you probably realize! You definitely need to get the low-down before taking that jump! Today, I’ll tell you all you need to know…
First, ask yourself why.
I often see nurses asking questions about Hospice Care as a career when they feel burned out on their current position. While Hospice care is DIFFERENT than most other avenues of nursing, it is far from easy or relaxing. In fact, the turnover rate in Hospice care hangs around 19% compared to the average rate of turnover in acute care at 17.8%. While there are many factors that play into these rates, the primary cause that I have seen, is burnout and stress. If you’re trying to escape burnout by heading to Hospice, you’re unlikely to achieve your goal. That being said, if Hospice care is your passion, and you’re prepared for what’s ahead, you’ll likely find that it IS as amazing as you hoped! The compassion, the love and the care that goes into a career in Hospice will infiltrate your entire life and you’ll never be the same!
The question of emotion…
Before applying for your first position in Hospice care, you have to ask yourself how you will handle dealing with death and dying on a daily basis. If you haven’t dealt with death much in your career thus far, you may be shocked at how much it can take its toll on you. Have you dealt with death? What has your experience been? Do you hang on to the emotions? Do you have personal death experiences that you have or have not dealt with yet? Are you a person who is able to compartmentalize and disassociate from the situation? What is your typical reaction when someone cries? How would you handle the death of a child (even if you’re working in adult Hospice, remember that 18 year olds die too)? Where do you stand spiritually? Do you have a faith base? Do you believe in God? Do you have biases against those who believe differently than you? And most importantly….DO YOU VALUE LIFE? You need to ask yourself these questions before you go forward. It’s imperative that you reconcile your own experiences, thoughts and outlook before you show up as a support person to a dying person’s home. Take some time to really think through these things and consider how you will handle the day to day emotions that accompany you from home to home, consider how your own outlook on life will affect your practice, and most importantly consider very carefully if this is the right choice for you.
So, you’ve decided to jump on in? Great! Let’s talk positions!
RN Case Manager
There are several nursing positions available in the Hospice realm. The most common is the RN Case Manager. As an RN Case Manager, you’ll visit patients on a daily basis, perform assessments, provide wound care, educate patients and families, assist with personal care needs, and coordinate care across all avenues for the patient. This is a great position to start in if you’re new to Hospice care! The downfall to case management is that your day doesn’t end when you see your last patient. There is always documentation to do, meetings to attend, and required on-call hours. For those who work full-time, it can take over their life if they let it! (Side note: As I write this, my phone is going off. I don’t start my shift for another 7 hours. This is CM life!)
Patient Care Coordinator
PCC’s are RN’s that work from the office setting and coordinate the care of the entire patient load. They are essentially the supervisor to the Case Managers. This position is obviously more appropriate after getting a few years of experience. Most often, the PCC’s are a really wonderful point of contact for those in the field and spend their days working out various details of the patient’s care! The PCC is required to take on-call hours, so like the case manager, their job doesn’t always end at close of business.
Transition Nurse
Transition nurses are also a great option for those with Hospice experience. Essentially, their job is to facilitate a transition from not-on-Hospice, to on-Hospice. They meet with facility staff to assess the appropriateness of a patient for Hospice services, meet with families to answer questions prior to signing on, and often assist with the admission process once Hospice care is chosen. It’s a sort of cross between sales and care, and is great for someone who is skilled at building relationships!
Telephone Triage
Nurse Triage jobs are available through some Hospice providers and are a wonderful option if you have experience and want to work from home! The downfall? You’re going to be taking calls during off hours and overnight, and there are A LOT of calls!
On-Call
On-call positions in Hospice are a unique opportunity to work in Hospice and forego a lot of the documentation and daily stressors of a Case Manager. While you’ll work off hours and have to document your visits and outcomes, you can turn off your phone at the end of the day and know that your job is done! While the post-work stress is limited, shifts are stressful as the on-call nurses do admissions, handle emergency calls, and cover the entire organization’s case load!
Inpatient Hospice
Depending on where you live, you may find that inpatient Hospice facilities are readily available. If you find a position within a Hospice facility, it will likely be comparable to working in Skilled Care, but with some additional perks. The facilities tend to be peaceful and patient-focused, patient’s tend to be on less medications, and nurse to patient ratios are often lower than in skilled facilities (skilled facilities are 25-30 to 1, Hospice facilities are typically 5-6 to 1). This is a wonderful option for those who wish to avoid visiting patients in their homes.
Let’s Talk Pay!
I want to take a moment to address the elephant in the room…pay! Everyone wants to know, but nobody wants to ask! First, pay is negotiable and varies from area to area, so you may need to do a little research to get a better idea of your specific pay rates. However, it can be easy to get short-changed! Hospices work on tight budgets and one of their money-saving tactics is to save on salaries! Prepare yourself before walking into your interview and get ready to throw out a number and stand pretty firm on it! Otherwise, it’s quite possible that you’ll end up over-worked and under-paid! Now, for many Hospice positions, the pay is pretty standard at salary or hourly. But, if you are planning to work as a RN Case Manager or RN On-call, beware! Hospices vary in how they pay, either hourly, per visit, or salary. Let’s review each….
Salary….
This is pretty common for full-time Hospice employees. It sounds wonderful at first since you can flex your schedule pretty easily and nurses start off thinking that they’ll work banker’s hours and be done for the day. The reality is that most full-time employees end up working more than 40 hours when documentation time, follow up calls, and on-call hours are thrown in the mix. If you’re taking a salaried position, be sure that you’re comfortable with the pay, even if you’re working 50-60 hours some weeks!
Per Visit…
I’ll start by saying this. If you take a position that pays per visit, you’re setting yourself up to be underpaid and to fall into poor nursing practices. Organizations that pay per visit typically underestimate the time it takes to PROPERLY care for patients and therefore underpay their staff. For instance, if you currently make $40/hour and are offered a Hospice position making the same, it may sound good. Not all patients will take a full hour for a visit, right? True! But, some will take 2 or even 3 hours. And there is travel time to figure in. And phone calls. And post-visit documentation. I currently allot an average of 2 hours per patient across my caseload per week. That means that a patient who I see for a half an hour (in home time), helps to average out patients who take 2 hours (in home time). With travel thrown in, as well as phone calls, follow ups and meetings, I often go over my 2-hour-per-patient-per-week average. That being said, your $40/hour just worked out to less than $20/hour. When that happens, some nurses will fall into a habit of cutting corners and skimping on care in order to try to get everything done more quickly, so they can average out to their hourly wage. If you ARE taking a per-visit position, I would recommend that the per-visit rate be 2.5 times what you want to get hourly, if you want to provide high-quality care to your patients. (I recommend this, but I can assure you that you won’t find it easily).
Hourly…
Hourly is the diamond of pay styles. When you’re paid hourly (plus mileage), you can take the time that you need with each patient and you know that you’ll be compensated fairly when you have additional work to do after. It’s a win-win for everyone! While most full-time positions are not hourly, some on-call and part time options allow for hourly pay.
On-Call Pay…
I want to touch a bit on on-call pay. For those who work ONLY on-call, they are typically paid fairly. Either a salary, or a salary plus per-visit. Some are even hourly. BUT, for the RN Case Managers, it can be quite a shock to find out that pay during on-call time can be quite low. Some employers offer an additional day off for covering on-call hours, but that is not always the case. When taking on-call, you’ll be expected to answer the phone, triage and visit patients as needed. During that time, you may be compensated extra just for having the phone, though I’ve seen these rates as low as $5/hour. Considering that you may spend a great deal of time on that phone, those low rates seem outrageous. Depending on your current pay scale, you may or may not be compensated when you go out for visits. Salaried employees typically are paid a per-visit rate when on-call and hourly will often receive their hourly rate whenever they have to go out to a visit. Regardless, just know that anything you receive above your typical rate, is basically a gift from your company, because most of them require on-call coverage and many of them don’t compensate fairly for it!
If you’re still certain that Hospice is for you, then go for it! You’ll find that most Hospices train on the go and it may be a bit overwhelming at first, but stick with it and it will be a bigger blessing to your life than you ever thought possible!
If you have any other questions about Hospice nursing, please comment below and I’ll be sure to answer them!
