Written by Hadley Vlahos, RN
If your nursing school was anything like mine, hospice was very briefly touched on. Although we spent months in labor and delivery, we only got one day in home-based care. Additionally, we were randomly assigned to either home health or hospice. Not only are these two specialties widely different, but one day is not sufficient for understanding the scope of home-based care and if it is the right fit for you.
A Typical Week for a Hospice Case Manager (Registered Nurse) – Example
- Your day normally begins at eight a.m. at your home with a team phone call. The weekend nurse will run through all visits she made and what the patient needed. I make sure to have a notebook and write down everything pertaining to the patients assigned to me (this is called your caseload).
- After this, you will pull up your schedule and see who is assigned to you for the day. Typically, I will start my day with a patient closest to my house and end the day with a patient closest to my house so that a loop is made.
- See two to three patients before stopping for lunch. A typical visit is about thirty minutes to an hour. I try to chart while I’m with the patient so I am not overwhelmed with charting at night.
- After lunch, see two to three more patients. I try to see five patients per day, on average.
- Your day ends at five p.m. with either a phone call or email with the team to inform them of who you saw today and what has changed with them.
- Every day starts the same with planning your day and getting an update, this time from the night nurse.
- Every two weeks, patients need a joint visit from their certified nursing assistant (CNA) and nurse case manager. After seeing which patients need that this week I will call the assigned CNA and find a time that works for both of us to meet at the patients’ homes.
- During the day, it is not unusual for unplanned visits to be needed. You may need to re-work your route or move patients to a different day if patients need you immediately. Examples of these types of visits are uncontrolled pain, new symptoms, falls, new wounds, admissions, or death visits.
- Tonight is your night to be on call. Your day will start just like any other day, but make sure to take your lunch! It might be the last chance you have to eat for a while.
- After working your typical eight a.m. to five p.m. day, you’ll call into the meeting like normal. This time, however, you’ll be taking notes on all patients. Make sure to note any patients who are imminent or have uncontrolled symptoms- it’s likely that their caregiver will be calling you.
- As long as all patients are okay for now, it’s okay to go home and continue your normal routine. Keep your phone on and be ready to answer. Sometimes caregivers and patients only have questions that can be answered on the phone and other times you will need to leave the house and go visit them. Sometimes, your phone is quiet all night. Your on-call time will end at eight a.m. by giving report on anyone who called or needed visits.
- Either every week or every other week is a meeting called IDG. Ours is around lunchtime on Thursdays. I always pack my lunch and bring it to the meeting.
- The doctor, social worker, other nurses, and chaplain will all be in the meeting as well. Typically, patients will be called in alphabetical order. When your patients are called, you will give the doctor a short summary, or update, on them. The chaplain and social worker will also chime in as well. This is a great time to get medication refills from the doctor.
- Hopefully, your week hasn’t been too crazy and your Friday can be relaxing. I always try to schedule only a few patients for this day. If I had to move patients earlier in the week, Friday afternoon is always open. If not, I will use this time to catch up on charting or help the other nurses.
- The last thing you want to do is leave visits for the weekend nurses. They will be busy answering emergency calls and need to be available for those needs.
Hopefully this gives you a better idea of what it’s like to work as a hospice nurse. The job can be extremely rewarding and can provide a much better work-life balance with the right organization skills.
I’m Hadley- a registered nurse with a specialty in hospice and palliative care near New Orleans, LA. I’m here to inspire you to live your life to the absolute fullest by sharing stories and advice from those at the end of their life (my patients). I believe that by connecting those who have lived a full life to those who still have a lot of life left to live, we can learn to live better. At the end of the day, as we say here in Louisiana, laissez le bon temps rouler! Let’s learn how to make this life the best we can.