If this is your first time joining this series, I would encourage you to visit the page dedicated to this series so you can start from the beginning. Please click anywhere in this paragraph to get full context.

I have spent more time contemplating this article than all the others in this series combined. I have even considered skipping this section of the series completely. After much thought, I have decided to include this subject before closing the series.

If you feel like you are in the throws of hospice burnout, then this article may be more pertinent to you than any of the others in this series.

Is it time for you to leave hospice?

I don’t desire for anyone to leave hospice. This specialty is absolutely desperate for high-quality nurses. It’s hard work. Maybe the hardest in all of medicine. I haven’t worked them all, but I have experienced enough other specialties to see the unique challenges that come with caring for the dying.

My first job out of nursing school included some ER work. I really expected to love it. I thought I would enjoy the action and adventure I heard so many nurses rave about. One evening we had someone come in who attempted to complete suicide. He had cut his arms from elbow to wrist with a blade. he didn’t even come close to death, but he had long cuts on both of his arms that needed to be sewed up. I stood by his bed as I watched one of the ER physicians repair his wounds. I got light headed and almost passed out. I learned real quickly that any type of nursing that involved sutures and stitching was not going to be for me. It made me nauseous. Over the years I found other areas of nursing that were a better fit. Ultimately I landed here in hospice care.

Below I have come up with a series of questions you should ask yourself in determining if you should continue with hospice as a profession, and find a better fit for yourself.

1. Am I waiting for hospice to become easier?

Waiting for hospice work to get easier is an exercise in futility. Difficult patients, family members and caregivers are all a part of hospice work. If I wake up each day asking myself, “Maybe today will be much easier,” my expectations are unrealistic. There is always a challenging situation awaiting our intervention. There will always be difficult symptoms to manage. There will always be patients who either challenge our ability to remain calm or become almost like family and leave a hole in our lives when they die.

If the only reason you are still working in hospice is anticipation of this work getting easier, it may be time to change specialty.

2. Am I unwilling to work an 8 hour day?

This work cannot generally be done working less than a full day. We need to be willing to arrive at our first visit by start of day and leave our last visit at end of day. Business hours vary among organizations. They tend to be 8.5 hours and start at 8:00am and end at 4:30pm. Not every work day needs to be this strict, but if we develop a routine that has us showing up to our first visit at 9am or 10am and trying to end our day by 3pm we are setting ourselves up for frustration.

No other area of nursing allows its staff to just wander in and out whenever they feel like it. Just because we can start our day late and leave early doesn’t mean we should. This is a recipe for lots of working from home. What takes you 10 minutes out in the field will take you 30 minutes at home.

If you are unwilling or unable to get out of your home timely, it might be time to change specialty.

3. Do I struggle with autonomy?

The autonomy that comes with hospice nursing may be one of the biggest reasons it draws in staff. It may be the same way with home health. It’s nice to be able to swing by the grocery store in the middle of the day and grab something for dinner. You can stop in and have lunch with your kindergartener as well.

The difficult side of autonomy is that there isn’t someone in the back seat of your car reminding you of the work you still need to get done for the day. A quick stop at a big box store can turn into an hour or two of the day lost real quick. Nobody is calling at you from the garage reminding you to get out the door by 7:30am so you can be to your first patient by 8am. You only have the still small voice in your head, and we are all great at shutting that voice down.

There is very little direct supervision in hospice. Many hours of the day can be lost or mismanaged easily resulting in a lot of work that goes unfinished. Management is plenty busy getting their work done. They aren’t calling all day long to make sure patients are being seen timely.

If you struggle with managing all the time away from supervision, it might be time to change specialty.

4. Am I unwilling to turn off my work phone?

When we are off work, we need to turn off our work phone. Leaving our work phone on is a recipe for constant reminders of the work we do. As many times as we remind our patients and caregivers that we don’t work after hours, they still cannot resist the temptation to send us notes or trying to call during our off hours. We end up answering those calls and messages, and we end up trading in our personal time by working for free. We have on-call services for a reason. The only way we can get our patients and caregivers to become dependent on the whole team, is to be sure we cannot be reached after hours.

If you struggle with the “not knowing” part of being a hospice nurse, it might be time to change specialty.

5. Am I unwilling to learn to chart at the bedside?

Cal it what you want. The general idea is your charting for patient A is done before you see patient B. All my charting happens while I am with my patients. Nobody calls me rude or says anything about it.

I addressed this issue in depth during Part 2 of this series. If you have been reading this series as I have been releasing each article, you should be making progress in this area. If you continue to do a lot of charting at home in the evenings, I highly encourage you to read Part 2 again and get working on this.

There is absolutely no reason for you to spend your evenings charting. No reason at all. None. Zero. Zilch.

Don’t chart at home. Ever. Have I been clear?

If you have decided charting at the bedside is not appropriate or impossible, it might be time to change specialty.

6. Do I have to always be right?

Our medical brains are full of very useful information. The unfortunate reality is that not all patients and caregivers want to access that information. Many of them have their own thoughts and ideas on what is best medically. As frustrating as it is to see them choose WebMD over hospice best practice, we have to be willing to accept that not all of our advice will be implemented.

When we push and push we just find ourselves in constant conflict with patients and their caregivers. We cause ourselves and our clients undue and unneeded stress and anxiety. We go home frustrated because we feel unsuccessful from the day. That one difficult patient wears on our mind. We spend countless hours away from work trying to figure out how to convince them to start or stop certain behaviors.

If you just can’t handle watching others make bad decisions, it might be time to change specialty.

7. Do I have to fix every problem?

In general, hospice professionals operate in very imperfect environments. Our patients are dehydrated and malnourished. Often they are bed bound, or they have severe dementia. They have wounds, shortness of air and pain. There can be fighting among family members in our very presence. Sometimes everyone wants our help with these problems, and sometimes they just want to handle it all themselves.

We are in homes with bugs, cigarette smoke so thick you can hardly see and spoiled trash in the corners. At times it can overwhelm the mind and the senses. The patient or family may point out just one problem that is important to them. We look around and see ten problems that need to be solved. Maybe the one problem they want fixed is something that cannot be fixed. Now we are struggling with helping the family come to terms with the dramatic changes they see in the one they love more than anything on this earth.

We have to come to terms with the realization that we can’t fix everything. This is end of life care. Our patients’ bodies and minds are failing them.

If you find yourself having really long visits and getting caught up in family drama, it mightI be time to change specialty.

Organizations do contribute to burnout. I have mentioned it a few times during this series. Generally speaking, I believe organizations play a small part in hospice burnout. Much of what causes burnout can be found in bad behaviors and practices by staff. The short list above is my own observation of the biggest contributors. You have to master all of the above to make it.

Still, there are bad organizations or offices out there. Maybe the company philosophy of care is just too much on the staff. Maybe they have caseloads or travel times just too high.

I am limited in my ability to assist you with finding the right organization. I only know my region and how hospice care is delivered here. We have more than one organization in this area that pushes staff too far.

I can only offer this simple advice.

Don’t leave hospice before making sure it is you, and not the organization you are working for. Start by having a good one-on-one conversation with your direct supervisor. Ask lots of questions. Treat the meeting like you are interviewing the company to make sure they are worthy of your continued involvement in the organization.

Don’t stay with an organization or specialty that makes you miserable. Life is too short.

Visit The Hospice Nursing Community for more assistance in avoiding hospice burnout.

James

James worked on-and-off as an LPN for over 20 years. In 2014 he completed a bridge program and became an RN. James became a hospice nurse in January 2015. He lives in the Kansas City area with his wife of over 30 years, 4 daughters and 2 sons in law.