A Nurse Explains How Hospice Works, Why So Many Nurses Have Side Gigs, And Whether Virtual Nursing Actually Helps

We share a candid look at hospice nursing from the RN case manager seat, then shift to data on nurse side hustles and a frank review of virtual nursing’s mixed results. Honest, practical, and focused on what helps nurses and patients most.

• RN case manager scope across 20+ patients
• Home visit realities, safety, and family dynamics
• Medicare-driven charting and start of care admissions
• Scheduling swings, urgent calls, and travel load
• Why hospice intimacy is rewarding and draining
• Side hustle stats, popular paths, and how to start
• Reasons nurses avoid side gigs and risk of burnout
• Virtual nursing programs, evidence gaps, and limits
• Practical ways tech can help without replacing staff

Please let me know in the comments below what is something you're interested in and that you would like to see

Chapters

• 0:00 Check-In And New Study On Side Gigs
• 0:32 First Impressions Of Hospice Work
• 2:45 RN Case Manager Role And Scope
• 4:24 Home Visits And Family Dynamics
• 5:55 Medicare-Driven Charting And Documentation
• 7:24 Emergencies, Travel, And On-Call Realities
• 8:16 The Intimacy Of Hospice Care
• 9:25 Scheduling Chaos And Start Of Care
• 11:00 Admissions Specifics And Care Plans
• 12:14 When Hospice Isn’t A Fit
• 12:24 Palliative, PT, And Insurance Questions
• 13:10 Pivot To Nurse Side Hustles
• 14:07 What Nurses Are Actually Doing
• 15:25 Why Some Don’t Side Hustle
• 16:09 Take The Leap Into A Venture
• 17:23 Do Virtual Nurses Reduce Workload
• 18:10 Mixed Results And Evidence Gaps
• 20:03 Closing Recap And Listener Requests

Transcript

SPEAKER_00: 0:00

Do you have a side hustle? Because apparently there is a story that 66% of nurses have side hustles, which I completely am on board with because I believe nurses should have some form of more than one income. Welcome in, welcome in with Jobakondar in. I got a lot on my mind, but I'm not here to waste your time. Let's get into it, man. How are you doing? How's your week been? How's your physical, mental, spiritual doing? Let me know in the comments below. Always check in on my listeners on this show. All right, man. So right off the bat, so first topic for me, I've recently tried hospice. Hospice, hospice, hospice. So, you know, a lot of us, um, when you think of hospice, you think of the deaf and dying. And so it was something I've never done, something I've never tried, something that I've seen from working, you know, med surge, and I've seen from, you know, long-term care, especially hospice nurses come in and out. I had a general understanding of what they did. But recently in my nursing career, I decided to give it a try for myself. And depending on how this goes, I may expound on it a little bit more or a lot more, depending on the interests of this topic. So let's start with the introductory. I, my role was RN case manager. So basically, I have a managing role over my patients. So I think I had, I think one point maybe 20 to 23 patients that, you know, I was overall over their care. Um, I managed, you know, their meds, I managed their treatments, I'm also helped manage the AIDS that are under their care. I dictated visits in terms of nurse visits and also aid visits as well. And we work together as a team along with our director and supervisor and scheduler to make sure we meet the needs of the particular patient. Now, with that being said, it also has its varying challenges as well as RN case manager, because I think some people think of an RN case manager as somebody who's typically sitting in an office and they, you know, they're not really active in the care. Well, for this particular company, I was very active in the care. I saw patients every single week. Some patients I saw once a week, some patient, some patients I saw every other week, some patients I saw, you know, multiple times per week, just depending on um what their needs were. So it just there is varying degrees of that. So that that's a start. That's a start. And so I really thought at first it was kind of be more of a me sit, kind of sit down a little bit, which is fine. I I've I've been on the floor most of my career, not a big deal at all, seeing patients. But the biggest transition for me from going from somebody who worked bedside to hospice was obviously the travel. I was spread out. Uh, I'm trying to think how many, what's the mile radius? Probably within a 40 mile radius. I'm trying to think from the placement of the office or the placement where I lived, my home, I think it's probably 30 to 40 miles, give or take, in terms of the patients that I saw. And it's what's interesting about that is you would have to go into patients' homes, which I know that's kind of a big thing for a lot of people. Sometimes people, for some people, that's not a big thing going to somebody's home, but it's a big thing going into somebody's home because compared to like a patient's room per se, to where you know, like, okay, the bedside table's here, and you know, pretty much the the setup is generally the same throughout every room. Well, that's not the same going into somebody's individual home. So you can have a lot of variables in there. You're talking about, you know, the patient themselves, you're talking about whether or not somebody has firearms, somebody where they have multiple pets, multiple family members that are living there, other fight family dynamics, that's the other thing too, um, family dynamics, which I can expound on probably in this own podcast episode. But there's a lot of factors. And so, you know, you don't you go in there, and of course, you know, you have to take their bottle signs and you're doing your own head-to-toe assessment, assessing what their needs are at the time, and you're just doing what's required of you within the patient's home. But everybody's different. Everybody's different. Not all patients are the same, but this is throughout healthcare, but especially within hospice. I think people just automatically assume that they're dying. And some people, they may have a terminal prognosis, but they're not immediately dying. Like they're not gonna die within the next three days. There's patients that have been on hospice for six months or been over it for on it for over a year, and they have to go through recertification periods to see if they still qualify for hospice, and that's its own thing. Sometimes, you know, you know, the people they have a lot of needs, and you got to help meet those needs, but you have to rely on your resources as well as well, such as, you know, you know, you have your social worker, that's there as a great resource. You know, you have people that are more experienced than you in terms of senior nurses, that can be a great resource. Volunteers, people can come in and volunteer for services, sit with the patient, especially if they have companionship needs or maybe pet therapy. It just kind of depends on what that particular patient needs. But then, you know, you do whatever you have to do within the visit. Sometimes you gotta set up meds or or whatever, and then you have to get up and then you do your documentation, which that documentation is different than long-term care documentation or even acute care documentation because it's very Medicare driven. And so you have to meet Medicare guidelines within your charting, very specific, very um, there's specific language that has to be used within the documentation in order for them to qualify for hospice services. So you got to meet that as well. And, you know, that is charting to the client. You know, in in regular nursing, you're charting as things are happening. You know, you're doing a narrative note, you're charting things in real time. Hospice charting is different because you're documenting to the client. You're trying to show that, you know, hey, one month ago they were able to perform most of their ADLs, but now today they're unable to perform ADLs due to a decline in functional status. Like you're gonna chart like that. And so the charting aspect is different. It's different. Um, if you're not used to that, it can be a little bit of an adjustment. I charted off of, they gave me a tablet. Um, I had a tablet to chart off of, and so took that with me everywhere. It was my little buddy. We went everywhere together, it felt like. Um, and so I had that going on. And then also I will say something else that was a challenge. Like, so you know, if you if there's an emergency or somebody's declining or somebody's had a rapid change, the room is literally right next to you, right? If you're in if you're an acute care setting, the patient's room is right there, that you know, somebody's having a decline or a rapid, you can just go literally next door. Well, in hospice, you have to drive wherever this patient is at. And you may, it may take you an hour to get there. And I'm not exaggerating, it literally may take you an hour. Your scheduler may call you and say, hey, so-and-so may have passed, and where's your what is your ETA? And you give them an ETA and then they communicate with the facility back until you get there. So that that was an adjustment because I was like, huh, they I have to get there within, you know. So, you know, it's an adjustment in that sense. And so that is different. And then the other side, too, I think that people don't understand about hospice, it's very intimate. Very, very intimate. Hospice is a very intimate specialty because you are lit literally with with the patients, with the family. And depending on the time spent with these people, they look at you as your own, they get very attached compared to like acute care, especially where you see them for a few days or you're an emergency department, you may see them for a couple hours and then you know they're gone. Hospice, you spend a lot of time with them. A lot. You know, like my typical visit can be 30 minutes, 25 to 30 minutes. And that is a lot of time spent with the patient compared to what I'm used to. Now, some of you may vary depending on where you listen to this, but for me, that is very, very different. So spending a lot of time with those patients, with those families, answering questions, meeting their concerns, like you do a lot of that. You do a lot of reassurance, and because they're trusting you with their loved one, they're trusting you with their care and to meet their needs. Um, you know, things like that. It's it's it can be very rewarding at times, and then at times it's very challenging because, like, for example, I did admissions are what's called start of cares. So I literally could have my schedule, because I get my schedule at the beginning of the day of, you know, well, I get it a few days prior, like like if let's say on Friday, I may get my schedule for next the next week. But on Monday, it could change depending on who calls in, you know, what occurred over the weekend or what occurred the previous day. There's variables that happen that changes your schedule. And so, but once you kind of get through, like we have a morning call. Every morning we have a morning call, talk about what the previous on-call or the overnight nurse, what they went through or their report. And then, you know, we may make changes based upon that, depending on patients' needs. So that was a thing. But once you get your schedule and you kind of have your mind, like, okay, well, I'm gonna see Mr. Smith at this time, I'ma see Johnette at this time, and then, you know, but in in between all that, you could have a starter care. And I know for some nurses that is very, very challenging. I know for me it was challenging too, because I'm a very schedule-centric person. I'm a very um I'm a guardian, if that makes sense. That kind of helps you guys understand. So I like things to be particular a certain way. And if you're not used to that, it could be a huge challenge because you you could kind of literally map out your day and then somebody calls you. Like you could be on your first patient, second patient, third patient, you get all the way to your fourth patient, and then somebody tells you you have a starter care, and you gotta go do an admission. And so I'm pretty sure I'm gonna have to probably do a part two to this to this video explaining hospice a little bit from my perspective. Starter cares are its own thing. I will admit, starter cares are the longest admission process I have ever done within healthcare. I have never done an admission process as long as hospice starter cares, and it may be different depending on your hospice agency, but you gather so much information and you have to be very specific on what their needs are, and it is very particular. If not, you have people that will flag your starter care, people that'll go over your starter care, and have you make corrections to make sure it is completely correct. Because you you dictate everything. I mean, you dictate their visits, you dictate, you know, you have to put in their meds, make sure their meds are absolutely correct. I mean, you're determining what the aides can and can't do. It gets very specific on, you know, let's say somebody needs homemaker services, like somebody can help clean up in a home. You have to be very specific. You have to put, we'll take trash out one time during visit, or you have to put, you know, well, the aide will bathe with patients' own soap and shampoo. Like you have to be very specific because if you're not very, if you're not specific on that particular aid care plan, then aid technically cannot do that particular care. You have to go back in, edit, and change it, and it's it could be a hassle. So I'm gonna keep that the short and sweet. There's been times where I go do a starter care, my schedule is arranged, and then somebody cancels. They don't want to do the starter care because some information was left out. You know, I like for example, I had one patient that was gonna do hospice care, and then he realized he couldn't do dialysis with us because it's a form of aggressive treatment. Like I said, it varies depending on your hospice and and and a lot of other factors, but we couldn't do um dialysis, which I was well like I think an hour into the starter care, and then the question came up, and then he didn't want to do it, and so I feel like I wasted an hour of my time because you know this wasn't explained to him, or maybe he forgot, whatever the case was. It he was it was not understood that that's what he needed, and he felt like that need couldn't be met, so he just backed out of hospice services. So that's like a short, short, condensed version of hospice services. There's some other things like you can do palliative care, and there's some contracts with certain um hospitals and companies that can do palliative care with you. Um I can also talk about a little bit about PT services. Some people don't understand that in within hospice they have to offer PT services. It may not be as extensive as regular PT, but you do get PT services as well. Um, and then there's other things like insurance. Like once you get on hospice insurance, you know, what does that cover? What does that not cover? Can you still see your primary doctor? There's some other things too that I have not covered that I may talk about another episode if there's enough interest. If there's more interest, I can talk more about it, and some more questions, maybe share more stories. But you guys have to let me know in the comments if you want to want me to talk more about hospice in my experience. Shifting gears. Let's talk about, you know, if you're a nurse listening to this, or you're a CNA or whatever, you're a tech, do you have a side hustle? Do you have a side hustle? Because apparently there is a story that 66% of nurses have side hustles, which I completely am on board with because I believe nurses should have some form of more than one income. I'll be big on that. So, according to this study, a study by St. Thomas University found that four and five nurses have side hustles outside of nursing due to the increase in financial burdens. Nurses with side hustles earn 17% of their total income from other ways other than nursing, while only 17, or excuse me, 11% save the money earned. Social media, including TikTok, is one of the main reasons why many nurses start a side hustle and utilize the platform for engagement and publicity. So, you know, the reasons that many are faced with financial burdens and needing a side hustle includes raising the cost of living, student loan debt, burnout leading to decreased shifts. The study specifically looked at side hustles and how they're connected to nursing, whether furthering education and better support the nursing profession, or if nurses are seeking side hustles for enjoyment, um, side hustles that nurses are pursuing. So if you're a nurse looking for potential side hustle, or if you're in healthcare looking for potential side hustle, maybe this these are a few things that the study found. Maybe these things are interest, interest you. Um the most common side hustle is selling products, 37%, either from Etsy, e-commerce, or crafts. Other side hustles nurses are pursuiting include per diem, traveling nursing shifts, that's 20%, um, rideshare slash delivery, Uber, DoorDash, Instacart, that's 17%. Content creation, TikTok, Instagram, YouTube podcast, 16%. Uh ironically enough, I'm doing a podcast right now, so that's ironic. Health and wellness coaching or consulting, 12%. Uh, med spa, beauty, aesthetic services, 5%. So if you're interested in any of that, you thought about doing any of that, get into it. Just get into it. Um, so here we go. Even though side hustles are becoming the new normal for nurses, there are plenty who prefer their time off. Completely understandable. The study found that the top reasons nurses don't have a side hustle include 41% worry about burnout, 38% don't have time outside nursing, 34% don't know how to start a side hustle, 28% said their nursing income is sufficient. So if you fall into that category, um, just let me know. Let me know. And there's some other percentages like role of social media and a couple other things, but I feel as though we're we're pretty good on that. We're real good. So you thought about a side hustle. Now's the time. Now's the time, man. I I feel as though that 2025 going to 2026, why not take a leap? Why not take a risk? You know, you thought about do you are you good at something? Do you have a product that you've been thinking about selling? Go ahead and sell it. Go ahead and do it. You know, I've talked to people on this podcast. They went on and, you know, they started their own, you know, like insurance business. I've talked to, you know, another person that runs their own like nursing doses calculation business. You know, I've talked to another person who helps people with NCLEX. I've talked to another person that did their own, their own scrub brand company. Look, y'all, I'm telling y'all, like, I'm trying to bring y'all content for these potential side hustles. And eventually, if you want to get completely out of nursing, you can make that your full-time thing. Like, I want nurses, I understand the need the nurses in today's society, they are burnt out, they're tired of the nonsense, they're tired of the BS. Completely understandable. That's why I try to give you guys platforms to talk about your business and also if you have the awareness that you can do something else. You have a talent within you that the world is just waiting for, and you need to show it to the world. So that's all I gotta say about that. All right, our next topic. A new study says that virtual nursing programs were supposed to help, but most nurses feel no relief. Now, I want to hear what my audience has to say with this because, you know, this is not in every hospital. I'm sure there's some rural hospitals that don't have this. So I am curious to hear what you guys have to say with this. Key takeaways at Penn State University of 880 hospital nurses found that the majority of bedside nurses felt that using virtual nursing programs did not relieve their workload. The study also revealed that many nurses reported virtual nursing programs couldn't improve patient care, but not in a substantial way. Study authors point to the fact that virtual nurses are not a substitute for bedside nurses, and adequate staffing is a critical issue with all care models. With hospitals across the country wrestling with ongoing nursing shortages, many are experiencing virtual nursing programs as a possible fix. These programs use real nurses through video calls, chats, and other tech tools to handle tasks like patient monitoring, education, care coordination, and all from a remote location. Hey, we'll talk about side hustle. Maybe if you want to be a virtual nurse, maybe that's something you can look into. Virtual nurses sound promising, and nursing.org has reported on some virtual nursing programs leading to successful outcomes like decrease new nurse turnover. But here's the million dollar questions are these programs actually easing the burden on bedside nurses? According to a new study at a Pennsylvania University, the results are mixed at best. Um, a big study from Nursing's Pen Center for Health Outcomes and Policy Research surveyed 880 in-hospital nurses to get their own take on working alongside virtual nurses. The results showed that majority of nurses, 57%, said a virtual nursing did not lighten their workload. 10% even reported that virtual nurses even made things worse for them at bedside. One-third nurses reported that the virtual nurses were able to lighten their load. I have got to hear. One third? We'll see. Um, let's see. She, okay, so there's a quote there. Virtual nursing programs have been heralded as innovative silver silver bullet to hospitals. Nursing staffing changes, challenges, but our findings show that most bedside nurses are not experiencing major benefits. Patient care, let's talk about patient care. About 53% of nurses thought that virtual nursing had a positive impact on care quality, but only 11% said that the improvement was substantial. So while there is some indication that virtual nursing might help a little, it's not exactly revolutionizing care delivery. One of the big challenges here is lack of solid evidence to. Guide decision making and integrative review on nurse virtual nursing programs found at six studies on a topic, and only one of those had a uh quadisual experimental design. Okay. So, like society ignorance superhero. Anyway, so you you guys get the gist of that, right? We get the gist of that. So, with that being said, it seems like the the reviews were mixed on you know the the virtual nursing and does it really help bedside? And you talked about how you know nursing school programs could use it and it could be beneficial. I could see that. But as a whole, on patient care, I mean, if you experience this, please let me know in the comments below. I would like to know. I've used um, you know, telehealth, I've used telemedicine, you know, for specialists and things like that, but not actual virtual nursing, at least not in my area. So if you have used this, please share your insight, please share your opinions below because I would love to hear it. Okay, so in this particular episode, I talked in depth about the hospice experience and my particular experience with it. Um, talked about some pros, talked about some cons. I just gave some insight. If you guys want more on that, please let me know in the comments below. I could definitely talk more about it. And I talked about how 66% of nurses have side hustles, including TikTok, including arts and crafts, and other various things about side hustles. So we talked about that and how that can impact you, and you can get started. And we talked about how a new study, how virtual nurse programs were supposed to help, but most nurses found no relief. So if you like topics like this and other topics below, please let me know in the comments below what is something you're interested in and that you would like to see. I thank you for tuning in with your Rakondar and I love you guys. I hope you have a blessed week.