Dear Barbara, I am a hospice nurse advocate and working on an education piece for hospice leadership. What is the average length of time you feel is appropriate for a comprehensive/quality nursing visit that includes education and psychosocial support?

This is such an important question, particularly today after all of the changes that have taken place in hospice over the years. Before I address time let me plant an idea: today, most hospices have an assessment nurse, an admitting nurse, and then a primary care nurse. This is WAY TOO MANY people for families to understand and bond with.

Families are stressed and frightened and by the time they finally reach out for hospice services, they have already wanted and needed them for days if not weeks.

Get to the house for admission within the first 24 hours —even on weekends and holidays. Time and fear are the enemies here. A big part of our job is to address both as quickly as possible.

How does this admission visit look? I would like hospices to send the primary care nurse on this admission visit. The first person to walk in the home is the one the family will bond with. Remember they hesitated to call and needed you long before you arrived. The first one who walks in the door represents what the future of their hospice experience will be. Trust is established with the first handshake, not three days later when the primary nurse shows up.

Now to the length of a visit: there are no hard and fast time frames because each family and each visit is different, has different assessments, adjustments, teaching and supportive needs. That said, most routine visits other than the admission visit or death calls can be done without hurrying in 45 minutes to an hour. In most cases if you are there shorter than that, you are not building trust or educating enough. If you are routinely there longer than 60 to 90 minutes (I’m talking routine visits, not emergency visits) you are probably talking too much.

This leads to how many visits a nurse can make in a 9-to-5 day. Generally, you are not going to make a home visit before 9AM or after 5PM. (That is being thoughtful of the caregiver.) I can’t give a set number because there are too many variables. Driving distance, driving conditions, and nursing home visits can all impact the number of visits you can make in a given day. In computing numbers, not only do you look at driving time, but also factor an hour for lunch and two breaks. (What? Does that ever happen? It didn’t for me).

If you want to retain your employees and provide high quality care for your patients, you will not overload your staff with more visits per day than they can comfortably provide. Rushed nurses cannot provide quality, compassionate, thorough care when the clock is ticking loudly in their head. 

Something More… about Rushing Your Hospice Nurses Benefits No One

If you want suggestions for creating a fulfilling work environment, staying balanced and healthy amid constant sadness, I encourage you to show my DVD Care For The Caregiver to your whole staff at least once a year. Maintaining a happy, engaged personal life is important to the well being of our agencies. Professionals who support, educate, and guide patients and families through the dying process often carry unrealized grief which can lead to burn out.