[kelluvanurse]

Okay, Ive been doing hospice now for a little over 2 mths, I had very little orientation and Ive had a case load of 9 pts since the first week and now Ive got 12 and I fill like Im drowning, Im behind on my paperwork and I have 3 recerts due next week. Im doing about 16 visits a week and traveling about 300 miles a week. I work in a small office and therefore Im the only nurse except for my supervisor who has been doing most of the admissions but thats it, I went in today and told her that I was overwhelmed and needed help and ask for another nurse, prn or a lpn to help with visits so that I could have some office time, well her solution is for me to fill out my paper notes and then someone else will put them in the computer. Yes,that will help some but Im still overwhelmed and feel cheated out of a real orientation. I love what Im doing I just wondered if everyone else recieved real training or did everyone else have to figure out the dying process and all that it withholds on their own.

[mtnmom]

I am just finishing my first month in hospice and my experience has not been much different. Very little orientation and what I got was very fragmented. One of the nurses that oriented me for 3 days got fired 2 weeks ago so of course I am wondering what kind of bad habits I picked up from her. Our office is larger than yours...but there is a great deal of turnover. Our DON is very sweet and knowledgeable but is extremely disorganized which makes all of our lives more stressful.
I don't know...I really enjoy the type of work but am wondering if I made the right choice. I am not sleeping from the stress. Plus since my hire I found out that nurses are expected to work 50-60 hours a week if that is what is needed with all the call and caseload. I just cannot do that for several reasons, although I know the money would be nice.
Yes, I would also like to know how other hospices orient their people.

[bay bay]

Hi, and welcome. I can relate to your story because I too, am new to hospice.(3 months) I recently posted about the heavy focus on recerts, paperwork etc, at the end of my "angry patient" thread. Yesterday, as a matter of fact, I went to my director, and told her how much I loved my job, and let the point be known to please be patient with me because I really like what I'm doing, and want to do well. I was starting to lose focus on my patient goals because of all the "policies and procedures" we are faced with learning. I empathize with you, and understand where you are coming from. With all the stress you are enduring right now, I pray you will be blessed by a patient with whom YOU have made a difference, and places a gentle reminder in your heart that are in the right field. Best of luck

[req_read]

Wow! It amazes and saddens me how nursing in general and hospice in particular have evolved. As an ‘old’ nurse (no longer practicing in a traditional setting ) it is disturbing to hear what y’all have to endure. Small wonder there is a nursing shortage when for so many managers the MO seems to be: Get a new nurse, burn her up and throw her out, then go get another new nurse.

Sadly, some nurses play into this by bragging up their ‘workaholism’ as though it were some sort of merit badge… which only adds fuel to the fire.

If nothing else you can wait until your next JCAHO visit and when you are asked what kind of orientation you were given you can say, “Basically, none.” When your response is compared to what your P & P says about orientation, your agency may have to rethink how they do business.

[doodlemom]

It makes me sorry to hear that you all are going through this. There really are some good hospices out there. Are the hospices you work for older, established agencies that have a name in the community? If they are not, then I would search for a job in that direction. I have found better luck working for agencies that have been in the community for 15 or more years. If you really want to do this work, please don't give up!

[aimeee]

I am sorry to hear that you are struggling so. I raised an eyebrow when you first reported that you already been given a patient load but I didn't want to say anything at the time that would undermine your confidence.

We would have a minimum of 2-3 weeks orientation for even an experienced hospice nurse. Nurses who are "green" to hospice would have more like 6 weeks and then be started with 4-6 patients and then be given more based on their performance. Nurse managers try to be available for lots of mentoring during the first 6 months or so.

Being the only nurse except for your supervisor sounds like a difficult way to learn a specialty field. Who is there for you to fall back on? What happens if you are sick? Who sees patients then? You mention paper notes AND computer entry. Are you doing double documentation?

[silverwillow]

Originally Posted by kelluvanurse

Okay, Ive been doing hospice now for a little over 2 mths, I had very little orientation and Ive had a case load of 9 pts since the first week and now Ive got 12 and I fill like Im drowning, Im behind on my paperwork and I have 3 recerts due next week. Im doing about 16 visits a week and traveling about 300 miles a week

Sorry to hear that you had so little orientation. If they are so busy there, they should have just let you do revisits for awhile to let you get ahold of the hospice philosophy, which as you know is alot to learn in itself. Gaining confidence about decisions you make is important, and your agency should be allowing you to focus on symptom management, etc before throwing the heavy things like recerts at you.

[jerseyRN]

I've been a hospice nurse for four years and things have changed so much since I started. Everyone is expected to do more (higher census) with less (reduced staff) and the bottom line is, as a case manager I work way more hours than I can bill for. I keep doing it because that's what it takes to get the job done the way I want to do it.... but we keep hiring nurses and nobody stays very long... wonder why??

[req_read]

No doubt that when you complain to administration about not having sufficient staff they come back with remarks about rising costs… right?

It is true that the percentage of total hospice revenues going to nursing and meds have risen since hospice’s early days. However, per diems (income) have risen about 1/3 in the last eight years and hospice income has been shown to exceed hospice expenses by 10-12 percent.

Having run a hospice myself I am aware that breaking even should not be a problem. Getting rich is something else again. Hospice was not designed to be a “cash cow,” although some have tried turning it into one.

If your agency suffers from chronic understaffing then there are 2 possible causes; 1- administrative/managerial ineptitude, or 2- plain old-fashioned greed.

[kelluvanurse]

Hey, I finally found time to respond. Thanks everyone who replied, we are up to 14 pts now and Im still the only case manager. I told them last week if they did not get me any help that I would probabley be leaving because I cannot handle the pressure. So they have asked our oncall nurses to help out with some visits so that will help some, I asked for another case manager but they said they just couldnt do that right now. Im really thinking about throwing in the towel because when I get home Im stressed out and I have 3 school aged children and we are very active and I just cant deal with all of this. Weve been slammed with admits this last week, my supervisor has been helping with that but its just not enough. I have a daily dressing change on a elderly man with malignant melonoma and she's having a fit because we have been doing dailys she said we should have never started that and now she wants the aide to learn how to do it and now the wife is very upset. Oh well, maybe things will look better tomorrow. Oh, this company has been around for 10 yrs but a little less than a year in our community. thanks again everyone for the replies.