[tencat]

Hi, all. I'm new to Hospice (May 2007), and I was wondering how many patients you all have. I visit patients in their homes, and I have a caseload of fifteen patients. I'm beginning to feel a bit overwhelmed, and I feel so rushed in my race to visit everyone (lots of driving time in a rural area), that I am missing things that I shouldn't be missing (double-checking all med supply levels, basic supplies in the home, etc.) At least I don't make the same mistake twice, but it's frustrating for me and my two other fellow nurses who have to take call on nights and weekends (we all rotate weeks) and get called out because I missed something I shouldn't have. I have thought about making checklists for different situations to carry with me so I don't forget anything. If anyone has any suggestions, I'd be happy to hear them. Also, I have the least amount of experience in nursing (one year), but I have the biggest load of patients. Does anyone have any suggestions for approaching that issue? My fellow nurses (one of whom is the manager) are overwhelmed too, but their loads are not quite as high as mine. Right now I'm on their doo-doo list because of the mistakes I've made. I really respect the two nurses I work with and I know they really know their stuff. I just kind of feel like the dead weight of the bunch. I'm trying my best, but it doesn't feel like it's good enough. I love my job in spite of it all, and I want to be good at it. I guess I'm new enough that I can't tell if my mistakes mean I am not suited for Hospice, or if they are symptoms of being overwhelmed. Ok, this is WAY too long. If you've made it this far, thanks! Comments? Advice? Hugs?????

[lesrn2005]

((((HUGS))))) I'm a hospice nurse for 1.5 yrs, and had been a nurse for only 7 mos. prior to hospice. Cut yourself a break! I work in a rural office and have the least amt of experience (coworkers are veteran nurses for 20 to 30 yrs) Sometimes I do feel a little embarassed (sp?) or squirm with this fact and mistakes I've made. Also, some of the nurses can be critical. I do alot of mental forgiving and just tell myself they're so lucky to have me!! I run a caseload of about 10 to 12 pts. Hope this helps!!

[tencat]

Thanks! It's just nice to know I'm not alone.

[aimeee]

10 to 12 patients is usually considered a decent caseload but if you have a lot of windshield time that could affect it. Also, acuity plays a part and how many times a week you are needing to visit to handle their needs. If you just started in May, that is a high caseload. It takes a good 6 months to really start getting comfortable with hospice nursing and for someone with only a year under their belt total, I am sure it is a stretch for you. Its hard to keep caseloads even when patients come and go so quickly and their acuity levels is changing rapidly too....expecially when you want to also factor in continuity.

You might try asking your colleagues for their tips on how they organize themselves and stay efficient without compromising care. A few sincere compliments at the right time may help to shift them from criticizing to mentoring.

[RNKittyKat]

I started off with a case load of 5. It got as high as 13. Just recently it dropped down to 4 due to deaths and live discharges. Obviously it's not a stagnant thing. When I got to 13, things started getting pretty intense, especially when acuities became high.

BTW, my last day with hospice was this past Friday so I guess that makes me a former hospice nurse.

[AtlantaRN]

I have 16 right now, but I have two primary facilities (4 at one facility, and 6 at another), so it isn't too bad... we have 3 prn nurses- one has 7 patients herself...

we can call on the prn nurses if we get overwhelmed.

[Never2L84Peace]

I've been working with hospice the past 5 years. I have had a caseload as high as 23 (home care & hospice-mostly hospice). Right now I have the lowest caseload I've ever had of 8 hospice and 3 hc.
Acuity makes a huge difference. Sometimes 8 hospice, high acuity can be 16. I think I am one of the most fortunate hospice nurses ever as our agency is expanding by the day. We have a team leader for our area who is constantly looking out for us and making sure our caseloads are manageable.
It all varies. But it is SO stressful when you miss things. Especially when you are fairly new. Hang in there!

[uahrn915]

I work as a Clinical Director for a hospice in Alabama. Our nurses are capped at 12 patients. If everyone is full we hire another nurse and I see patients until new nurse takes over. The advice about organization is the best. It can seem overwhelming but if you take some time to organize patients, tasks and paperwork/puter work, everything will eventually get easier. Best of luck, and remember that everyday is a blessing.

Jeff

[Rnmomajmj]

I certainly wish my hospice worked that way. Our load is suppose to be 13, right now I'm at 15 and have been up to 19 at one time. It is very overwhelming. I love hospice, just wish our company loved its nurses. They keep telling us that once our census increases and stays up for 30 days we'll get a new nurse, they don't seem to realize that for those thirty days, they are slowly killing the nurses!

[RN4ustat]

I currently have 15 and have had as many as 25 but my company utilizes LPNs to assist with the visits. We set our frequencies of course to meet our pt needs and we only have to see our pts q 14 days to do the supervisory visit, but most of us try to see all our pts at least once a week. They want the RN's to do 20-22 visits a week and the LPN's to do 28-30. This is really a fairly decent caseload....I even have one full day that I can dedicate to recerts and updating charts, etc and my team director will either let us come into the office on our "paper day" or work from home!! I've never had so much flexibility!! Its awesome!! We have a full-time after hours team and a full-time admit team but we do take backup call approximately one night a month and are back up for admits about once a month. Our service area is pretty large and there are days when we have 5 or 6 admits. It really isn't too often that we have to do a backup admit however. And if we do an admit voluntarily after hours or on a weekend, we are compensated VERY well for it!!