[Em1995]

Just wondering if anyone knows the answer. Do your full-time home care nurses carry about 12 patients? And, what about facility nurses? To me, it seems like they can handle more as in facilities the facility nurse carries out the work and the hospice RN assesses and makes recommendations, not to mention less driving when patients are in a facility compared to homes which are greater distances.

[aimeee]

The only savings is really the transportation time. That is offset by the fact that in a facility you don't just talk with the primary caregiver, but you must hunt down numerous people to get the whole story and collaborate fully. You need to find the wound care nurse, the unit nurse, and maybe the MDS coordinator as well, then touch base with the CNA, read the chart notes, check to make sure the doctor didn't come through and write new orders without telling you, find the food acceptance book, and check the BM book. And once you are done with all that you still need to call the family and provide an update.

[nurselearner]

I agree. The only difference is that you are not driving. But patients may be on different units. And You must also document on the facility chart. You may be done and thena family member comes. You are speaking to manny more people and checking the MAR to se if the patient is taking their meds. All in all takes as long as a home visit.

[Mazzi]

The LTC I work in as a hospice nurse expects our IDG to do most of the work. Of course, we are in the building maybe a total of 6hr a week. That leaves a lot of hours that the LTC staff must care for the pt. If any thing goes down, we may or may not be notified. Then when I make my next visit, they are all over me to fix it. Ex: pt rolled out of a Hi/Lo bed with 1/2 side rails, and mat on the exposed side of the bed. Two days after the roll out, the DON calls and says "What are YOU going to do about it." Did I mention that State is in the building almost monthly. I have had home pt and now totally LTC pt and am ready to as my coordinator to state giving me back home pts. It's is much easier!!!!

[koalalu]

Originally Posted by aimeee

The only savings is really the transportation time. That is offset by the fact that in a facility you don't just talk with the primary caregiver, but you must hunt down numerous people to get the whole story and collaborate fully. You need to find the wound care nurse, the unit nurse, and maybe the MDS coordinator as well, then touch base with the CNA, read the chart notes, check to make sure the doctor didn't come through and write new orders without telling you, find the food acceptance book, and check the BM book. And once you are done with all that you still need to call the family and provide an update.

That is so true. I have 2 Nursing Homes in my territory and it can be a handful. I had at one point 5 clients in one LTC. I spent most of my day there and yet they still gave me 7-8 clients that day. All because they see it as hours saved with driving time. The one LTC I can breathe easy because all the books are within reach and accessible to find for info. The other LTC I am constantly tracking down the Staff RN who has no time for you but wants you to take care of it all. I am reminding them over and over that I am there to suggest/recommend and support, not to take their job and responsibilities.
My caseload is around 20 right now and I just injured my knee which puts me out for 3 weeks. This is my time to regroup and see how they deal with a high census and low staffing.
I am sorry to hear that it is like this anywhere else. I will say that I love what I do and I dont have a straight answer when families ask me how I do this everyday.
I think we all feel that and know there is no set response. I just love that family connection and the privledge of being a part of their lives at such a vulnerable time knowing that they are so grateful that you are there.

[CANRN]

Originally Posted by Mazzi

The LTC I work in as a hospice nurse expects our IDG to do most of the work. Of course, we are in the building maybe a total of 6hr a week. That leaves a lot of hours that the LTC staff must care for the pt. If any thing goes down, we may or may not be notified. Then when I make my next visit, they are all over me to fix it. Ex: pt rolled out of a Hi/Lo bed with 1/2 side rails, and mat on the exposed side of the bed. Two days after the roll out, the DON calls and says "What are YOU going to do about it." Did I mention that State is in the building almost monthly. I have had home pt and now totally LTC pt and am ready to as my coordinator to state giving me back home pts. It's is much easier!!!!

OMG!!! This sounds exactly like a facility I go to. State there regularly, they expect hospice to fix everything. We write orders and they don't follow them, when you do find the nurse to see how things are going you get, "I don't know, I just started. or I don't know, I was a for three days" It is soooooo frustrating. I would much rather have home patients, there is more teaching, more conversation and the caregiver always has answers to questions.

If I had to continue seeing only LTC patients, I would quit!