[windsong]

I hate to sound like a cry baby, but I really need some advice.

Here is my problem. I work for a hospice and I am the only RN.

Iam over the outpt. which I manage the Lpn's and also I have a pt. load of about 30 pts. myself.

I live an hours drive from our corp. office. We have been in need of a couple more RN'S . My employer has yet to hire any. This has made it
very stressful for me. Lately we admitted a pt. who lives a 200 mile round trip from where I live. She is seriously ill. My problem is trying to deal with
how does my employer expect me to give this pt. appropriate care living
so far?

I am on call 24/7. This is a problem too. My life at home is falling apart and
so am I. I am having anxiety attacks and trouble sleeping because I feel
I can't handle all this responsibility by myself.

My employer only gets angry when I express my opinion. I love my job and I don't want to be forced to give it up.

I have been hanging on in hopes things will change. There has been one RN
to apply recently. I am hoping they will take the job.

This particular pt. has lung cancer . She is in the end stage. There is no one to stay with her 24hrs. a day. We have a very beautiful inpt. unit but she refuses to come to that. I don't think she realizes how this disease progresses.

I don't understand why my employer keeps piling on the pt's when we don't
have adequate staffing . This too is bothering me.

What would you do? How would you manage a pt. who is so ill living so far away?
I don't want my pt. to suffer while she waites forever for me to get there.

Any advice is welcomed .I am desperate at this point.
Blessings, Windsong

[EmptytheBoat]

April fool or just a fool?

[windsong]

No! not a April fool , but maybe I have been a fool.

Blessings. Windsong

[JSCOOBY]

You have LVNs. If she is end stage, symptoms are out of control and she is iminent, LVNs could do crisis care. This is a good case for crisis care!

[EmptytheBoat]

Dear Windsong,
I'm sorry your posting was not an April fool, if I were to think of an
April fool for hospice, or either a nightmare, I couldn't have come up
with a more demanding situation. I can't imagine the stress you must
be having, you are not a cry baby, but you must be super human to
keep up with your work load and 24/7 on-call. You ask, what would
you do? I would find another job! As for the patient 100 miles away,
I'm unable to think of a manageable situation other than to convince your
patient to go to the in-patient unit or to revoke from your hospice
and utilize a hospice within the service area, hopefully with adequate staffing.
Take care of yourself and may God bless you for your perseverance.

[nurselearner]

Not all hospices are run the way yours is. Look for another employer - or work the inpatient suite. Your employer keeps taking patients without the staffing because they get paid a daily rate for each patient even if they don't get the care they need. Not fair to the patient, not fair to you. You can not possibly keep up with your case load -look for something else and give your notice before you fall apart. It sounds like your employer won't make changes unless forced to and they are putting the responcsibility for making it all work on your shoulders while they collect the money.

[jwelhwel]

Originally Posted by windsong

I hate to sound like a cry baby, but I really need some advice.

Here is my problem. I work for a hospice and I am the only RN.

Iam over the outpt. which I manage the Lpn's and also I have a pt. load of about 30 pts. myself.

I live an hours drive from our corp. office. We have been in need of a couple more RN'S . My employer has yet to hire any. This has made it
very stressful for me. Lately we admitted a pt. who lives a 200 mile round trip from where I live. She is seriously ill. My problem is trying to deal with
how does my employer expect me to give this pt. appropriate care living
so far?

I am on call 24/7. This is a problem too. My life at home is falling apart and
so am I. I am having anxiety attacks and trouble sleeping because I feel
I can't handle all this responsibility by myself.

My employer only gets angry when I express my opinion. I love my job and I don't want to be forced to give it up.

I have been hanging on in hopes things will change. There has been one RN
to apply recently. I am hoping they will take the job.

This particular pt. has lung cancer . She is in the end stage. There is no one to stay with her 24hrs. a day. We have a very beautiful inpt. unit but she refuses to come to that. I don't think she realizes how this disease progresses.

I don't understand why my employer keeps piling on the pt's when we don't
have adequate staffing . This too is bothering me.

What would you do? How would you manage a pt. who is so ill living so far away?
I don't want my pt. to suffer while she waites forever for me to get there.

Any advice is welcomed .I am desperate at this point.
Blessings, Windsong

Advice from a hospice nurse of 20+ years: Set some boundaries with your employer. Having a case load of 30 hospice patients is insane. (The average should be no more than 10-15.) Most hospices do not accept pateint that live further than 50 miles from the hospice office. (Rare exceptions do occur but the patient should be aware of the slow response time and agree to it.) I would advise you to talk to your director and if nothing changes in a short period of time, go elsewhere! You are working under conditions that put you at risk. There are other hospices that would love to have an experienced hospice nurse!
jwelhwel

[kjmrnmom]

Is your agency accredited? An anonymous contact may be in order. Also, go to the NHPCO.org website and there is information about what is a reasonable caseload. I have found that often the only thing adminstrators listen to is money so put all your information together and present the reality of the situation in that you cannot successfully manage that number of patients and if someone decides that the care is not enough they could sue. (the medicare hospice benefit is a RIGHT) Also, state your concerns to the director in writing keeping a copy for yourself. This is truly unsafe staffing and even if you send LVN's everyday - you are the casemanager. Read the Medicare Conditions of participation. They are clear about services delivered and if your agency is not upholding those standards, they could lose medicare funding retrospectively which is a large chunk of money. Finally, check with the labor relations board about 24/7 coverage. Are you considered supervisory staff? There are some limitations to what you can and cannot be responsible for. The others are right- there are many other hospice programs so look around. I am currently working for my 3rd one and they are ALL different.

[Hospice Nurse LPN]

Why are you allowing this? Here our service area is 50 miles---a 200 mile round trip---that's 3 1/2 to 4 hours! Why aren't the LPN's being used? I'm an LPN and do routine visits and take about 75% of the call. I like to do the pre-admit paper work (legals) so that I get a chance to meet the family before they are actually admitted. That leaves my RN free for sup visits and admits. We just hired another nurse (RN, I think) for a PRN position.

[CHATSDALE]

the more patients under care *** getting by with the least amount of staff
the better the proft

utilize cnas and lpns the best that can be done,,is there someone of the staff[lpn/cna] who live closed to most seriously ill pt that can do followup visits
but these are stopgap measures the real need is at least one more regular rn plus any prn/pt this is necessary for you to give good beneficial care to those who really need you now