NEW Hospice RN Case Manager Question!!

ErinS, BSN, RN · Sep 15, 2011

It is important that the facilities you work with understand your expectations. When we first go into a facility we have an IDT with our whole staff and the facility DON. We lay out our expectations for care, for their help in our care, and what we will do if we have a problem with this. Your pt's are your responsibility, even if they are in a facility. One of the quickest ways to ensure the care is top notch is to diplomatically discuss that you will move pt's to facilities that are more friendly and easy to work with if you do not see the care you expect. This often gets the attention of management, and can get the ball rolling on getting problems fixed.

GGT1 · Sep 15, 2011

I'm not a case manager, but I work on-call hospice occasionally. If I don't find that the staff are helpful, I just do it myself. I know that is not ideal, but it is MY reality. I know that our case managers eventually get to know the staff that work at the facilities and help them in order to get help with their own patients. Also, if you can get your Nurses aid to come to the facility on the same day and at the same time that could help both of you out big time. I love when I get to a facility and one of our CNA's are there...I help them get the pt clean and dressed and they can in turn help me change dressings and really assess the pt.

Just one more note... I also work in a hospital with a Hospice unit and when the hospice nurse comes it can be frustrating because they want me to drop everything I'm doing to help them with their assessment, new orders, etc....but guess what, I've already done MY assessment, meds, etc.

Good Luck!

bugmom · Sep 15, 2011

I agree, if you can meet your CNA at the same time this is best. Because if the nurses or CNA's of the facility are not helping you...guess what, they aren't helping your CNA either. I use a lot of team work for my facilities because these nurses and CNA's are not on my schedule. I also make it a point to be friend the staff, help them when you see something you can do. Paying it forward sometimes helps!

Hospice Nurse LPN, BSN, RN · Sep 15, 2011

I'm really blessed that 95% of the staff in the LTC where we have pts are great. Both myself and the CNA are friendly and helpful to all the staff. We don't expect them to stop what they are doing to help us. We are visitors in the facility. I carry company ink pens and sticky notes in my bag and pass them out on a regular basis to nurses, CNA's. SW, DON, or whomever I see in the halls. Our marketer takes goodies to the staff about once/month.

When one of the staff helps me w/ a pt (turning, etc) I make a point of thanking them and mentioning to the nurse how helpful Suzie, CNA is. It's all about team work. Good luck!

CoffeeRTC, BSN, RN · Sep 15, 2011

wow..that stinks that they are so bad.

Speak with the DON about this, but they probably already know that they have a problem with staff.

Do you give them a schedule for when you will be in? That way they might be able to free up help for you, but for the most part...if we are expected to turn, reposition on our own they might expect you....still...I ask for help.

ShimmaShimma0304 · Sep 15, 2011

Well, it's going to be my route but I haven't actually been going routinely just yet. I just started a week 1/2 ago. I am going to try to develop a great relationship with them.

leslie :-D · Sep 15, 2011

i'd even consider meeting w/the unit mgr, charge nurse, and adon (if applicable), tactfully asking them that you've heard of their less-than-desirable reputation...

and do they have any idea as to why people are saying this?

this scheduled meeting would ideally take place before planning routine visits.

hopefully it'd give the mgrs pause, something to think about.

esp if the adon/don is present...they'd really take it to heart.

i would also consider erins suggestion, about convening at idt meeting.

much luck, marie.

leslie

ShimmaShimma0304 · Sep 16, 2011

After almost 2 weeks there, I STRONGLY considered quitting today. So sad!!!! The freaking wound care nurse came in the room and yelled at my ADON (who is training me) for taking some dressings off my patients arms-- to assess the skin tears that he recently acquired-- So she had to go speak with the administrator. Before THAT, I asked the LPN to count two narcotics with me on my OTHER patient and she SIGHED and ignored my request. REALLY?????!!!!!!!?????!? :0(

ShimmaShimma0304 · Sep 16, 2011

And I'm not exaggerating about the wound care nurse-- she yelled at us and said that we could start changing his dressings EVERY day. *****!?

Hospice Nurse LPN, BSN, RN · Sep 16, 2011

And I'm not exaggerating about the wound care nurse-- she yelled at us and said that we could start changing his dressings EVERY day. *****!?

I try to cordinate w/ the wound care nurse to observe any wounds. If he has already done the wound care, I just ask him what it looks like. Is is healing? I never undress wounds in the LTC. Just my :twocents:

MN-Nurse, ASN, RN · Sep 16, 2011

I try to cordinate w/ the wound care nurse to observe any wounds. If he has already done the wound care, I just ask him what it looks like. Is is healing? I never undress wounds in the LTC. Just my

Sometimes they are hard to catch during a visit. If the dressing doesn't look super fresh, I'd take a peek too. Especially given the horrors of how hospice pts were treated at the LTC my first CNA job was at.

So the pt gets an extra dressing change.