At our company we have a policy that all patients must be seen by a nurse no less that 2 days
per week if stable. I feel this is unreasonable since as an RN I usually do both visits.
Shouldnt an RN only have to visit pt once every 2 weeks. We only have 1 LVN:3RNs.
Im told not to use LVN for visits unless I have more than 5 visits per day. I carrry the
biggest caseload. I have to save the LVN for extra visits or continued care.
This is very difficult even with the most stable pt. Caseload of 10, and only allowed to
work 32 hrs (4days) Budget cuts. Thats 20 visits per week in just 4 days. With not enough time
for anything else. I never have a good day anymore, its almost always hectic since these changes.
I have to do my careplans on the weekend on my time off ( usually 5-6 hours to complete).
I tried to ease my workload by placing 3 of my most stable pts
to once a week and got reprimanded severly. Anyone think this is unreasonable?
Can anyone share visit frequency and requirments of other hospices.
jenkayaker...don't feel guilty about visiting the stable clients only weekly. That is part of the job. Those are the visits that allow you to complete a great deal of education...leading to families that are more likely to be well adjusted and confident in the last days. Sometimes when nurses come into hospice they are accustomed to families and patients being very dependent upon them for their every need...that is afterall how we see people in the hospital. My general plan for visits is this...when a person first comes on service I tentatively plan for visits 2-3/wk for the first week, maybe two. I plan to taper as quickly as possible to once weekly assuming that the patient is truly stable with all symptoms adequately managed. Any evidence of decline in the patient may result in an immediate increase in RN visits. In essence, I make the front and the end of the hospice experience nursing heavy...the middle is for the patient and the family...I WANT them to go, be, do...without worrying about appointments with me. There are always families for whom this model will not work, but in my experience they are NOT the norm. In a typical case load of 12-20 patients it is pretty common to have approx 1/3 of those patients who are transitioning and perhaps 1/3 who are pretty stable. The other 1/3 is shared by those who are actively dying, having some sort of a symptom crisis, or a caregiver issue requiring your oversight. The ability to organize your schedule along the lines of who needs to be seen based upon clinical judgement and CoPS rather than a corporate mandate is essential to providing the responsive, excellent hospice care that these people deserve. Using paper documentation slows you down...too bad your agency is stuck in the 20th century. You need to make sure that you use the mobile office tools available to you to improve your organization. Make sure that you keep frequently used forms with you AND in your car. If you spend a great deal of time in particular facilities, talk to the management and determine if you can keep things there that will improve your ability to meet the needs of your patients. Paper IDGs are a real bother but a necessary evil. If you don't have a notebook or some such method to keep ongoing notes for your patients give it a try. It may help you to organize your thoughts for IDG prep. I used a spiral steno pad. During my visits I would jot down notes that I thought might be pertinent to the IDG presentation, because they were organized by dates and time it was pretty easy to complete a quick review of the past several visits. Paper documentation doesn't allow you to review previous notes, so the notebook can help to jog your memory about a symptom or issue that you may want to follow-up on. Ask your aides to give you a call the day before IDG to report on any issues that they are seeing. Make sure that if the paper forms are not meeting your needs that you discuss this with management. I am sure that there are improvements that could be recommended by the nursing professionals on your team. Sometimes simple changes can improve your quality of "work life" significantly. Good luck!
Last edit by tewdles on Aug 23, '09
: Reason: typo