Frustrated with Case management

[GundeRN]

So my plan was to stay per diem until I had worked a full 2 years in med surg before going into case management. I wanted a clear understanding of the job before going full time. But they needed a case manager sooner so I jumped and now I am regretting it. I love my job, I love this kind of nursing, but I am going crazy over the chronic low staffing. I try to schedule my patients to give me a few light days a week to get my paperwork in a row but when the office sees my light days they just pile on visits from other case managers who didn't show up to work or are at hours and I NEVER have time to get things organized. By the time IDT meetings come up I am scrambling to get everything done and the stress is ruining me! Every week I think it will pass, but every week it is the same thing. I NEVER just see my own patients. Someone is always gone.

Our office carries about 50 patients give or take, and we have three case managers with two per diem nurses. I think we would be able to carry the load IF everyone came to work but I am starting to think that isn't every going to happen. I have only been carrying a case load since November and I am thinking of going back to per diem already.

I guess my question is, is it like this everywhere? I am broken hearted that my desire to be a hospice nurse my not be feasible.

[TammyG]

We usually get a PRN nurse in to handle the case loads of the people that are out sick or on vacation or whatever, though sometimes that doesn't work out due to budgets, availability, etc.

[softrbreeze]

What is the number of required visits per week for each case manager? What is your case load? This may just be a case where the company has devised some ridiculous requirements and is making everyone miserable with their expectations. I used to work for a company like that- worst 6 months of my career (that was the longest I could put up with it). A change of scenery may be all that you need. There are several hospices in my area that have high employee turn-over because of company rules. "Tucking a patient in" when they come home from the hospital even if it's late in the evening (wouldn't a phone call suffice?), 20 or more visits a week (needed or not), etc. With the amount of documentation that is expected these days, the number of expected visits can be unreasonable. It seems to me that it is usually the larger nation-wide hospice companies that have these requirements, but I could be wrong. I personally would not give up my 40 hours/wk or less job even for more money. What's more money if you don't have life???

[goldberryRN]

I've taken a sabbatical of sorts from hospice, but when I was working we had a CM or two who really knew how to " work it" and dawdle with certain tasks to get themselves up in hours. No one was allowed to go overtime so they would have to be given a partial or even full day off which typically was Friday. And so as you are experiencing, other nurses would have to see their patients. Certain nurses seemed to get away with it. It wasn't fair and morale was low.

[toomuchbaloney]

The agency is content to pay you overtime?

You are content working the number of hours that are making you crazy?

In a per diem status you have considerable control over the number of days you commit to the employer, yes?

Make certain that you are completing your documentation before you end a visit.

[GundeRN]

Last day today. I am not leaving hospice nursing but I am definitely done with case management. I think I will just do the per diem and casual at the hospital for a while until I figure out what kind of nurse I am. There has to be somewhere I fit.

[areensee]

Sounds like the problem isn't with your nursing skills, but rather with a hospice agency that has serious issues. Find yourself another employer. You deserve to be treated with the respect due a professional. There are good agencies and bad agencies.