Guidance for a new case manager? - page 2

by MarcyRN

Hello, all. I am to start a new hospice case manager position in a few weeks, and am freaking out a little bit inside. Looking for your thoughts on a bunch of questions...appreciate any help or insights you can lend. 1.... Read More


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    I am also new to Hospice, case management. I have worked in nursing for about 18 years in the ED and the ICU. A little about me I moved back home to a rural area and I have an area that is a small town with rural patients and small hospital, the largest town is 70 miles away. So this is new to me also. I have been shadowing other hospice nurses, out in the field, and in the hospital for those patients I read their charts then go see them, taking their vitals do wound care and whatever else is needed to do.
    Some of my patients have been on hospice to 2 years or more. I attended one meeting this week with a family on the status of the patient and her decline. This was in the hospital setting and with all the entities, (dietary, nursing, activities), I drive every two weeks 40 miles one way to meet with the director of hospice to discuss all of my patients and what is happening with them and any changes we have made in their care. He then signs the papers needed and makes any suggestions that I might not of thought of.
    I also can not talk to anyone outside of the facility while eating lunch because the town is so small everybody know everyone and it is a violation of hippa law. I need to be care and discuss all patients in the office.

    For uniforms I can wear what I want but when I see a patient I need to have a scrub jacket on or a lab coat. So I wear my scrubs for now, maybe later I will change to something nicer.
    I have about 25 patients to see that are in patient and 6-7 outpatient, some I see daily others I see monthly just depending on the needs of the patient and what is going on.
    MarcyRN likes this.
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    I am also a new hospice/case manager, in a small town. Your reply makes me feel alot better about this new endevour. I was a ICU, RN for many years and was getting burnt out fast.
    Thank you
    MarcyRN likes this.
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    I am an rn case manager, home care only, no admissions. Last week was an aberration; I had 18 pts but lots of help from my colleagues. I wear business casual always, and I drive anywhere from 30-60 miles a day for my job with my caseload spread through a metro region. I see 4-5 pts a day. And I have at least 2 hours of charting after I come home. I have very critical and young patients mixed in with a bunch of "long termers"' dementia, debility, CHF.... My usual caseload is around 12.

    It was my first job as a new grad-2 years now. I love it. And I am going to take my certification exam in December.
    tewdles and MarcyRN like this.
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    Thanks for sharing your experiences, everyone.

    I have been at this job for about two months now. And I'm completely on the fence about it. I LOVE the patient and family contact. I mean, seriously, how many people have jobs where they're thanked profusely and basically called an angel every day? LOL. I seriously doubt I could love the patients and families more. Unfortunately, I'm finding patient contact time makes up about 20% of my time. The other 80% is spent charting, charting, charting, phone calling, ordering DME, ordering meds and reconciling them, arranging for respite stays, doing admissions, dishcharges, recerts, etc. (mostly with computer-based stuff)....UGH. I've come to the realization that I don't want to be a case manager. I just want to take care of dying patients and their families. Sigh. I can't stand all the fine details.

    I have to say, the company's been great to work for. They have delivered everything they said they would during the hiring process. I was afraid they'd lie to me about stuff to get me to take the job, but so far, they've been just great -- keeping my caseload on the lower side of the range until I get totally acclimated, etc. I'm just feeling like it's maybe not for me.

    I'm really at a crossroads, here. I need to decide what I'm going to do soon. I have stayed per diem at my hospital (cardiac ICU) in case I didn't like the hospice thing, but I'm barely working there now because I am SO freaking exhausted from this job and charting at home until 8 or 9 at night most nights and working five days a week instead of three 12s... The five day work week is killing me. My hospital won't hold my spot forever. I usually pick up two or three shifts a week as per diem. I've been doing like one a month.

    I don't know how you guys do this job. You are amazing people. Thanks again to everyone for sharing their experiences with me. I just wish I knew what to do.
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    Quote from MarcyRN
    Thanks for sharing your experiences, everyone.

    I have been at this job for about two months now. And I'm completely on the fence about it. I LOVE the patient and family contact. I mean, seriously, how many people have jobs where they're thanked profusely and basically called an angel every day? LOL. I seriously doubt I could love the patients and families more. Unfortunately, I'm finding patient contact time makes up about 20% of my time. The other 80% is spent charting, charting, charting, phone calling, ordering DME, ordering meds and reconciling them, arranging for respite stays, doing admissions, dishcharges, recerts, etc. (mostly with computer-based stuff)....UGH. I've come to the realization that I don't want to be a case manager. I just want to take care of dying patients and their families. Sigh. I can't stand all the fine details.

    I have to say, the company's been great to work for. They have delivered everything they said they would during the hiring process. I was afraid they'd lie to me about stuff to get me to take the job, but so far, they've been just great -- keeping my caseload on the lower side of the range until I get totally acclimated, etc. I'm just feeling like it's maybe not for me.

    I'm really at a crossroads, here. I need to decide what I'm going to do soon. I have stayed per diem at my hospital (cardiac ICU) in case I didn't like the hospice thing, but I'm barely working there now because I am SO freaking exhausted from this job and charting at home until 8 or 9 at night most nights and working five days a week instead of three 12s... The five day work week is killing me. My hospital won't hold my spot forever. I usually pick up two or three shifts a week as per diem. I've been doing like one a month.

    I don't know how you guys do this job. You are amazing people. Thanks again to everyone for sharing their experiences with me. I just wish I knew what to do.
    Out of curiosity, are you using EMR? If so, what software please?.

    I have used several now, and some of them are down right painful to use.
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    May I offer an additional bit of perspective? Having worked at 2 different hospices, i can say that they can be INCREDIBLY different. I've been a RNCM for almost 7 yrs now. I left the original small hospice I started with to work for another MUCH larger national company, thinking the grass was greener on the other side, had a HELL of a rude wake-up call, and was very grateful that I was able to get my original position back. I work a 40 hr week, take about one weekend of call per month, have a caseload of (currently) 11 patients, but sometimes as high as 15, most of whom I see once a week. Granted, the paperwork is obscene, but my visit notes are one page, our IDTs once q 2 wks usually last less than an hour, our Monday morning staff meetings (when we have them) last 15-30 min, and I NEVER take work home (unless I'm on-call). When I am on-call, I generally get very few calls requiring a visit and very few calls in general.

    The other hospice had AT LEAST 5 meetings/wk lasting an hour or more, their visit notes were 4 pages long, I spent HOURS every week just FILING the %$#@* they kept putting in my mailbox, I had one night per week where I was on-call but the dang patients called ALL NIGHT LONG and frequently needed visits (one day I worked 21 1/2 hrs straight), my work week was 55-70+ hrs, at least, and my caseload was 20 or more (an LPN made 2-4 visits/wk to help me out- whooptydo). The other RNCMs and myself were absolutely MISERABLE but the management completely ignored our pleas for help. With all the hours, I was making a lot more money but I was basically living to work, instead of working to live, so I eventually had to call it quits. To say the least, I am very grateful to have gotten my original job back although it is by no means perfect.

    If you like working hospice, maybe you could dip your toes in another pool? Keep your job at the hospital and do some PRN hospice work at the same or a different company? I'm always envious of the PRN nurses- they get to do the visits without all the paperwork! Realistically though, whatever job you work will have its pros and cons, the trick is to find the ones you can live with. It can be a very rude awakening to put a lot of energy into persuing something you later find is not up your alley at all. BUT you should be cautious about giving up your dream without checking out your other options either. If you only want to work directly with patients, maybe a private nursing job would be better for you? (although there is probably a ton of paperwork with that too- Oi!) Good luck with whatever you choose!
    Last edit by softrbreeze on Nov 22, '12
    tewdles likes this.
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    Quote from tewdles

    Out of curiosity, are you using EMR? If so, what software please?.

    I have used several now, and some of them are down right painful to use.
    We use allscripts and as it was not designed for hospice use, we are getting a huge revamping of it. I haven't seen my boss for weeks because she is locked in with the software developers redoing it. I would say that it is the reason why I spend so much time after hours documenting. I do chart at bedside, I always have a narrative note going and I do vitals and scales right into the database assessment. But then I have all these stupid circles to check and repetitive crap and it's maddening. Can't wait to see the new version but I'm not optimistic.
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    Unfortunately, many if not most hospices use EMRs that were not designed for hospice but for home care and have been "tweaked" to accommodate hospice.

    When I grow up I want to design hospice software...


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