How many pts do you care for? - page 2

Hi everyone... I have been a hospice nurse for eight months now and my caseload just keeps rising and rising. I currently have 16 patients. All of my pts are hospice, my agency does not do home... Read More

  1. by   FrankieJane
    Just a little update: Since my last post, one full-time nurse from our team quit. I got so frustrated that I did go on a couple of job interviews. I checked out other hospice's in my area...and although their pt loads are smaller, they were not a good fit for me. It does look like things may improve at my facility. The manager just hired two new workers and our census did drop. I hope the new employees are easy to work with and I hope they stick it out. As we all know, hospice is not for everyone and the turn-over is high. My load is between 11-13 now. The manager says he'll do his best to keep the pt load at 13 or less once the newbies get up and running.
  2. by   nightingale
    Thanks for the update FrankieJean; It sounds like you are redirecting your energy and able to hang in there a bit longer. I hope it continues to improve for you and/ or you find other more satisfying work.

    I decided NOT to interview for Hospice; the number of pt responsibility are unreasonable AND "they" are okay with that caseload (13 to 17)... no thank you on this end.

    Thanks for this thread as it helped me make my decison along with the networking I did with my current contacts.

    ((((((((Nurses)))))))))
  3. by   jerseyRN
    I work four days a week and have a current caseload of 22. I have an LPN who also makes visits to my patients but there's no way I can see everyone at least once in every given week. As for documentation, I'm doing it in the evenings or on weekends- no time during the week. Throw in on-call, and ... you get tired. I would rather have fewer patients and be able to make the visits myself.
  4. by   Liddle Noodnik
    This is an old thread but I inquired about a position in my area (was just curious). Didn't know if it was FT or PT but I guess I have an idea NOW, based on the job description I asked for and received. YOWSA!



    Our RN Case Manager Manages a patient and family
    caseload up to 16 cases, which includes
    assessing, planning, implementing, evaluating, and
    documenting the care provided.
    Plans, coordinates, and delivers nursing care to
    patients and families.
    Supervises and documents LPN and home health
    aide/homemaker plans of care and documents
    supervisory visits.
    Participates in on-call coverage.
    Attends deaths of patients to assist and support
    the family.
    Submits paperwork in a timely manner.
    Updates and maintains patient hospice medical
    records.
    Participates in regularly scheduled hospice
    interdisciplinary team meetings to coordinate the care
    of the patient and family, exchange information
    and problem solve, and receive staff support and
    education.
    Participates in hospice programs providing
    orientation, training, and in-service.
    Applies the policies and procedures of the
    hospice and the rules and regulations of Federal and
    State regulatory agencies and other certifying
    agencies in providing hospice care.
    Coordinates and develops patient/family plan of
    care and ensures the care plan is current,
    up-to-date, and reviewed at every team meeting.
    Assesses and evaluates patients’ level of care,
    needs, and requirements.
    Participates in community programs as requested.
    Accepts other assignments deemed appropriate.
    Participates in agency quality improvement
    programs.
  5. by   req_read
    From the HPNA website:

    http://www.hpna.org/DisplayPage.aspx...al%20Practicum

    Under: Standards For Clinical Practice

    3. Program has sufficient case load (clinical volume) and diversity of clinical settings and patient population (age, diagnosis, culture, economic status) to meet program and participant's goals, and competencies established by HPNA.

    So you can see that one of your professional organizations has summoned up the courage to take a vague stand on your behalf. Yippee Ki Yay!

    What it always boils down to for nurses is: they have the power to get what they want and always have had... but almost never use it.

    You can say whatever you want but it is what you do that matters. Talk is cheap. You can commiserate, sympathize and play "ain't-it-awful" till the cows come home, but as long as you do nothing, nothing will change.

    You could, for example, call a meeting of the nurses at your agency and decide among yourselves what case load you will accept... and no more. Then all of you say that to your manager(s); i.e. I will take 13 and no more... period. If management fires all of you they will no longer be in business... no longer be making money (which is why businesses are in business in the first place.) How management makes that happen (no more than 13 for example) is their problem. It is management's job to manage, not yours. Your job is nursing, theirs is to manage. If they can't do their job that's their problem, not yours.

    There is a simple, basic fact on one side of the nursing ledger; i.e. they possess tremendous power. On the other side of that same ledger nurses have ten thousand excuses why they won't use it. Instead, they whine and practice self-neglect... sometimes woeful self-neglect.

    The caring mind-set has its up and its down side. It is at once a nurse's greatest attribute and most serious flaw.
  6. by   wonderbee
    I'm being offered a position doing a mix of hospice and palliative care with hospice being the greatest number. The case load of 12 to 17 and expected to make 4 patient visits per day. I would take call one weekend out of every month. The palliative care patients are on vents and gtts. I don't understand how I manage gtts if I'm not there to titrate. Should I steer clear of this offer? The territory is my own neighborhood which is a big selling point. Do any of you handle a mix? It sounds like a lot of hat changing and then there's the OASIS paperwork.
  7. by   req_read
    In real estate they say it is either a seller's or a buyer's market. In that sense, this is now a nurse's market. Take advantage of it.

    When you speak to management do so with a bit of an attitude. I once saw a bumper sticker that said, "An attitude is a terrible thing to waste." You should not be asking management how many patients they are going to give you, you should be telling management how many patients you will accept.

    If management knew that if they took on too many patients there would be no nurse to take them, or if they knew they would have to refer patients to another agency if one of their nurses quit, they would find ways to recruit and keep nurses... because they would know that if they did not they would lose money.

    The way it works now is, when management messes up they know the nurses will bail them out. So not only do they not loose money they actually make more (every nurse works harder.) You are literally training your managers to abuse you.

    And don't give me that line about how concerned you are for your patients. You all know perfectly well that when your case load is swamped you are not providing good care. When you allow yourself to be abused you are shorting your patients as well.

    Your managers need you more than you need them. Standing tall means acting like the valuable asset you are and not taking any guff from anyone. You are professionals for crying out loud.
  8. by   AtlantaRN
    I had 3 patients, now I have 5 as one of our nurses are out with her own medical condition.

    I worked 6.25 hours yesterday, I saw 4 patients. I'm seeing 3 patients tomorrow, two are mine, and one is another nurse... I get about 16-20 hours a week. Also I work at a hospital 6/12h shifts a month. I was on call jan 1-15...

    The good thing is my patients are in the suburbs south of atlanta. Also, I have a royal navigator gps (hubby got online for $190...once you plug the patients address in, you just click the name and the gps tells you where to go, also figures out the mileage).

    Do you HAVE to take all patients that they offer you? One of our nurses also works a hospital prn position and she has 2 small kids at home, she just says "no."

    Also, I have learned to not do "it all." I have social worker do the advanced directives stuff, and dnr stuff, and most of the psychosocial stuff. I do what I can while i am at the patients home. I've been doing hospice for 1.5 months and i've found when initial care is started, they require most of the education and reinforcement...my visits were taking 1.5-2.5 hours, with pt and family education, documentation, and hospice pharmacia stuff....NOW, much better, visits are 1/4 to 3/4 hour....I'm doing education while doing my physical assessment...it just depends on the patient and their condition...some of my folks are getting stronger and putting on weight!!! I try to cluster as much as I can while I am at the home. Writing narrative while we are conversing. Im always reminding to call hospice for anything, questions or concerns...I always give 3 additional sheets that have the hospice phone numbers on it...one for frig, one next to bed, one next to chair where they watch tv, etc... Clustering is the key.

    the first couple of weeks, i just wanted to scream....but this week has been wonderful.

    hang in there! It's ok to say "no, i'm at my limit..."

    linda
  9. by   req_read
    Not only is it okay to say "No," it is required if you intend to stay sane.

    Also, consider this...

    Among the general population there is a certain percentage of workaholics. In nursing, because of all the pressure to work longer and harder, many nurses just quit... go on to something else (hence, we have a nursing shortage... not because there aren't enough nurses, but because so many of them have simply quite.) Those remaining in nursing are, more and more, the workaholics in the group. They are the ones who boast of how many hours they put in... just like a group of alcoholics will boast of how many shots & beers they had last night, but still managed to drive home. It's the same disease, but with a different drug of choice. The workaholics are the ones your managers point to and say, "See, Suzie works 18 hours a day and loves it. What's the matter with you?" In a strange sort of way, it is the sick ones who are becoming the standard by which the rest are measured.

    Abused children almost never run away... and most of them think that the abuse they receive is their own fault. Many nurses refuse to leave abusive employers and wonder aloud whether the feelings they have of being overwhelmed are their own fault. An awful lot of nurses act like abused children... instead of acting like confident, competent, professional adults.

    Workaholism is an addiction... a disease. It is progressive and debilitating. Unfortunately, those who are afflicted with it are often looked up to, admired and even envied.

    John Bradshaw said that studies have shown the children of workaholics have a tougher time than the children of alcoholics.

    Nurses are professionals with valuable skills and knowledge. Act like it... and expect to be treated accordingly.
  10. by   JailHouseTeer
    I work in a medium security prison I just wish we had 16 patients a day. Its a tiny city with MD call 3-4 times a week not to mention chrinic care clinic, sick call, lab draw, little emergencies during the day, pill call and on most days there are only 2 of us to cover it all we are lucky if we have 3 of us here. Oh we have up to 450 inmates at our unit
  11. by   Liddle Noodnik
    Quote from AtlantaRN
    Also, I have learned to not do "it all." I have social worker do the advanced directives stuff, and dnr stuff, and most of the psychosocial stuff. I do what I can while i am at the patients home. I've been doing hospice for 1.5 months and i've found when initial care is started, they require most of the education and reinforcement...my visits were taking 1.5-2.5 hours, with pt and family education, documentation, and hospice pharmacia stuff....NOW, much better, visits are 1/4 to 3/4 hour....I'm doing education while doing my physical assessment...it just depends on the patient and their condition...some of my folks are getting stronger and putting on weight!!! I try to cluster as much as I can while I am at the home. Writing narrative while we are conversing. Im always reminding to call hospice for anything, questions or concerns...I always give 3 additional sheets that have the hospice phone numbers on it...one for frig, one next to bed, one next to chair where they watch tv, etc... Clustering is the key.
    Linda that's GREAT! I am surprised at the 3-5 patients (compared to "up to 16", is that based on the number of hours you're scheduled?) anyway - sounds like you have found your "rhythm".
  12. by   Liddle Noodnik
    Quote from req_read
    Those remaining in nursing are, more and more, the workaholics in the group. They are the ones who boast of how many hours they put in... just like a group of alcoholics will boast of how many shots & beers they had last night, but still managed to drive home. It's the same disease, but with a different drug of choice.
    The work isn't the only drug involved, the money is also. It's one reason I kept hanging in, or going back, to nursing. The nurses who are burnt say "Who can survive on x amount of $ per hour?" Well, I've found out that I can, and my quality of life is far better!

    I know of nurses who brag of how many hours they work, the OT they get, the "deals" they make with the managers since they will do what others will not (ie, getting double time for doing two doubles on the weekend on top of their regular schedule - ridiculous). I know one nurse who is ALWAYS smiling about that - and about her house, car, jacuzzi, etc etc. She definitely brags about it. Don't know how she survives - she can't have time to SLEEP! But -she seems genuinely happy, and has been doing it for 15 years (shrug).
  13. by   Liddle Noodnik
    Quote from JailHouseTeer
    I work in a medium security prison I just wish we had 16 patients a day. Its a tiny city with MD call 3-4 times a week not to mention chrinic care clinic, sick call, lab draw, little emergencies during the day, pill call and on most days there are only 2 of us to cover it all we are lucky if we have 3 of us here. Oh we have up to 450 inmates at our unit
    !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

    There must be separate standards of care for prison health services, is that even LEGAL? oh my ... {{{{{{{{{{{{{JailhouseTeer}}}}}}}} I feel for you!

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