How many pts do you care for? - page 3

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   req_read
    I've know a few happy alcoholics too. Sooner or later though, it comes home to roost.

    jailhouseTeer...

    I am curious... is your institution owned/operated by the government or privately?
  2. by   JailHouseTeer
    it has its good days and its bad! Today was kinda quiet, but I really got tired of my name being called! (giggle) I advised all that I was changing my name and not going to tell them to what! My superviser just grinned. :uhoh21:
  3. by   Liddle Noodnik
    Quote from req_read
    I've know a few happy alcoholics too. Sooner or later though, it comes home to roost.

    jailhouseTeer...

    I am curious... is your institution owned/operated by the government or privately?
    It's true of MANY alcoholics, they are happy for a while ... and then, :trout: , hit with 20 fish at a time ...

    Do you feel/notice that they seem to be younger and younger? Is it because we drink harder than we used to? Maybe it's just more awareness, but those young people (and I was) are pretty sick with it...

    By "your" institution, do you mean mine? I'm not working in nursing right now if that's what you meant - taking a long vacation ...

    edit: sorry - I figured it out that you were talking to JailhouseTeer
  4. by   req_read
    Gosh, I really don't know if alcoholics are younger than they used to be or not.

    But the major thrust of my point is that against the backdrop of a nursing shortage, nurses are more than usually in a position of power. I have seen the pendulum of nursing shortage versus relative nursing abundance swing back & forth over the years. As the farmers say; make hay while the sun shines. Right now the sun is shining on nurses, so make some hay.

    In poker you watch the up cards and calculate mathematically your chances. Then you watch your opponent's body language for tips. Well, right now the numbers are in the nurse's favor, so when you apply for a job or talk to your manager the odds are, s/he is bluffing.

    Say what you will accept, don't ask what they will throw you. That way everyone knows up front what to expect... no game-playing to see how far you can be pushed. Let them know right away what you will tolerate, then stick to it.
  5. by   BeExcellent
    AAhhh. I always feel better about my job when I come back to the hospice forum. I had sustained a high census over the holidays (15-19). That's to be expected in hospice. People are sicker, more depressed and we get more hospice referrals. Stressful Holidays vs winter? We have great disparety in my hospice. Some nurses may have a census of 5 another 19, depends on territory. It is hard to balance case loads and folks get attached. I just had my case load decreased by 6 patients by equalizing case loads. Might sing, might dance. Wanna do lunch and talk about hospices?
  6. by   rnrae
    My patient load just went up to 23 due to a nurse quitting. The office has a census of 48. I am the only fulltime RN, besides the PCC. We have 2 PRN LPNs and one parttime RN. I do love my job, but I'm exhausted and extremely stressed. The administrator says she's actively looking for more nurses, but so far no luck. I realize that hospice is a specialty that's not very popular and it's difficult to find nurses to work in it. However, they had better find someone soon or I'm going to crash and burn!
  7. by   Liddle Noodnik
    Quote from rnrae
    My patient load just went up to 23 due to a nurse quitting. The office has a census of 48. I am the only fulltime RN, besides the PCC. We have 2 PRN LPNs and one parttime RN. I do love my job, but I'm exhausted and extremely stressed. The administrator says she's actively looking for more nurses, but so far no luck. I realize that hospice is a specialty that's not very popular and it's difficult to find nurses to work in it. However, they had better find someone soon or I'm going to crash and burn!
    I take it the admin is not a nurse? Can they get agency nurses, or transfer patients to another company? This isn't cool at all. {{{{{{{rnrae}}}}}
  8. by   amys2
    Hello all,

    Our average pt load is 8-9 pts. We have different shifts, Mon-Fri 8am to 5pm (with one weekend on-call required every month) and a 5pm to 8am that is also on call. I wanted to share a wonderful new concept, we have hired a few different triage nurses that take all of the patient calls from 5pm to midnite. They do everything that they can to solve the problem over the phone. If they can't, then an on call nurse is dispatched to the patient. This has really helped nurses to avoid burn out.
    Just an idea, it has made such a difference in our organization, maybe this can help others to either help implement something like this or search for an organization like mine!!
  9. by   aimeee
    We have triage nurses on weekends. On the weekdays the oncall nurses take turns triaging the calls and going out to handle them. But at all times, the oncall responsibilities are all handled by a dedicated oncall team so the case managers only have to help out with call during the holidays. It not only helps prevent burnout but it also helps with continuity. We made the move to the special on call team a couple years ago and everybody loves it.
  10. by   rnrae
    Our PCC is an RN and she does have some patients of her own. I'd love to have the same arrangement your office has, Aimee. Actually, they're trying to make some changes to improve employee retention and satisfaction. I hope they come up with something soon, before I crash and burn! On Monday I'm having an EGD to see if I have an ulcer.

    Why are RNs so hard to find???
  11. by   yayanurse
    I just left a hospice position because of the unreasonable workload with a census of 23, on call 10-12 days/month, if I was on call w/e it was guaranteed I'd be out 10-12 hrs each day. We were also doing all our admissions, no triage for phone calls, and we covered multiple counties in PA. It was not unusual to drive 300mi+ on weekends.
    We were also told they were trying to hire, but it just seemed to me that were hiring more administration than practicing nurses. I found out that they LAID OFF our on call nurse in March 2006 and were not actively looking for a replacement because the rest of us could pick up call. This company laid off LPN's as our census was exploding.
    I felt used and disrespected by this company. The RN's were salaried so it didn't matter to them if we worked 60,70,80 hrs/wk. We actually made less per hour than the LPN's and some of the CNA's. Also no comp time, and if you were off sick you can be sure they used you vacation time.
    This is the 3rd largest hospice in the US owned by a major nursing home corporation and they posted a very nice profit for the 3rd quarter of 2006. You would think that a corporation that depends on its nurses for it's livihood would treat them better. Instead they spend their money on fancy seminars for administrators, and stupid bright green buttons for employees to wear to advertise their service.
    We need to speak up about these unreasonable workloads. It is not fair for the patient and their love ones to get the kind of minimal care that is provided when the nurse has a heavy caseload. It is not fair to the nurse to have to give up family life for a heavy caseload. I am not talking about the occasional spike in patient census. I put up with an increasing case load for 8 months until I said ENOUGH! There are other hopsices out there that care about the patinets and nurses. I would pursue a position with them. Good Luck!
  12. by   mommazac
    Our agency made the decision last year to incorporate CHHA and Hospice case loads. Unfortunately the productivity expectations remain 5 patients per day. The average case load is 27 patients, of which 2-4 are hospice patients per nurse. Unfortunately, with the shortage of nursing recruiting is difficult. Home care of any sort is hard to staff for a variety of reasons, experience, case management, travel......

    Incorporating CHHA and hospice has cut down the on call shifts of nurses during the week.
    I believe we hospice nurses have to find a happy medium to support the family and allow the family to support each other, we don't have to be the "all" of the patient being home. They can receive "support" from the SW, clergy, HHA and the volunteers. What they need from the nurse is symptom management, and support, but we can share that role.
  13. by   ksb13
    I just started a position with hospice 3 weeks ago. I have done home health for the last 15 years, but had moved and was driving 50 miles one way to the office, and serving 9 counties. This position pays much less (about 25%) but it is for ONE county. The office is ONE block from my house. There are 3 full time RNs, 1 per diem RN, 1 LPN, 1 personal care aide, 1 clerical person and the coordinator. The coordinator and the perdiem nurse do call from Friday until Sunday am. Each nurse takes call one night during the week and one Sunday every 4 weeks. The pt load is about 4 visits a day, occasionally more if things are hectic or someone has to have multiple visits. We do schedule visits with the aide to do together, which has been wonderful for me. She is GREAT and there is no better way to assess skin, etc than when assisting with a bath. I am loving it. Have been told that sometimes it gets really hectic but usually short term. The nurses have a "caseload" but share patients so that every one knows each pt at least minimally. Have the ability to "flex off" with or without pay if things are light and get a minimum of 2 hours call back pay if called out. It has been worth the cut in pay, to have good team mates who are not burnt out or overly stressed, although I know there will be times that census goes up or the week from chaos appears.......

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