How many pts do you care for?

[FrankieJane]

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 healthcare. We see pts four days a week and do patient care conferences one day per week. We are expected to see pts on meeting day, but since meetings and care planning takes up most of the day...only 1 or 2 pts can be seen that day. I am finding it hard to give these pts what they deserve. I used to see each pt 2-3 times per week, daily if the need was there. Now I see my stable pts once per week and everyone else 2 times per week. It just doesn't seem possible to give the families the emotional support they need when I have to get in and out of a visit within an hour so that I can squeeze in 7 pts in an 8 hour day. I love hospice care, but I am feeling burned out from the load of work. We also have a lot of on-call. I am on-call approximately 5 week days of the month (5p-8a...this is after working 8a-5p) and I am on call for three 12 hr shifts on weekends. Luckily our triage is good and I don't get called out that often...but having to put my own life on hold is getting old.

How many pts do you take care of? How many visits per day do you do? What is the maximum amount of pts that your agency can give you? What is your on-call like? Do you case manage as well as do the visits? Any input would be appreciated. I would like to see how my agency compares with others. I don't know if I am overworked or just not organized enough to keep up.

[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!

[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.

[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.......

[maryalycebell]

Hi Frankie. Your company sounds eerily like the one I work for.... starts with a V????? I have been in the same boat, as we are a "new start..." Every time an RN gets hired, she either quits, or the number of patient load increases to 16 or 17 before they are willing to hire another nurse.

[Liddle Noodnik]

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.......

That sounds GREAT, let me know if you have any openings!

[SCgirl1962]

I work in a rural area and usually my caseload is 8-10 patients. ( which is really good ) I have had as many as 12 and that's okay depending on how far you have to drive between patients and how many visits per week you do. We are on primary call one night per week, secondary call one night per week and weekend back up one weekend per month. Our hospice is not for profit and I think that makes all the difference. In my opinion, For- profit agencies tend to focus less on quality care and more on the bottom dollar.

[2grumpy1]

I have been working for a hospice in CA for the last 6 years. My case load is usually around 18 to 22 patients. We work in teams, one RN and one LVN. Most of our patients are seen twice a week and it fluctuates from there depending on patient and/or family needs. We usually see 5 to 6 patients a day each (RN and LVN) for about an hour long visit. As everyone know these times are ideal but not what always happens. We have 2 full time on call nurses, which greatly decreases the day nurses requirement of on-call duty (This position is very hard to fill, so if one leaves or Lord forbid both, then of course our on-call duty increases-We bend over backwards for our on-call nurses just because of this reason). This has not always been the casewith on-call, when I first started we would do one weeknight, 5p-8a after our 8 to 5 shift, and a whole weekend, Sat 8a to Mon 8a, every 2 months. My agency has grown and evolved as hospices are doing all over the country. I know that the other two hospices in town do things differently. I have seen wonderful changes over the last 6 years. I work for a hospice that listens to their staff and changes are made for everyone, from patient needs to staff needs (which in the end helps the patients). Hopefully with postive input from all areas of staff, the administrators will be up for improvements.

[pjp122954]

Tough business..where do you work?

[Hospice Nurse LPN, BSN, RN]

I currently have 15 patients. Which is between 25 and 27 visits per week. Way to many as far as I'm concerned. Wednesday is my light day when I try to get to the office and call my out of town families and nursing home patient families. But I always feel rushed and then it's on call in the evenings and on weekeds. By the time my off weekend gets here I'm exhausted and just want to sleep.

[tatgirl]

I am thinking of moving to hospice from LTC. Can ya'll tell me what the LPN's do in hospice? I love my LTC job, but since they hired too many new nurses they have cut my hours down (despite the established nurses helping during a staffing crisis by working doubles, and coming in on days off) Any information would be much appreciated!!!!!!!!

Wendy

LPN

[wonderbee, BSN, RN]

Our team is new and still growing. When I was hired on, I took on cases from a very overloaded RN case manager with over 30 patients. She has an LPN and was utilizing two very capable HHAs. I don't know how she did it, even with the help. I've been with the agency for 3 months and am very fortunate to have a case load that has see sawed back and forth from 8 to 11 patients scattered in homes and facilities. Pretty doable and I work with one HHA. Things get a little crazy when I go over 10. It just takes one GIP admission or a quick crumper with anxious family members to put things on the raw side.

We are encouraged to be autonomous and there is very little said about communication with the attendings. Once the facility patients have been referred to hospice care, I think many of them really don't want to be bothered. We do court facilities though and are encouraged to make marketing visits. Like we have time! If we do the right thing and act like true hospice nurses, that should be PR enough.

[RNDYN2CU]

OMG!!! My case load is 17-22, with an LVN and I help with admits and take b/u on call one weekend a month and b/u every monday night and and and...well, I DID get a $3.00/hr raise last year because our RN's were dropping like flies... but for some crazy reason? I love my job 90 percent of the time... Well it was 17 patients for a long stretch of time (like 4 months) and we FINALLY got an admit nurse, but sometimes there are more than 2 admits in a day you know? And when my case load grows we have growing pains, but thats nursing..

All in all, we give quality compassionate care and folks often want us back for another patient, I just feel REAL bad when I become too busy to give them the personal care they called me back for! But thats nursing. so each day I endeavor to tackle it again and so far.... it's still jiving. I love hospice. It's a job I can really make a difference in peoples lives which is why I became a nurse.

THese posts are so theraputic. Phew.