We have a ten bed unit staffed with ONE RN and one HHA for up to seven pt's...if we have more pt's (8-10), we are given an additional LPN. USUALLY agency, usually hasn't been there prior, and legally, cannot perform admissions, obviously.
Interestingly, if our pt's are general inpatients (higher acuity) those #'s stand. If the seven are a mix of routine homecare inpatients and general inpatients, NO EXTRA LPN.
Our computerized charting takes an average of 45"/pt if one is very rapid (both rapid at answering assmt questions and typing; which thankfully, I am!), and a total admission takes no less than three hours to complete under the PERFECT CIRCUMSTANCES. Thus, on an average day, with say five pt's, and an admission, that adds up to around eight hours charting (plus much more if many new orders are received, if there are any incidents whatsoever, and so on...)
There is no unit clerk, no one to answer the phones on days, which ring approx every 5-10". Sometimes we have to break our pt care into three minute time segments. It is a tremendous, almost impossible challenge to ensure pt's receive optimal care, families receive optimal comfort, and other, ancillary staff (MD/SW/chaplain/managers, etc...) receive the necessary info to do their jobs.
All I can say is you get darn awesome at prioritizing and time management or you don't last long. Of course, no one has but one 3" bathroom break, you eat while moving, and you are lucky to drink water over 12 hours. I come home so exhausted that I'm lucky to take off my clothes before falling into bed after a thirteen hour day (am/pm report included) & family knows better than to talk to me after work.
I adore hospice...the way it was ten years ago. I still adore the pt's and the idea of giving the care I'd hope I'm giving...but its easy to wonder whether that is possible anymore. Hope whomever is getting wealthy (corporate biggies) due to keeping our staffing #'s so low is REALLY ENJOYING the money they're getting, because dying people & their families are getting shortchanged no matter how you choose to look at it!
Still, I do my very, very best wherever I can and pray it makes a difference. My patients tell me they are thankful for me...I always wish I could tell them "ooh, you'd be so much happier if I was able to give you the care I WANT to give you!"... :0(