I don't know about a specific acuity tool, however I can describe my day and why I am working at least 50-60 hours every week?
First, I love my hospice job, I am an rn case manager, in a growing office. We have had difficulty finding and keeping dedicated people, because, well, it's hospice and a very stressful job. It's not for everyone. My immediate boss is the rock we all stand on. She is so stressed, as she is trying to make sure our people all get taken care of, and take care of a growing staff, which currently is short by a 1/2 dozen people. Not easy.
That being said, my caseload varies between 16-20 people, plus recerts (I may see other case managers patients to do recertification visits, we split those evenly.) Our standard is to see everyone twice a week, and we do our own admissions, although we have a part time "admission nurse" but she is rarely available to us-and the families need us when they need us...sometimes our patients come in at night, sometimes they come on in the middle of the day and it's not scheduled.
I have been seeing 8 patients a day, plus meetings, family calls, and idt, admits, and recerts. This is not manageable. I say this because we have computers, we are supposed to document at bedside with, and there is about 8-10 forms for each patient plus a narrative note to be filled in on the computer for every patient, and it takes upwards of 10-40 minutes just to do that and put your md orders into computer, medication reconciliation, etc.
Also, when there is a patient doing poorly, well scratch everything I just said, and I am with the patient and family and md all day, coordinating social worker, chaplain, volunteer, and hospice aid support around me. I am not a one man team, and our team works awesome together.
So, I have patients in three locations, about 31 miles and 6 miles from each other. So let's do the math. I spend an hour plus on the road, so that knocks my "working" time to 7 hours. Then I spend at least another hour on the phone ordering equipment, giving/getting report, and organizing myself for the day. 6 hours. Spend another 1/2 to an hour on the phone with family members who need updates, and you are at 5 hours. Now I have a facility meeting today, which can run another 1.5 hours. I'm left with 3.5 hours. Now, providing I don't have a very sick patient, (which with 18+ patients is very unusual), and I don't get an admission, and the facility nurses don't collaborate with me, and I don't have last weeks or yesturday's work to catch up on, I go see my patients. The vital signs, reading the chart, and documenting takes up the better part of 45 minutes. That leaves 2.75 hours for 7 more patients.
Maybe I can see four more, then I am in overtime. And half of them by that time will have family visiting them, which means I'll be hugging family and talking to them about their nana's illness, which means maybe I'll see two.
So I am ending my day, leaving two or more patients unseen, and it's 7 pm. Now I have to go and print all my documentation and fill the charts, and make sure my care plans
are up to date based on the collaboration with staff, mds, and families and patients that went on during the day. These people are sick, their acuity and their needs change in the blink of an eye.
So most of the nurses in my office, they use their "day off" to do their work, if you scheduled some kind of family function or had your kids basketball game, well, 7 out of 10 times you are not going to be there. Sometimes, my boss will call me at 3 pm, and tell me there's an admission at 4, or possibly later. An admission takes 5 to 8 hours to complete.
I love Hospice, but it is truly a broken system. The point of hospice was to be able to have the time to spend with patients and families, to be able to provide comfort care, and to be an extra hand to the nurses caring for these patients. Now we have become a medical model, governed by the same medicare/medicaid laws that have regular nursing overworked and frazzled. It doesn't work. I would like to see whoever makes the budgeting decisions for medicare or for the staffing of the hospice agency try to do any person's job in my office for a week.
Oh, and btw, you get weekends off, unless you decide to take on-call. But people still call you all weekend, your hospice aids who might be on for the weekend, mds, families, and on-call nurses who aren't familiar with your patients. Oh, and btw also, I am a 40 hour salaried nurse. I have never worked just "40" hours since I started. It cannot be done. It cannot be done in 50, sometimes 60. I carry work over from the week before, nearly every week. This week, I have lost four patients. I am still working on last Tuesday's work. Sometimes, it feels you will never catch up.
All the while, I get emails all day long from our auditors telling me I haven't put this one's orders in, or I need to redo this or that, as documentation has to be absolutely perfect or medicare will not pay the bill.
It's a hard, hard job. But when I get to spend the time holding a patient's hand. Hugging and supporting the wife who is falling to pieces losing her husband, and knowing that you did everything you could to make that person's passing a beautiful, peaceful experience surrounded by love, then none of the other stuff matters. I only wish, I could be home when I'm home, and spend more time with my family, as my family life has suffered dramatically, so I cannot see myself in this position for a long time. My office seems to have a major turnover, nobody stays for long term, we only have one nurse who has been there for a long time, out of 7.
Hospice needs to be looked at, it is only getting worse, the level of work vs the ability to do it, it is humanly impossible, even on my best week. Good luck to all who get into this business, and I hope the wind is always at your back, and your caseload never exceeds 12.