part time Rn casemanager, full caseload and Lvns in office - page 2

by americanTrain

Scenario 1: hospice nurse part time working 3 days a week. Should it be ok for the manager to make that nurse take a full caseload? Caseload of 13. Rn visits twice a week on each pt. Rn is to do both visits. Thats 26 visits in... Read More


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    While I hate changing jobs, Iam in the process of looking for another job. 8 out of 10 days
    I feel like Michael Douglas in "Falling down" the movie. Just get out of the car and start walking,
    do not look back. Anyone who has seen this movie knows the feeing I'm talking about.
    After a night out with the girls last night and a little advice from them, I know Iam truly burned
    out. At this point I might even consider changing careers, because in the last 8-9 years, I have
    realized that I have never been unhappier with my career, than before I started nursing.
    I thought hospice would be the answer, because it was what I always wanted to do.
    Now, feels more like the med surg floor from an automobile.
  2. 0
    American Train: I swear we must work in the same office. I am serious. Unfortunately, I do not feel safe indicating where I work. I, too, am looking for a new job. The director of the company I work for is definitely more interested in the bottom line (and padding her salary) than in patient care, although she puts on a good show when she needs to do so.
    We have one LVN who is very willing to see patients, another who is definitely NOT willing to do so (unless specifically told to do so by the PCC). We also have caseloads of 16+ (which might not be a lot for some people, but literally ALL of the nurses in my office are about a week or more behind with documentation, even when putting in the extra hours) and are expected to take call and do admissions. I always work at least 50+ hours per week (usually more) salary. I and the nurses in my office have stated multiple times that we are overwhelmed and that we need to have more manageable caseloads, but when this concern is addressed, the director mentions the census - basically, the caseloads have to get high enough (too high) that it warrants hiring a new RN, and then the caseloads drop to a manageable level for awhile - and then the cycle begins again.
    It is very sad to me as I truly love hospice and my patients and families (and most of the nurses with whom I work). It just feels as if I am being sucked dry.
    Nursing (especially hospice nursing) IS a "calling", but for me, being a wife and mother is also a calling - and for me personally, it is a higher calling than any career. I just don't feel I have the time and energy to give to my family with this job (and my family confirms this).
    Hopefully, I will be able to find a position at an agency that has more ethics than the one where I currently work - I will, however, have to be very careful when I apply, as every agency is going to claim to be ethical and "patient centered" whether they are or not. American Train, I hope you have had good luck - please wish me the same!
  3. 0
    you are being sucked dry and you need to move on...in preservation of self. Not all hospices treat their staff in the manner you have experienced.

    I too have experienced the type of management practices you have described here...these are not places where you want to stay for any period of time because it is clear that the field nurses are not valued by the company. You MUST seek other employment if you want to remain emotionally healthy in hospice...IMHO.
  4. 0
    Thanks Tewdles! I'm working on it. My plan is to try to get a PRN position at another agency and "feel it out" before I jump in with both feet.
  5. 0
    OUr census is just at 60. 5 fulltime Rn case managers. I'm the weekend call nurse, and the dayshift nurses take turns backing me up 8-5 sat & sunday. Mgt is in the process for interviewing for a m-th 5p-8a call nurse because the dayshift nurses were taking turns covering that and it had about burned them all out. Some days are better than others for the dayshift nurses and I know what you mean by "falling down" reference....some of the girls will call me and just cry because they are so exhausted......We are praying things will cool down once we get another nurse on board so dayshift nurses can really be "off the clock" during the evenings.
  6. 0
    Ah, maybe I should move to Atlanta! Sounds like you have good management that wants to be sure their staff is able to provide QUALITY care to the patients. I think 12 patients is PLENTY for a fulltime case manager - as I said, we are at 15-16, at times more. I had a patient die at 10:30pm one night and immediately the next AM I was asked to admit (that day, of course, in addition to seeing my regular patients) a patient and add them to my caseload. I also think it is WONDERFUL that your agency is trying to staff on call separate from the regular staff nurses. It is just too, too much to work a full day, then take call and possibly get only a few hours of sleep, and then be expected to work a full day again. We have a couple of nurses (literally, 2) on a staff of 7 who WANT to take call all the time (for the money). I have seen these same nurses falsify visits, vital signs, etc. and also "pad" the amount of time their visits last when they are on-call and getting an hourly wage. These 2 nurses support management's decision not to hire on-call staff, as they feel their opportunity to make extra cash will be jeopardized. The thing is, the 5 of us that are left are then required to take call as well (despite the fact that we have families etc., and that we would like management to hire on-call staff). The sad thing is, one of our best nurses just put in her resignation because she was tired of working 60 hours a week and still being behind. I know of one more that will be leaving next month, and two more that are actively looking (me included). I hope this mass exodus will be a "wake up call" to management, but I'm not holding my breath. I guess I am a nursing "snob" of sorts - I don't think a business person should be the director of a hospice - I think a NURSE with good management skills should be the director of a hospice. I don't care how long one works in healthcare and around nurses, if you have been and are an administrator and have never been a nurse, you don't know what it is like to BE a nurse. Period. And if you are in charge of a bunch of nurses and you choose not to listen to them because you don't like what they have to say (because it will cut into profits and possibly your commission and company car if you do what they ask), then you are not a very good administrator. JMHO.
    Thanks for letting me "vent"!
  7. 2
    Quote from americanTrain
    I was told that unless I had 7-8 visits a day, I shouldn't ask for a back up nurse. The lVN gets mad everytime
    you ask for them to see pts. LVN wants to stay in the office, looking at facebook, searching internet and downloading pics and music, etc. The other day, she told me that she couldnt see pts, because she was going shopping for a new....../ Now the manager knows this and she is tolerating it. What kind of brown nosing is going on here? All of our Rns are angry about this, whick makes for poor morale in our office. We our tired and overworked. We are planning on getting together for a meeting where this will all be brought out in the open. Even if it means losing my job, I will not take this anymore. Miss nice guy has just gotten to the boiling point.

    And get this, Iam working over 34 hrs a week (this is not part time) and I dont get paid fultime benefits like everyone else. I get the feeling that they are trying to push me hard to make me leave.

    Are you in my office? Things have gotten so out of control where we are. Our call has increased to the point that I am breaking and have accepted a new job at another Hospice and will give my notice next week. I do not want to take call three times weekly and every other weekend and work 50 hours a week. I too have a life which needed my attention, children that need my attention, laundry that really needs my attention. I think written notice is proper protocol. But I have to tell you I have twinges of guilt because I will be the fourth nurse to leave this month.

    I also hate the term field nurse, I am a professional and behave in a manner that is professional but we too have that facebook, shopping, and goofing off problem within the office. It just makes my job harder when I order meds or DME from a remote location and it isn't ordered or sent out.

    Patients should be the priority not facebook updates!
    mylittlelulu and tewdles like this.
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    To the original poster--

    Scenario #1-the only way I could do 26 visits in 3 days would be if 9 patients were at the same nursing home (then 9 visits a day at one location).

    Scenario #2- Id rather supervise an lvn in the field, do a supervisory visit every other week, and order my own meds.
  9. 0
    Yep, you are right. And mine were all in homes, with only 5 in nursing homes. I was driving 250 miles a day, not included commute to work and back. Well, I finally left hospice and now for the last 8 weeks, have been the director of nursing for a home just 2 blocks from were I used to work. No more driving. Sure makes a difference. I love it.


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