PT/number of visits

toomuchbaloney · Jun 2, 2015

So I'm new to hospice and was just offered a part time position at 20 hours a week with a case load of 8. Is this doable? Just wanted some experienced nurses input please! :)

Are you considered a part time RN case manager? Do you job share with another RN who works on your days off? Are the team meetings considered part of your 20 hours weekly?

Does this mean you are only ever going to be seeing those 8 patients?

RubyS · Jun 3, 2015

I would be considered a case manager, no I do not job share; on the days I am off, the "on call" nurse covers my patients. Team meetings are included but are infrequent I'm told. I'm only going to see those 8 during my 20 hours but also am required to take call 6pm-2am every other week in addition to my 20 hours a week.

toomuchbaloney · Jun 3, 2015

I would be considered a case manager, no I do not job share; on the days I am off, the "on call" nurse covers my patients. Team meetings are included but are infrequent I'm told. I'm only going to see those 8 during my 20 hours but also am required to take call 6pm-2am every other week in addition to my 20 hours a week.

Interdisciplinary team meetings must occur at least every 14 days and the RN Case Manager must be present to discuss the ongoing POC for the patient. That is a requirement for all hospices, a Condition of Participation.

At minimum you should anticipate spending at least 8 hours per week simply engaged with your patients in their environment of care...providing the nursing assessment, teaching, intervention, and documentation (avg 1 hour visit/pt/week unless they are experiencing symptoms requiring intervention). That 20 hours will include any travel time to and from patient homes.

You have to follow up on every patient who has c/o pain after hours that was addressed by the on call team. Ideally, the RN CM follows up next day with ANY patient on his/her team who accessed the oncall staff in the previous 24 hours to make certain that there is an adequate POC in place to meet their needs during the coming nights and days.

Additionally, as the RN Case Manager you will be responsible for updating the POC and generating all documentation needed for the IDT meeting and all follow up that is required AFTER the meeting (there are generally new medical orders, etc for at least some patients). Dependent upon how you are documenting, this pre IDT prep often takes at least 15-30 min/patient dependent upon their physical and emotional status.

So if you work your 8 hours and then start call at 6 pm, what happens if you are out and about the entire 6 lhours of your call shift and then have to work the next day? Are you compensated for your oncall time? Are you paid OT if working more than 8hrs/day or only if more than 40hrs/week?

Hospice is a very rewarding field of nursing.

Take the time to learn about professional boundaries and how they are critical to successful hospice nursing, please. Good luck!

rnin0513 · Jun 10, 2015

We see our patients twice a week, 4 days a week. So a caseload of 8 would equal 4 patients per day. For me, that would be a dream day. Our ratio is 10 but with PRN, sick nurses, etc., I often see 6 per day. That's difficult to do AND get your charting done. To me, 4 is perfect.

toomuchbaloney · Jun 14, 2015

We see our patients twice a week, 4 days a week. So a caseload of 8 would equal 4 patients per day. For me, that would be a dream day. Our ratio is 10 but with PRN, sick nurses, etc., I often see 6 per day. That's difficult to do AND get your charting done. To me, 4 is perfect.

This sounds like a "cookie cutter" approach. In my view hospice nursing visits should be based upon the patient needs and the POC. Many hospice patients, once symptoms are stabilized do quite well with a single RN case manager visit/week. Some do well with a nursing visit by an LPN or non case manager visit one week and a RN CM visit the next (to prep for IDG).