Is it me, or is this job too much?

[VivaLasViejas]

I'm an experienced LTC resident care manager with a case load of 40 residents right now, 13 of whom are skilled/rehab patients, another 12 are young adults with drug/ETOH/failed suicide/psychiatric issues, and the rest are long-term ICF residents. I've been putting in 50-60 hour weeks, taking work home, and every time I get even close to catching up I get 2 or 3 admits in one day. On top of this, I'm expected to drive the nutrition-at-risk committee, attend meetings every day (sometimes as many as 3, and some of these last 2 hours or more), help the charge nurse out on the floor, do 1 1/2 hours in the dining rooms once a week, and do complete skin assessments & documentation on everyone with skin issues (that's at least 8 residents right now). THEN, in my spare time, I have to investigate each and every incident report (roughly 20 or more per week with the young adult unit and the 2 or 3 residents who fall every couple of days).

Honestly, if I worked 80 hours a week, I don't think I could do everything this job requires of me. I'm such a perfectionist about getting my paperwork in on time, but I'm so far behind now I don't think I'll ever catch up. State surveyors are expected any day now, and I KNOW things are a mess, but I can't do all of this myself. The administrator and DON keep saying they're going to hire another RCM (there are only 2 of us for 88 residents) and to hang in there, but it hasn't happened yet, and there doesn't seem to be any real motivation to speed up the process. Then, when something ISN'T done, guess who gets the a**-chewing?!

I've never been afraid to work hard, but I feel like I'm drowning. I've been told by several consultants that no RCM should be responsible for more than 30-35 residents, and if you're in charge of the skilled unit, 20 should be the maximum because of the frequency of assessments and other government-required paperwork. So if that's true, I've got twice as many as I should........but nobody in upper management seems to be listening. In the meantime, I'm on the verge of a nervous breakdown, I barely have time to see my husband or my kids except on weekends (and sometimes I have to go in even then), and I can't stop stress-eating---I've gained 12 pounds in the three months I've been at this job. I make good money, but at this point I'm almost ready for a job where the biggest responsibility is remembering to say "DIDYA WANT FRIES WITH THAT?".

Please help me figure out where I'm going wrong before I have a stroke from all the damned stress. Thanx!!!

[VivaLasViejas, ASN, RN]

Hi everyone.......I just got back from a 2-day training session that has me just about convinced that I can NOT keep doing this job much longer. My company will foot the bill for a $150/night hotel room, free meals, expensive goodies, etc. but will not hire the staff we need to meet the needs of all the admissions they want us to take regardless of how complex they are or how severe the behaviors. They think an RCM is some kind of machine, that can handle all the crap we already do PLUS the extra paperwork they just handed us at the seminar.

I wonder what planet these people are from???

On a more positive note, my administrator and DNS ganged up on me last Monday and told me I have to start going home at 5 PM, leaving the building for lunch, and delegating some of the charge nurse work I've been doing back to the charge nurses. Easier said than done, and I'm behind in my work big time (which is really difficult since I'm so anal about deadlines), but I'm also being encouraged to try to restructure my job so I can live with it.

Even with this help, I'm not sure I even want to do this work anymore---LTC is tough all over, and I don't have the energy to try to change the system. But then again, I don't know what I DO want to do; my physical condition is such that I can't do floor nursing (especially with those 12-hr. shifts), and I need to make a steady income, so part-time or agency work is out of the question.

I guess I'm stuck until I can figure all of this out, but I'm not happy about it. At this point I'm making almost fifty grand a year, which makes the decision even harder since there aren't a whole lot of nursing positions in my part of the country that pay anywhere near that much. Of course, as was pointed out to me by both my bosses and my family, that money won't do any good if I'm not around, but what the hell do you do when you've got 3 kids still in school, a mortgage, a husband who makes nine bucks an hour (and may get laid off any day now), and a drawerful of bills?

If any of you have any ideas as to how I can help myself out of this mess, please let me know...........I'm normally pretty sure of myself, but right now I literally can't see the forest for all the @#**&!! trees.