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Discussion

Case Manager Admissions

Just wondering if there are Case Managers out there who do their own admissions? I work for a fairly large organization on the east coast and the Case Managers are averaging 13 to 15 patients and now the Case Managers may be having to do their own admissions. A float RN would do the initial admit -- get appropriate forms signed and order equipment. The Case Manager would make the 2nd admit visit and enter all the meds and do the assessment. They want the Case Managers to block out time on their schedules to make time for admits (2 to 2.5 hours). Case Managers are already working 10 to 12 hour days 5 days a week and do our own recert visits. Last week I worked a 60 hour week (supposed to be 40) which is not unusual.

It is very difficult to "block out" time on our schedules because as you know your schedule is often not predictable -- a patient may be transitioning to EOL requiring more visits, a family member calls with an urgent need, etc.

As much as I love being a Hospice nurse (I have been an RN 15 plus years and used to work in a hospital before becoming a Hospice RN 5 years ago), this will put me over the edge and I think I will have to start looking for a job elsewhere. Other nurses are saying the same.

Would like to hear from others how they are doing their admits and if Case Managers are expected to do their own admits (or the bulk of the admit)? Does this plan sound reasonable to you with a 13 to 15 patient caseload (many who are high acuity)?

Thanks for your input.

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    We started doing our own admits about 2 years ago. Previous to that we had admission nurses. Initially everyone was up in arms and upset at having to add yet another task to their workload. However, it wound up not being as bad as feared. The initial visit wasn't actually all that much longer, since at your first visit you need to answer lots of questions, thoroughly assess and document the patient, etc. The only additional time was with respect to entering meds and other documents. So, it wound up not being nearly as bad as expected and I don't think anyone quit over it. That said, it did lengthen the work day.

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    Just curious TammyG -- what is your average caseload?

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    About 14 -- all home patients. About 40 miles driving daily.

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    I have worked both ways.

    In both scenarios I carried a caseload of 12-18 patients who were primarily in their homes and about 50% of them were rural as opposed to urban. I averaged about 80miles/day.

    In both situtations the employer was required to pay OT for all hours greater than 8/day because that was my labor contract. The employer who was using CMs for routine admissions began switching staff to 12 hour shifts to accomodate the longer days but then were unhappy that they could only schedule staff for 3 consecutive shifts.

    Personally, I don't mind doing my own SOCs as it makes all subsequent visits easier. When I knew ahead I changed my schedule to accomodate the SOC and the visits that HAD to happen that day. Otherwise I moved them to another day or to a per diem nurse or LPN to assist.

    If patients called with needs while I was doing a SOC I deferred that care decision tree to the office.

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