case manager turnover

Specialties Hospice

Published

Hi all. I was wondering if the organizations that you all work for are having the issues that mine does, in regard to staff turnover. To my knowledge, staff turnover at our hopice here in philly has been at its current level for the last two years. That level, to me, seems inordinate. Just last month we had 5 rns and 2 msws leave. Administration blames it on growing pains,but I see it as poor planning, poor training of those in administration and management, chronically poor staffing, ect. What is your opinion? Is this just something we as nurses are just expected to accept? Perhaps my expectations are too great for hospice care.:confused:

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Specializes in ER, Cardiac, Hospice, Hyperbaric, Float.

I am still very new to hospice, and our "veteran" nurse CM has been there less than 2 years. Yikes. I am planning to dig in my heels and stay for at least a year, hopefully more. I have already picked up on the fact that the agency I work for will definitely take advantage of you and "dump" on you if you allow them to do so, and this leads to very quick burnout. A lot of nurses seem to feel like if they say "no" they are somehow cold and uncaring or a bad nurse or something, and the agency seems to feed this. I have had to really struggle with being "okay" with establishing "boundaries" in this job. If I am not on call and it is after hours, I turn off my phone. I do my darndest NOT to work more than the 40 hours a week that I am paid a salary (not hourly) for (I have only succeeded in working about 42-45 hours per week, but I am DETERMINED not to get to the 50-60 that some of the nurses I work with are already into). I know that nursing is a "calling", but it is also a JOB. If I were asked to choose between my job and my family, I would choose my family with NO hesitation. If I quit this job, there will be someone there to step in and take my place. My patients "need" me, but I am replaceable. This is not so with my family - my family needs ME, specifically, not just "me", a nurse CM. I work with a few nurses who seem to take pride in the fact that this job has consumed their lives, as if they are a better nurse than me. Well, in some ways they may be "better", but in other ways _I_ am better because I am not as likely to become "burned out" as they are. I am not sure how it is with other agencies, but the general "feel" I get is that it is generally a widespread problem in this specialty. I hope I am wrong.

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If the case managers are paid below par like the regular field staff are, as is the case at my agency, that is probably a good basis for why the CMs leave so quickly.

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Personally, money is not an issue for me, though obviously there is a huge difference in pay for inpt. versus outpt. Putting in an avg of 60 hrs a week on a salary does feel abusive, but i'm not sure financial compensation would help, though it would definitely not hurt! So many people i work with are really drawn to the work, but are unable to balance the work demands and home life without difficulty. I have found that there are great expectations in this field about "dedication". I do believe that this can be used to the detriment of case managers, social workers, ect. As for the "calling" of hospice, the most long-term staff at our organization happens to be nuns!

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Hospice is a calling and management takes advantage of that. If you don't say no, they will walk all over you and claim it's all 'for the patients'. I don't say no very well sometimes, and I pay the price. But, the alternative (not working hospice) was too painful for me.

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Specializes in Med Surg, Hospice, Home Health.

No is a full sentence. You have to set boundaries or you will burn out quick. I went to the weekend shift and most weekends it is better for me that the regular staff nurses...They are not only expected to see their regular list of patients, but do admissions and put out fires. For me, I'm the primary weekend nurse 5pfriday to 8amonday. I usually have NO scheduled visits, unless these are new patients admitted friday who need a 24 hr visit on saturday and a phone call on sunday. I just put out fires and do admissions, plus I have a backup nurse. In 2 years at my current employer, we had 1 cm leave by choice, and 1 that was fired secondary to patient and family complaints. Its ebb and flow....the last place, we lost a nurse every 3 months due to burnout.

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Specializes in Hospice, Pediatric, OB/GYN.

A good hospice company will not have the high turnover rate that other hospice companies do. I know this from personal experience. Our longest Case Manager has been with our branch for more than 6 years (basically since our branch opened); I have been there the shortest amount of time and that is right at one year. I came from another company that replaced at least one position every 6 weeks due to high staff turnover. For the most part the case managers hung in there for an average of 6 months (I almost made it a year). I think a lot of it has to do with the expectations of management, training and the overall structure. Many hospices I hear about (and the one I use to work for) require their case managers to do admissions, continuous care, and primary call every other week, with a case load of 18-20 patients. This is just too much in my opinion based on the emotional and mental work you do. If you are providing continuous care for a patient then who is watching over all your other patients.? I could go on, but that would just be ranting.

Gail Y, RN CHPN

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Specializes in Med Surg, Hospice, Home Health.

as for continuous care, we pull from 4 other offices to staff for continuous care...other locations have more prn nurses than our location does...We have only had a few continuous care cases-most opt to go to the ipu

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Specializes in PICU, NICU, L&D, Public Health, Hospice.

High case nurse turnover is suggestive of something amiss in the organization...IMHO.

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