Compensation and Job Structure for Hospice

[funlovincutie]

Alright- so I am a little on the slow side so I am asking for some help from this forum. I am a pretty new hospice nurse and unsure of the overall norms in hospice nursing- if anybody has any feedback I would love to hear it. We are all salaried at our place of employment. We are expected to case manage 12-15 patients. We have one LPN who is shared among 6 RNs. Our expectation is of course to see our patients at least weekly andPRN, and we do our own admissions. Our supervisor says that our standard is to "make sure our patients are well managed" to determine how good of a job we are doing as case managers. Nobody at my place of employment seems able to set any guidelines or define the term well managed. I would love it if someone could help me define that concept.

We rotate call one week at a time throughout seven weeks and we are each expected to take back up call one week at a time once through each rotation. We are reimburesed $150 for first call and then $75 for back up call for being available. If we are called out then we are to receive $50 per visit for up to two hours and then an additional $50 for every two hours after that. Continuous care (which my company strongly encourages) pays us an hourly rate that was used to determine our salaries (mine is $27/hour). For this area this is what my base day shift rate was in the hospital. Once we have met 40 hours of actual time worked we are given time and a half if we can justify it to our supervisor- which I thought that was kinda weird. Their rationale is that our drive time does not contribute towards our hours worked and we can only be given credit for direct or indirect pt care time but not while driving.

Our management has said this is more than reasonable and that we are very generously compensated because we have "such low caseloads" and that we will ultimately make more money being paid by the visit after hours instead of our time and a half that they we were receiving for all after hours time prior to this change. It is also good to note that this is a for profit hospice and receive 2 weeks vacation and employee health coverage paid 100% with a $1500 deductible. No retirement or anything else.

I am sorry this is so long and I really appreciate any input. I am very uneasy about being salaried anyway and worried about how much time I should be expected need in order to keep my patients "well managed."

[aimeee, BSN, RN]

12-15 is a full caseload which will vary in its manageability with the acuity of the patients and the amount of windshield time needed to see them. It is by no means a "low" caseload, especially when you enter having to do your own admissions into the mix. I can't speak to the compensation for the on call visits. Its not the model we use. Drive time not counting would certainly not fly here!

If your patients are "well managed" I would expect to see evidence in your charting and practice of preparing for expected issues before they happen....bowel regimens in place for patients on narcotics, medications ordered before they run out, families knowing what to expect of the dying process, pain and other symptoms managed at a level which the patient considers acceptable, patient has an ATC med AND something for breakthrough pain, etc.