very confused about my hospice job- need advice

[maybug]

I graduated in May 2012 and only did home health for a couple months before coming into Hospice. I have been an RN Case Manager with Hospice for 7 months now. I really do enjoy Hospice, especially comforting my patient and their family in those final hours. I feel confident for the most part in my role, and feel that I do a very good job. The issue is that my company is expanding and we are new to the area I am in. I am currently the only nurse covering an 80+ mile radius. I only have 8 patients as of this moment, but I do at least 1 admission a week, and am worried about our area growing too fast before another nurse is hired. Supposedly they are looking for a PRN nurse to assist me, but it has been 2 months now with no applicants, which I don't understand. The other issue is that almost all the call is placed on me. I take call anywhere from 20-25 days out of the month. It is very draining. I am unhappy more often than not. I spend a lot of time thinking about and searching for new jobs. I am worried that this is just how it is, how all of nursing is, how the working world is, and I just need to get used to it. Is that the case? Would I be better suited for a Hospice House with set hours, and patients in the condition I find most rewarding? Should I switch gears completely and try hospital nursing? The hours of the job are killing me more than anything. I work with an incredible team of nurses, and dont know if I even have the balls to leave them in a bind- 8 patients with NO nurse. This company gave me a shot as a new nurse that no one else would, and I am very grateful, but I am invaluable to them at this point in time, but feel as if I am being somewhat used. PLEASE lend me your advice and support!

[Caffeine_IV]

As a former inpatient hospice nurse I have to say it was anything but "luxe". I literally ran my butt off the entire 12 hours sometimes, having to be in patient's rooms every hour for symptom control. It was extremely difficult to maintain the pace day after day and often I would go without lunch (which was the only meal time we would get). Several co-workers quit before I did.

We did have actively dying patient's, but also had respite patients. Each nurse took care of 5-6 patient's each shift. Many times the families and their pets would sleep in the rooms with them.

Don't get me wrong, from the patient's & families perspective we did a wonderful job. They just didn't know the inner workings. It was anything but mellow and slow which really was a shame. Hopefully, that's not the case with other hospice inpatient facilities.

I agree. While it isn't as demanding as med surg..for me, it can be quite busy especially with a patient in crisis. Then throw a death in the mix and it is hard to catch up.

Admissions are very time consuming where I work.

[maybug, ADN, BSN, RN]

Not sure if anyone will read this post since it has been 4 months... but i guess ill write for myself more than anyone. ive done my best to stick it out, and am pretty proud of myself - its been almost 11 months! i really did want to make it to a year but i was recently offered a med/surg position in a hospital close to me and i am so RELIEVED. its surprising how much worse this job has gotten. i had my very last straw on the day i got the job offer- Just in the nick of time! i had been up since 330 am on a call; ended up having 2 deaths that day (one of which was personal to me) and ended up working until midnight... a 20 hour shift! and thats not even that first time thats happened... the worst part is that there was no support for me whatsoever, my management was very aware of my situation yet sent no one to help me or was even available via phone. i was so close to calling it quits! i put in my 2 week notice the morning after this awful night and the first thing my supervisor said was "i knew you were going to walk." !!!!!! if you KNEW that then why didnt you give me some kind of support to prevent it??? so unprofessional! i am currently the only full-time nurse taking call covering well over a 100 mile radius. i have many patients that are over an hour away that i have to see several times a week. i easily spend 3 hours a day driving! you know what it means when youre the only full-time nurse? whatever days the prn nurses dont take for call, YOU get! as of this moment... almost all of the month of september is open! that means if i didnt quit, id have to cover almost the whole month! ive been covering 15-25 days of call every month since march! im DONE! im done with the disorganization. im done with the poor support. im done with always working over 40 hours a week and not getting paid for it. im done with working late nights. im done with putting 300+ miles on my car every week! im done with always playing catch up. im done with anticipating those calls in the middle of the night. im done with the ever-changing rules and regulations. im done with management thats only been doing this a year longer than me and has no idea what theyre doing. im done with doing everyone elses job because we constantly have nurses and social workers and chaplains quitting. i currently have NO SW or CH for my area! im done with my patients getting half-ass support. im done with being abused by families and having to take the blame for poor care when my office doesnt make another nurse come help me when i am already tied up so a patient is left to lay in pain for 8 hours until i get there! im done with ridiculous 3 hour long IDT meetings every week. im done.... i really needed to vent and write this. i am so relieved, i will miss my patients (most anyway) and their families. i will certainly miss hospice, but i am positive i will be back one day... in a hospice house though because case management is for the birds! :) i am beyond relieved.. i am looking forward to a fresh start and an actual LIFE with days off and time to myself! and hopefully a MUCH more supportive environment!

[dansamy]

Yay for you! Sometimes, it's hard for us to do something that's best for ourselves.

Sent from my HTC One X using allnurses.com

[hospicechpn]

Dear Maybug, feel free to private message me. I hope your company finds another way to cover call hours. They may have been doing it this way for so long it seems like the only way. If you approach them with your concerns come armed with a positive attitude and creative ideas for possible solutions. For instance, if your idea is to for the nurses at your company to share call time tell your supervisor that you love sharing information on what you've learned on the job, including how to take call, what families and patients seem to need most after hours, etc.

At my hospice agency we have a dedicated night position. My hospice understands that case management is a demanding job and would never ask a nurse to cover a night shift and then be expected to case manage the next day. It's a recipe for burnout.

I wish you lived in my area. We are looking for nurses and you sound like a jewel.

[hospicechpn]

Maybug, I wrote to you before I saw your update. I'm glad you got an offer to work med surg. I wouldn't trade my experiences on a medical floor for anything. To have colleagues at your side for support is great. When the shift is over you get to go home and rest. Bless you for the work you have done. By the way, I must honestly say that the hospice you worked for could do a much better job. It is completely inappropriate for them to expect you to cover so much call or to not back you up when a shift gets rough.

[maybug, ADN, BSN, RN]

Thank you for your kind words! The office i work for is only about 2 years old so they dont really know what theyre doing yet! I agree that there should be staff strictly for afterhours/on call support, with us CM only working our normal 8-5 days. I don't mind covering call 2 days a week, but 4-5 days a week is too much. I even had my administrator say to me that she doesnt understand why we dont like to take call.. she claims we dont even get calls that often. SHE doesnt understand because she isnt a nurse and will never be required to take call. I tried to explain to her that those are still days we dont get off; we have to stick around town and turn down plans and time with friends and family... even if just waiting for a call. AND when I do get a call at 3AM and am still required to work a full day, its exhausting. she just simply said "all the nurses have to do it." that doesnt make it right. no one should have to do it. thats not safe nursing.

I was wondering if you would suggest for or against complaining to HER supervisor about her behavior? She has said some really unprofessional things not only to myself, but all the other nurses. She is out of hand and I feel it is partly my responsbility to make it known how awful we are treated and how unfairly and unsafely things are being ran. I am comflicted on speaking up or just getting my work done and getting out... Any advice?

[Meliss214]

I commend you for surviving so long in those conditions. I love hospice, but have not been impressed by the business side of it. I tried case management after starting out as the weekend oncall nurse and have found that the CMs are exploited beyond belief. So I'm on the search for a weekend oncall position once again. Good luck in med/surg!

[DavidRNNV]

Hey Maybug,

So sorry you had to go through all that. I've been in similar environments when I first started nursing and it taught me a lot. I'm sure you learned a lot from this experience as well. Frankly, I think us nurses are usually very giving individuals and some administrators (and patients) definately take advantage of that tendency. I've told myself, that some people are just naturally like that. I'm not going to change them, but I Will Not Let Them Abuse Me. That is when my words become short and I use words and phases like "this is unacceptable", "this is a non-negotiable", "this is an unsafe situation", etc. Always with the focus on patient safety, care and appropriate treatment. You will find when you stand your ground like this, and show your assertive side, briefly, to demonstrate you have this side available to you, these people (administrators and patients) will be more cooperate. When I come across these types of people and I stand my ground, briefly, I see something 'click' when their looking at me and they become more cooperative (to me) 8 times out of 10 (The other 2 x they have AMS, pts and admins , remember to document in both cases).

I agree with Everything hospicechpn said as well. Very good information. You are a good nurse, you are a jewel, stand up for your patients and yourself and you will not get burnt out.

I've been a Med/Surg RN for a number of years now, I'm a preceptor as well, if you come across a situation that you need a sounding board on, please let me know. I tell all my new RNs on Med/Surg if you are not questioning what or how you are doing something, everyday, for at least the 6 months to a first year and seeking advice for the answer, everyday, then you may want to check yourself for being too laizes-faire toward caring for your patients. There is a lot to learn in nursing and you can't learn it all in school. Still, you seem to have a good moral and responsibility compass, rely on that and you will be fine.

[maybug, ADN, BSN, RN]

Thanks so much David! That is really good advice and I do need practice in standing up for myself. That is my biggest issue with my administrator- she is intimidating and very manipulative and I am too forgiving with a need to make everyone happy.

Thank you for the support... there is a strong possibility I will be contacting you in the future! But let's hope my preceptor and colleagues are as supportive as you seem to be. I will keep what you said in mind to remind myself to not be afraid to ask questions. Will keep you posted!

[NefforamaRN, BSN]

Wow. "Nursing guilt". Never heard it put that way in almost 7 years of nursing, but TOTALLY can relate. I thought I was just a softy or "overly" concerned with letting coworkers / managers down.... nonetheless......

... I agree that reframing how you view your next five months may be helpful in coping. I also think, however that under the circumstances and conditions you've described, you would be well within sanity (and rights) to begin to pursue other options if things don't start to change. Your well being may be at stake.

I stayed in a position fraught with burn out, relational bullying, CRAZY unpredictable hours, etc, all because I wouldn't allow myself to accept that conditions were bad and it wasn't ok. My hair started to thin and I began having anxiety.

DO NOT do that to yourself. You are a caring, thoughtful, responsible person (just like those you take care of) and you have a right to dignity and well being...... Take CARE of yourself.

All the best....

[TXregisteredninja]

Maybug, if you graduated in 2012 and you were already feeling burnt out it probably a good thing that this med-surg offer has come along! Bedside nursing can be so rewarding and the best thing is when you clock out, you're done! I wish you the best of luck in your new position! Get ready for a new adventure :)