frustrated and overwhelmed

Specialties Hospice

Published

Okay, Ive been doing hospice now for a little over 2 mths, I had very little orientation and Ive had a case load of 9 pts since the first week and now Ive got 12 and I fill like Im drowning, Im behind on my paperwork and I have 3 recerts due next week. Im doing about 16 visits a week and traveling about 300 miles a week. I work in a small office and therefore Im the only nurse except for my supervisor who has been doing most of the admissions but thats it, I went in today and told her that I was overwhelmed and needed help and ask for another nurse, prn or a lpn to help with visits so that I could have some office time, well her solution is for me to fill out my paper notes and then someone else will put them in the computer. Yes,that will help some but Im still overwhelmed and feel cheated out of a real orientation. I love what Im doing I just wondered if everyone else recieved real training or did everyone else have to figure out the dying process and all that it withholds on their own.:crying2:

This is off the topic --which is hospices looking to save a penny wherever possible... which is certainly within the realm of my experience and something that's required my patient advocacy skills over the years...

But about the specifics of your message... I never had much success with marinol. It never seemed to do anything. And it is expensive and sometimes the capsules are hard to swallow, and have to be refrigerated

Better luck with:

compazine and haldol for nausea

decadon for appetite (sometimes, for a brief while)- once in a blue moon, megace

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Specializes in Med-Surg, ER, ICU, Hospice.

Kelluvanurse

Are you serious? $50/day, flat rate? Nothing for being called out? $175/weekend? Is that a flat rate too… with nothing for actually going out? Are you sure you aren’t just pulling my leg? And they have you on salary (so no overtime I suppose.)

I am utterly flabbergasted and do not know what to say… other than to repeat my previous advice, which was to get out of there ASAP.

Does anyone else have any input as far as salary, wages & call-out pay are concerned… not to mention the lack of support.

Dare I ask… what agency do you work for?

I am stunned.

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on call, we get $25.00 (flat rate) for carrying beeper-if we get beeped, it's time and a half/per hour starting when we leave our house, plus mileage, which is .44/mile. Each nurse does on-call approximately 4-5 x's per month.

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Its impossible to judge the fairness of a flat rate amount without knowing what the average actual hours are for the people who work your on call. This will vary greatly depending on the total census, the acuity of that census, and how well the case manager and rest of the team are doing their work. Also, do they triage their own calls?

Pay per hour or pay per visit will vary greatly from one area of the country to another as well. Check with the home health agencies in your area...you should be competitive with them.

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I work in the Chicago area. We are on call every other month 8p-8a Sat & Sun. If we're busy(more than 3 visits), we get Monday off or we can take the $55 per visit and work Monday. We are paid $2.00 per hour for carrying the pager. We usually have 2-3 visits the entire weekend. We are fortunate to have a regular weekend day staff, weekday pm nurse and full triage staff. Our census is about 175 (and climbing). We also work a week or two during the year as a back up nurse if the regular on call nurse has car problems or too many patients to see. Usually during that week, we may make only one or two extra visits if that. Our holidays are done in 12 hour shifts and we only have to work one 12hr shift per year. Pretty good, huh?

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We have full time on call nurses that are salaried but our prns provide back up and some routine weekend visits. They get paid $3.50/hr to carry the pager and their regular hourly pay if they go out. Our full time case managers do not take call, Every once in a while when we are short, the case managers are offered time and 1/2 for on call (for the time that we put in) and regular pager pay. It's a pretty good deal and when I've been short on cash I've pitched in to make extra money.

Kelluvanurse, I think you are being ripped off! I would try for the other agency part time or prn. If they are a large agency then chances are there will be a FT position coming up. Also, usually in larger agencies, you don't have as much call.

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We have full time on call nurses that are salaried but our prns provide back up and some routine weekend visits. They get paid $3.50/hr to carry the pager and their regular hourly pay if they go out. Our full time case managers do not take call, Every once in a while when we are short, the case managers are offered time and 1/2 for on call (for the time that we put in) and regular pager pay. It's a pretty good deal and when I've been short on cash I've pitched in to make extra money.

Kelluvanurse, I think you are being ripped off! I would try for the other agency part time or prn. If they are a large agency then chances are there will be a FT position coming up. Also, usually in larger agencies, you don't have as much call.

The more I read this, the more I realize I should count my blessings. We work 40 hours Monday-Friday, with 7 days on call, then 7 days off. 4.75/hour for carrying the beeper from 1700 to 0800, two hours automatic call pay if you're called out, in addition to the time and a half you get while being out. 44 cents per mile. Very small agency, rural area.

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The more I read this, the more I realize I should count my blessings. We work 40 hours Monday-Friday, with 7 days on call, then 7 days off. 4.75/hour for carrying the beeper from 1700 to 0800, two hours automatic call pay if you're called out, in addition to the time and a half you get while being out. 44 cents per mile. Very small agency, rural area.

What happens to your case load when you are off for 7 days? Or did you mean that you are off call for 7 days? Having dedicated on call staff works better for me. I work M-F 8-5 with no on call.

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Unfortnately, Im telling the truth. I never have to take call because we do have a nurse who takes call for us but she is getting really frustrated about not getting paid extra and Im afraid that she is going to leave soon. Like this weekend, she had to go to the daily dressing change and I know that we lost 2 pts over the weekend and so I know that she was called out to take care of that and she will get her flat rate and mileage and nothing else. But in the past weve been slow and she might not get one call in 2 weeks and I always take care of everything at the end of the day so that she is not left with anything. And there are days that I dont leave until 6:00 or even 7:00 esp when we have IDT and I have to get all those papers done. And can you believe when I asked for a day off and I meationed that I have stayed over she says, we do not keep an official total of extra hours, if you stay late you may come in late the next morning but you cannot use the hours at a later date you must use your pto. Needless to say one week I stayed over late on several days, didnt have lunch and had to leave early for a doc app and I had to use pto, that was very irritating. I appreciate everyones input, it will help me make a very informed decision esp when they beg me to stay and ask what can we do to help and then I can throw all this info at them. I should be hearing from that other agency tomorrow and hopefully they will have good news, the only thing is that I feel so responsible for my pts, they will have a fit if they think Im leaving, and thats really one of the things that keeps me trying so hard. Thanks again.

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I know it is hard to leave your patients, but YOU are more important than they are. If you don't take care of yorself, then you will not be able to take care of other future patients.

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it takes a good 6 months to become acclimated to a new position. you need to take time and breathe during your day. the position won't change - but you need to be in control of your time - not the position in control of you. it sounds as if you have a great "handle" on your duties at this point. you have discussed your concerns with the administrative staff - now plan your days. not overtime - your working time!

your family needs you just as much. when you are on your death bed - you won't say, "i wish i worked myself more." i am an advocate of delegation. your position is exactly what?

read the job description and take the time to highlight your duties. if you cannot complete them in one day - then document, make copies and inform administration.

i believe that with every issue - bring to the table a solution. it sounds as if you have done that. every patient needs a great case manager. i am certain that you are performing your best - but at what cost? :balloons:

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How about teaching the wife to do the dressing change? Giving her some hands on training during your visit would be comforting for her. That would at least eliminate this daily dressing change. If you've been doing it for a while, she probably already knows how to do it.

Now, take a deep breath. Your going through a tough spell in your job. Utilize your on call nurses to do routine visits. Then see the patients who are declining the most. Things will get better! Good luck to you :nurse:

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