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:

I am reading here that many of you say that a 12 patient caseload is too many. What do you consider an appropriate caseload? Our max caseload is supposed to be 14 patients. I was a casemanager for 5 years and averaged 12-19 patients. I can say that 12 for me was the magic number, 14 is doable, and anything more than that is too much. I could give my patients the time and attention they needed and still finish my paperwork. I can say, as far as a new hospice with 12 to 14 patients, usually the administrator/DON should be seeing some of these patients, especially with a new nurse. Ideally, she should be visiting WITH the new nurse. I have been a manager in Hospice for 2 years and can say that I make patient visits frequently and am available 24 hrs per day 7 days per week to all of the casemanagers. To hear that a manager would let a newly hired nurse struggle without help is unacceptable. Staffing in our hospice is a big issue right now. We have high caseloads and have lost great nurses because of it. I am fighting everyday to add addition benefits and am working on a new on-call system to relieve the nurses stress and recruit and retain nurses. What do you guys think is the best thing to do to make a great hospice with happy nurses- who stay not leave after 2 months? No on call at all for fulltime? High pay for on-call instead? Days off after a call period? LPN's to assist the RN's? PRN nurses for overflow to ensure caseloads of no more than 12? I know this is somewhat off topic, but what does a Hospice do to set itself apart? To go from good to great?

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Specializes in Case Management, Advanced Illness, Hospi.

I so understand! I have been a Hospice nurse for four years and have recently changed companies. Cash cow syndrome drove me to find another employer. I would ask for an LPN to do alternate visits with you. Costs the company less and they are very capable of doing the task. The LPN can do the dressing changes too which would free you up for the paper work portion. Over the years my caseload has ran from 15-32. It can be oh so overwhelming to keep up. Keep in mind you are there for the patient. And remind your management about all the windshield time. They forget when they sit in an office!

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

jfordRN,

I am curious… do you work for a for-profit hospice?

I suspect that if your administration is motivated by profit rather than (like you) a desire to be a “great” hospice, all the good ideas in the world will fall on deaf ears.

Unfortunately, trends show an increasing number of for-profit hospices and increasing profit margins. This is accomplishing by providing less service for the same per diem reimbursement rates… and of course one of the ways to do that is to overload the nurses.

Since the majority of hospice income comes in via the government, you can expect the government will do something about these disturbing trends sooner or later. Hospice was never intended to be a cash cow. If that is what it has become (and it appears that it has) it will be changed.

A few greedy companies are ruining hospice for everyone. If you happen to work for one of these you are, ion effect, enabling them. Better that you leave than enable a hospice company whose chief objective is self enrichment.

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I do work for a for profit, however, I have worked for them from the time they were a tiny new hospice and can say that they do care about the patients and the staff. I feel that the ideas and feelings of the staff are being listened to and I am working on several proposals to make staffing better. To be honest our president suggested an increase in pay that was significantly above the other hospices in the area. The real problem is we GREW TOO FAST in a short period of time and just haven't been able to keep up with the staffing. I am never asked to cut costs/services for the sake of profit. I think there is a misconception that all for profits are uncaring money hungry companies that do not care about pts or staff. They are out there....I know people who work for them, but not all are like that. I do agree that Medicare will crack down and the Hospices who are following the regs and providing good care and HONEST will be the ones left standing, for profit or not. By the way, we have a not for profit here that CUT HHA visits to patients because of staffing instead of paying extra/increasing base pay to recruit! Sometimes not for profits are just as bad. Bad Administration is Bad Administration. It does matter what you are classified as.

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

It is good to know there are for-profit hospices with high standards. It sounds like you are doing everything right… so why are good nurses leaving? You are growing too fast?

Both my wife & I are nurses and over the years, when leaving one job to go elsewhere, I have always been amazed at how superficial “exit interviews” are. It always struck me that as an employee, intimately familiar with the inner workings of an institution, how little anyone in that institution cared about any feedback my wife or I might be able to provide.

All of which is to say, why not do heart-to-heart interviews with the nurses who are leaving and ask them why they are leaving? Of course it would have to be done with strict assurances of confidentiality… and you would have to be prepared to face the possibility of hearing things about your hospice or even your own management style that are not quite as rosy as your own description.

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Unfortunately, I already have been doing what you have suggested for years now. I even give a questionaire that can be sent confidentially to our VP. I have not received a negative comment other than that the nurse were offered more money and NO on-call. We are increasing salaries to above average for our area and working on a better on-call routine. I truly think it is so competitive, that we have to do something unusual. Above increased salaries, high bonuses, and changes in our on call. I am interested to see what nurse posting here enjoy about the Hospice they work for and any "outside the box" ideas. We are growing and unfortunately all it takes is 2 nurses to quit and growth of 10 patients and we are down 3 nurses. (snowball effect) Of course, this causes stress among the nurses who are left.....they start thinking well maybe nurse so and so had the right idea..........then there you go another has left. ARRRGH!!!!!

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