I am to start a new hospice case manager position in a few weeks, and am freaking out a little bit inside. Looking for your thoughts on a bunch of questions...appreciate any help or insights you can lend.
1. What do you wear? I know this sounds silly, but I forgot to ask if the case managers wear street clothes or scrubs? I'm thinking street clothes....but I don't know. If this is the case, I need to get shopping, as I'm currently a critical care nurse with a closet full of scrubs and then jeans.
2. What's the absolute worst part of your job? (Appreciate specifics, here...I've already been told about the horrors of the paperwork -- what kinds of charting are to be done on each patient/visit, i.e., WHY is there notoriously so much paperwork?)
3. The facility I will be working for has a lot of its clientele in skilled nursing facilities and assisted living facilities. If you work in this way, how do you get along with the facility staff? Do they resent your being there? Do they "dump" on you (i.e., leave patients unturned and in soaked briefs because they know you'll be coming soon?).
4. How big is your case load? I'm nervous about this; one person at the company said 10-12 patients; the other said 10-15.
5. As a case manager, how much time, on average, do you spend with each patient, and what do you do in that time? I've been reading on here that an average visit should run about 30-60 minutes. That seems so short to me -- what can honestly be accomplished in a half hour other than a set of vitals and an assessment, maybe a turn or dressing or undergarment change? I'm going into this specialty because I want to bond with the patients and their famillies -- not do a "drive-by" assessment in 20 minutes then have to chart about it for two hours. Am I too idealistic to believe that I'll actually have a chance to get to know my families and patients?
Tons more questions, but I'd be happy to get responses to these. Thanks again, so much, for your time?
Oh, one more thing...what's your favorite thing about being a hospice case manager?
I am an rn case manager, home care only, no admissions. Last week was an aberration; I had 18 pts but lots of help from my colleagues. I wear business casual always, and I drive anywhere from 30-60 miles a day for my job with my caseload spread through a metro region. I see 4-5 pts a day. And I have at least 2 hours of charting after I come home. I have very critical and young patients mixed in with a bunch of "long termers"' dementia, debility, CHF.... My usual caseload is around 12.
It was my first job as a new grad-2 years now. I love it. And I am going to take my certification exam in December.
I have been at this job for about two months now. And I'm completely on the fence about it. I LOVE the patient and family contact. I mean, seriously, how many people have jobs where they're thanked profusely and basically called an angel every day? LOL. I seriously doubt I could love the patients and families more. Unfortunately, I'm finding patient contact time makes up about 20% of my time. The other 80% is spent charting, charting, charting, phone calling, ordering DME, ordering meds and reconciling them, arranging for respite stays, doing admissions, dishcharges, recerts, etc. (mostly with computer-based stuff)....UGH. I've come to the realization that I don't want to be a case manager. I just want to take care of dying patients and their families. Sigh. I can't stand all the fine details.
I have to say, the company's been great to work for. They have delivered everything they said they would during the hiring process. I was afraid they'd lie to me about stuff to get me to take the job, but so far, they've been just great -- keeping my caseload on the lower side of the range until I get totally acclimated, etc. I'm just feeling like it's maybe not for me.
I'm really at a crossroads, here. I need to decide what I'm going to do soon. I have stayed per diem at my hospital (cardiac ICU) in case I didn't like the hospice thing, but I'm barely working there now because I am SO freaking exhausted from this job and charting at home until 8 or 9 at night most nights and working five days a week instead of three 12s... The five day work week is killing me. My hospital won't hold my spot forever. I usually pick up two or three shifts a week as per diem. I've been doing like one a month.
I don't know how you guys do this job. You are amazing people. Thanks again to everyone for sharing their experiences with me. I just wish I knew what to do.
Specializes in PICU, NICU, L&D, Public Health, Hospice.
Thanks for sharing your experiences, everyone.
I have been at this job for about two months now. And I'm completely on the fence about it. I LOVE the patient and family contact. I mean, seriously, how many people have jobs where they're thanked profusely and basically called an angel every day? LOL. I seriously doubt I could love the patients and families more. Unfortunately, I'm finding patient contact time makes up about 20% of my time. The other 80% is spent charting, charting, charting, phone calling, ordering DME, ordering meds and reconciling them, arranging for respite stays, doing admissions, dishcharges, recerts, etc. (mostly with computer-based stuff)....UGH. I've come to the realization that I don't want to be a case manager. I just want to take care of dying patients and their families. Sigh. I can't stand all the fine details.
I have to say, the company's been great to work for. They have delivered everything they said they would during the hiring process. I was afraid they'd lie to me about stuff to get me to take the job, but so far, they've been just great -- keeping my caseload on the lower side of the range until I get totally acclimated, etc. I'm just feeling like it's maybe not for me.
I'm really at a crossroads, here. I need to decide what I'm going to do soon. I have stayed per diem at my hospital (cardiac ICU) in case I didn't like the hospice thing, but I'm barely working there now because I am SO freaking exhausted from this job and charting at home until 8 or 9 at night most nights and working five days a week instead of three 12s... The five day work week is killing me. My hospital won't hold my spot forever. I usually pick up two or three shifts a week as per diem. I've been doing like one a month.
I don't know how you guys do this job. You are amazing people. Thanks again to everyone for sharing their experiences with me. I just wish I knew what to do.
Out of curiosity, are you using EMR? If so, what software please?.
I have used several now, and some of them are down right painful to use.
May I offer an additional bit of perspective? Having worked at 2 different hospices, i can say that they can be INCREDIBLY different. I've been a RNCM for almost 7 yrs now. I left the original small hospice I started with to work for another MUCH larger national company, thinking the grass was greener on the other side, had a HELL of a rude wake-up call, and was very grateful that I was able to get my original position back. I work a 40 hr week, take about one weekend of call per month, have a caseload of (currently) 11 patients, but sometimes as high as 15, most of whom I see once a week. Granted, the paperwork is obscene, but my visit notes are one page, our IDTs once q 2 wks usually last less than an hour, our Monday morning staff meetings (when we have them) last 15-30 min, and I NEVER take work home (unless I'm on-call). When I am on-call, I generally get very few calls requiring a visit and very few calls in general.
The other hospice had AT LEAST 5 meetings/wk lasting an hour or more, their visit notes were 4 pages long, I spent HOURS every week just FILING the %$#@* they kept putting in my mailbox, I had one night per week where I was on-call but the dang patients called ALL NIGHT LONG and frequently needed visits (one day I worked 21 1/2 hrs straight), my work week was 55-70+ hrs, at least, and my caseload was 20 or more (an LPN made 2-4 visits/wk to help me out- whooptydo). The other RNCMs and myself were absolutely MISERABLE but the management completely ignored our pleas for help. With all the hours, I was making a lot more money but I was basically living to work, instead of working to live, so I eventually had to call it quits. To say the least, I am very grateful to have gotten my original job back although it is by no means perfect.
If you like working hospice, maybe you could dip your toes in another pool? Keep your job at the hospital and do some PRN hospice work at the same or a different company? I'm always envious of the PRN nurses- they get to do the visits without all the paperwork! Realistically though, whatever job you work will have its pros and cons, the trick is to find the ones you can live with. It can be a very rude awakening to put a lot of energy into persuing something you later find is not up your alley at all. BUT you should be cautious about giving up your dream without checking out your other options either. If you only want to work directly with patients, maybe a private nursing job would be better for you? (although there is probably a ton of paperwork with that too- Oi!) Good luck with whatever you choose!
Out of curiosity, are you using EMR? If so, what software please?.
I have used several now, and some of them are down right painful to use.
We use allscripts and as it was not designed for hospice use, we are getting a huge revamping of it. I haven't seen my boss for weeks because she is locked in with the software developers redoing it. I would say that it is the reason why I spend so much time after hours documenting. I do chart at bedside, I always have a narrative note going and I do vitals and scales right into the database assessment. But then I have all these stupid circles to check and repetitive crap and it's maddening. Can't wait to see the new version but I'm not optimistic.
Alvindudley
52 Posts
I am an rn case manager, home care only, no admissions. Last week was an aberration; I had 18 pts but lots of help from my colleagues. I wear business casual always, and I drive anywhere from 30-60 miles a day for my job with my caseload spread through a metro region. I see 4-5 pts a day. And I have at least 2 hours of charting after I come home. I have very critical and young patients mixed in with a bunch of "long termers"' dementia, debility, CHF.... My usual caseload is around 12.
It was my first job as a new grad-2 years now. I love it. And I am going to take my certification exam in December.