Having a hard time with boundaries

Published

Specializes in critical care; community health; psych.

I keep hearing that I'm not to worry about making patients GIP because "somebody" will go out there. That they will always find the resources. We are down an LPN and between illness and vacation, the remaining aides are stretched to the max. They can't incur OT and we're not allowed to use our PRN nurses until our census grows. Well I DO worry.

I started my day at 7am yesterday following being on call for the second night this week. I saw six patients at four different places and was done by 2:00 pm. I haven't been done this early in weeks. Just to be on the safe side because I work in an area opposite to wear I live, I called in to see if anything was brewing before driving home and offered to lend a hand to someone who might be needy out in the field. There was nothing brewing. I wasn't home for half an hour when just before 4pm, I got a call from my PCC to go do an eval and a possible admission. Because of the hour (rush hour) and distance (20 miles) it would take me over an hour just to drive there. I don't understand what was the hurry. Why couldn't the night nurse do it? The admission lasted until midnight.

When is enough enough? Now I have two GIP patients, a case load of 12, seven facilities, one aide who is taking vacation days and no LPN. I'm having to make aide visits too. I'm hoping that this is not a trend.

Would I be unreasonable to confront this situation or am I just being whiny? I'm sooooo tired.

Up Vote Up Vote ×

What is GIP?

Up Vote Up Vote ×
Specializes in critical care; community health; psych.

GIP = general inpatient. Translates to daily visits to a symptomatic patient.

Up Vote Up Vote ×
What is GIP?

General Inpatient is a higher level of care, sometimes in a hospice house, sometimes in a hospital bed, and sometimes in a nursing home. But if done in a nursing home, they are actually supposed to be providing more intensive nursing that they would normally do and an RN must be on staff at all times. When done in a nursing home there needs to be a visit each day by a member of the IDT to assess whether the patient is still requiring that level of care and to address the care plan.

Up Vote Up Vote ×

I don't understand why they aren't utilizing the prn nurses to take some of the burden off you when your case load is so high.

Up Vote Up Vote ×
Specializes in Hospice, Med Surg, Long Term.

Sometimes you have to let the powers to be what your limitations are, not that you're trying to be mean, rude or demanding about it. But there is only so much 1 person can handle. If yo don't let them know you're having difficulty, they aren't going to know. If you don't say anything they are going to assume you're doing just fine with the load they are giving you. Then if they continue to load you down with such a work load after you've made your limitations known, then it's a different story to be handled differently.

Ana

Up Vote Up Vote ×
Specializes in critical care; community health; psych.

As a post script, it's been a while since I put in the initial post on this thread. Not a quiet or shy kind of individual, I did make known my need for boundaries to my DOCS and my PCC. I flat out told them that I was fiercely defending my right to a personal life outside of scheduled work time and that I could not be counted on to accept assignments on my off time.

When time for my eval came, it was told to me by my PCC that although a good nurse and there was nothing to fault me for in the performance of my duties, she didn't think I was a "hospice nurse". Maybe she is right. If being so available and so dedicated that you have to sacrifice personal for professional is a requirement, then I am definitely not a hospice nurse. I was feeling guilty for not sharing the same work ethic that I saw coming from several nurses on the team who are to be commended for their dedication. I have to dance to a different tune and agreed with my PCC. I'm going to try HH on for size with the same company. Our HH department is more laid back than hospice and is on the small side with a small territory. Keeping my fingers crossed but not convinced this is the last stop.

Up Vote Up Vote ×

I refuse to believe that hospice requires us to be "on" 24/7. In fact, in my hospice I am encouraged not to even think of checking my email on my day off, or on the weekend. I am salaried at 32 hours per week, and yes, there are some weeks that I work more than that--but never more than 35-36 hours a week. My personal life is busy in and of itself, and I refuse to allow my job to eat into my valuable time with my family. IMHO, that work/life balance is even more important in hospice than in other areas of nursing, because as the hospice case manager, you already feel so RESPONSIBLE for everything that happens to your patients!

I feel sad that you have a team leader that doesn't support you in this. Additionally, I think putting limits on call time is also a good thing. My hospice has a dedicated call team, but with some recent staffing changes, asked case managers to take some call--I took a few shifts I felt I could handle, but also made it clear that it's unreasonable to ask someone to work 8-430, be on call 4pm-8am, then come work another full day. If people are asked to take call then there must be some grace allowed to take a day off the next day (assuming the pager is going off.....if you have a quiet night, maybe it's a non issue).

My point, I guess, is this: if you enjoy the work of hospice nursing, maybe this just isn't the right company for you? I don't know if you have other choices where you are geographically, but I'd encourage you to think about it at least.

Up Vote Up Vote ×
+ Join the Discussion