feeling guilty about my decision

  1. I'll try to be brief, as I tend to ramble. Almost 2 months ago, I left my position in the field (case managing, etc) for an office position. I did so because I was so stressed....I'd had surgery 2x in a year, so physically feeling lousy. I also suffer from depression, and was in the throes of a bad bout. Meanwhile, my caseload was too much for me and I was taking too long with my paperwork each day. In retrospect, I realize I am a perfectionist, and spent a great deal of time in the patients homes...and even doing paperwork in the home, I still had a lot of paperwork in the evening...we're talking working all day, and pretty much all evening, so M-F 10-12 hours a day, every day, plus days I was on call, etc. I just couldn't do it. I turned in my resignation, and my supervisor offered to find me an office position that would be days, no paperwork to bring home. Still stress involved, esp with am scheduling...hence my reason for posting.

    First off, despite the stress in this current position, my depression has really lifted quite a lot. I feel better physically and mentally not working evenings or weekends (I do get tired working so early! haha....) and still do about 1-3 hours overtime a week. Here's the deal. We were already understaffed and overloaded. My leaving the field made it worse, and they have not been able to fill that position. In my head, I know I'd have been gone if I'd quit, but because I am in the position of scheduling, I am face to face with the problem every day. We are inundated with referrals. The weekends are always bad (of course). Last Friday was as bad as a weekend. Usually we have openings (several) daily. The nurses on my team are overloaded and every day I give them more. They are so stressed when I call them, I feel like the grim reaper. I know it's not my problem to fix, but having been in their shoes so recently, I know acutely how it feels, and it grinds my gut to have to make those calls every morning and dish out the bad news. I'm left thinking, did I do the right thing? Should I go back into the field? But then I think...oh man, I couldn't handle it. I guess this is kind of a whiny self indulgent post and I apologize. I am just feeling very guilty over something I can't change. Maybe I just needed to vent.
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    About sphinx

    Joined: Sep '02; Posts: 672; Likes: 29


  3. by   renerian
    You can be a great person in the office. I assume your company does not cut off referrals if the staffing is to low. Some do. I used to call the doc and try to get a delay of service order to ease some of the burden if that may help.

    Maybe if you can have a nurses meeting to see if they have any suggestions on how to streamline any processes that would be good?

    Has your company tried any recruitment new ideas? Karen who is the moderator may have good ideas as her company seems very progressive and seems to listen better than some companies.

    Are there any tasks you can do to ease their burdon such as faxing labs for them to the docs? Do they make their own open packets or does someone do that for them? Do you have discharge packets made up? How about recert packets? Are there ways to handle supplies better?

    Does any of this help? I did case management for 11 years and I feel your and their pain.

  4. by   hoolahan
    HOw about streamling the paperwork a bit? We turned our two page form for HHA referrla into a one page form and it really helps. We also formed a chart commitee where the nurses decided that certain forms would be in certain spots in the chart and all charts were to be the same (b/c they weren't and it was a mess!!!) This has made it easier for the per diems too.

    I was a weekend super in one agency and I know exactly bwhat you are going thru. I worked all day on Friday taking so many referrals, and it was stressful b/c the Liaisons would c/o if I turned one down, insur co's called to c/o if we didn't have an IV nurse on for the weekend, and I really felt bad for the nurses, as soon as one pt was d/c or died, bam, they got two more. I hated it and only lasted six months, but I only decided to leave after a weekend work 24 for 36 hr pay came available at my old agency.

    All I can say is you need to take care of you. You certainly shoud not feel guilty! I am desperate to get out of the field, but my alternatives don't seem to be working out.

    Maybe you can suggest a bonus to your boss on the field staff's behalf? Let me tell you money says thank you like nothing else can!!
  5. by   sphinx
    thanks for your post. You're right, we don't cut off referrals for low staff. I have at times been able to put off a referral with a doc's permission, usually to the next day. (call the patient and find out how they are, etc, then call doc and get permission). It makes things easier that day (which is great for days we get a ton of referrals or a lot of sick calls or days off).

    I know there has been meetings that have included nurses as well as admin that have discussed ways to improve the situation, but honestly I am not sure where that is going-the meetings were weekly and just concluded last Thursday. One of our nurses on my team was going, and was so stressed fitting it in, but I always did all I could to make her day easier and practically begged her to go so she could give admin an idea of what nurses in the field deal with on a daily basis.

    To be honest, I'm not sure about recruitment.... I asked my boss if we were getting applicants at all, and she said yes, but that nurses coming from hospitals are making considerably more than we pay, and so far have not wanted to take a pay decrease. I was a little surprised, because 2 years ago there was little difference. But recently, the local hospitals have done a lot to try and lure new nurses/keep the nurses they have, by raising pay rates. In my opinion, homecare has so much to offer, that the pay cut is worth it, but I guess if you need the money, then you need it. So, as far as recruitment, I just don't know.

    As for the other things you mentioned....well, lets see, our labs are done by an outside lab (unless if drawn from a line)...I send in the referral to the lab, the lab draws it and faxes the results to the doc and a copy to the nurse. The nurse usually follows up abnormal values, but we get our copies by mail, so the docs usually have already seen the results.....I myself do not even see the results, they come in the mail, go through the secretary into the nurses mailbox. Our opening packs are made up by secretarial staff. All our work is on the computer, and now all our nurses (on our team at least) are up and running with PC's, and only doing paper if their laptop is in overnight for repair. So....for discharge, the only thing paperwork wise is the signed DC form, the rest is all computerized. Same for recerts and ROC's, except they need a "routing slip", which all RN's keep on hand. Most supplies are ordered initially from the hospital. I have been calling in supplies occasionally to help out, it helps save time and cell phone bills. I also do HHA sups by phone when they can be done by phone. I try and field some calls from patients during the day......the secretaries often just page it right out to the nurse, but when I can I try to catch them, and if it's a simple question I can answer I will do so and document as such.

    There is so much more, I am sure, we can do. They were talking again about having PT do their own openings (ie on hips and knees), but frankly they've been saying this since I came to the agency, and probably before that, so I am not holding my breath.

    I appreciate your advice, it kind of helped me order my thoughts a bit. Hopefully relief is in sight soon. I can't help but think that it won't be long before another nurse leaves.....
  6. by   sphinx
    Hoolahan...as far as the paperwork goes, we are on computer.......first, hha referrals are done by me. The opening nurse does the careplan in the home. Then she has to enter the projected visits, and the tasks for the 485. I actually put the request in to the aide office (again, on computer). Our softwear is brand new......it has been buggy, but most of the bugs have been worked out. The forms are long, but actually quite easy to use, and certain forms only open if you click a yes, otherwise they don't need to be filled (ie if they are WNL).....it's kind of confusing to explain. But once you learn, it's not bad at all. It's esp comfortable to our newer nurses who were never trained on the older software, as they don't need to "unlearn" anything.

    In any case....I like your bonus idea! Our nurses sure deserve it! They've busted their butts a hundred times over!!!

    Meanwhile, I guess I realize I shouldn't feel guilty........I tend to take on too much emotionally. I guess I just know how it feels, and I feel so bad......I know how overwhelming it is, how stressful. I am a very sensitive person normally, and I just need to take some deep breaths and advocate for my peers, while taking care of myself.
  7. by   hoolahan
    We were posting at the same time so I didn't see the computerization info...lucky you!!

    Yes, a raise and a bonus will not solve your problems, but will make nurses feel appreciated.

    Also, how about geography? Are you ale to keep the nurses in a relatively tight geographical area? So they have less travel?
  8. by   sphinx
    Haha, no worries, yeah, the computer actually was a factor leading me to this agency as opposed to another. The switch in software was very hard at first, but a lot of hard work on the part of our staff working on this switch, it has come along....

    as far as geography......our team covers a third of the county. Our county is a moderate size city and surrounding suburbs (very little rural areas). Part of our problem is the specialty staff...ie we have the only OB nurse for the whole county who does case management(they have a couple on w/e evening staff with experience) , so she is all over the place. We also have 2 PEDS nurses, one who doubles as adult IV, the other does the whole west side of the county for PEDS. So she drives quite a bit as well.Other than that, they are kept in one area as much as possible. The only problem lately is the huge volume of patients in my former area (I did OB and adult). While it's a small area, it is very dense in the amount of pt referrals we get there. We only have 1 nurse who does just that area (who works 4 days a week) plus a cardiac nurse who does that area plus a little more. We've gotten so many patients there that balancing has been hard, and I've had to stretch boundaries a little farther on perhaps 2-3 patients/nurses. I hate to do that, because it makes things much harder. But it seems certain areas consistently get hit hard. One nurse, her area always get dumped on, this weekend alone 4 new in her area, plus at least 1-2 new per day. She'll DC 1, she gets 1-2 more to replace. The nurses who travel more have caseloads that are lighter, and their productivity is not expected to be as high as everyone elses. But man, do I ever *cringe* when I see referrals coming in for these overburdened areas. Even when the nurses are in a small area, their mileage will be low, but poor things, they'll see soooo many patients each day!
    I guess I am thankful we are not in a more rural area and still dealing with the same issues.......it would be a lot more difficult with all the extra driving.