Hospice CNA Frustrated re:caseload

caliotter3 · Jun 7, 2008

You have done what a professional is expected to do when you brought the issue to the admin attention. Inasmuch as it is apparent that they intend to do nothing to remedy the situation, if I were you, I would take matters into my own hands. Nine clients in one day is too much. The norm is six. It is time to find a new employer. When you interview with prospective employers be sure to ask what the caseload will be so that you don't go from the frying pan into the fire. Good luck.

CANRN, MSN, RN · Jun 8, 2008

I am a Hospice CNA with 17 years experience and previously worked with an excellent Hospice where I never doubted my value. We were a team with prn employees to jump in so we could go to meetings or even jump in if we had a difficult case and simply needed a break. I have moved to SC and want to know if the following is just the "way things are here".
CNA's at my current Hospice...
*carry a caseload as high as 9 patients a day
*cannot go to IDG/inservices/support meetings unless we work a longer day or cancel pt visits(they advise us to do this)
*if a cna is out often the pt is called, told the cna is out (AND WHY THEY ARE OUT) and that they will have NO visit that day because of it-some aides are required to call their pts themselves to tell them they are out and ask them if they want someone else to visit(to save the supervisor the time)
We are exhausted and many are getting burnt out. Call ins are getting ridiculous because of this which of course doesn't help, pt care is going down due to time restraints with caseload or just exhaustion. Speaking to the higher ups about all of this did no good, they have been saying for two years now that they are looking for help, but they don't advertise. I gave it one last shot last week laying our issues all out on the table for them and letting them know that many aides are now actively looking for another job which would make us even shorter. I have an excellent reputation with my nurses and patients and told them I was on the edge of burnout and needed some help. They basically told me to keep up the good work and that things would get better. It was like talking to a wall.
So, was I spoiled by my other job where I carried a load of 5-6 pts a day, was able to attend meetings and know that my pts still received care?

NO! What you are experiencing is not normal. The one hospice I worked at expected their HHA's to be at IDT, they are part of the team. The one I work at now, does not. I would like to see that change.

Personally, I would find another agency to work for if you can. That just sounds crazy!

Good Luck.

aimeee, BSN, RN · Jun 8, 2008

Our HHA's attend team and we certainly value them and include them as a part of the IDT. That is a very heavy caseload. It would be one thing if this was temporary due to census increase at the same time as a staffing crisis (one or more of the other HHA's due to family leave, health crisis etc.) but if its been the norm for 2 years something is badly amiss.

southcarolina716 · Jun 8, 2008

Thanks! Because of being at a former Hospice I was really shocked at the way things are run here, but since it was in a different state I've delayed leaving in case the next place was much the same.

After putting my behind on the line and going to every superior I could and getting no changes however I think it's time! I came to this one when we moved because it was known as "the best" in the area, and they promised 5-6 pts per day tops, shortly after my hire they changed the HHA supervisor and it's been downhill ever since. I keep delaying leaving because I know that will make it even harder on the girls I leave behind and I absolutely hate job switching- but I know that this situation is making my life outside work suffer because I am emotionally spent.

Thanks for letting me vent and letting me know I'm not just "spoiled" or expecting too much.

piggypoke · Jun 10, 2008

I am so sorry that you are having this difficult problem. No, I dont think that it is like that everywhere and I dont think that you were spoiled where you were before.

Unfortunately, It sounds like you and the other aides are not supported and that is unfortunate for the patients and you. I would start looking somewhere else, it also sounds like their morals are not right. I am a RN and I have made many aide visits to ensure that my patients are taken care of.

kayla123 · Jun 12, 2008

I am a Hospice RN and say that I could not function without my CNA's. They are valued members of the team, and we all function as one unit. Their caseload varies, usually 4 to 5 visits per day, if the pt's are particularly difficult I co-ordinate my visits at the same time. They do the baths, so they are my eyes and ears, and I tust their opinions. We have weekly team, and our co-ordinator makes sure they do minimal visits that day. EVERYONE participates in IDT, we all get along, we all help one another when needed, we call one another all day to discuss pt care, and sit down together to go over care plans. No, not all places are like where you work, believe me, I think I DID work there!! Our company motto is "this is the best job you'll ever have", it is true. You need to find a place that will support you, and respect the important job you do. :yeah:

koalalu · Jun 23, 2008

I am a Hospice CNA with 17 years experience and previously worked with an excellent Hospice where I never doubted my value. We were a team with prn employees to jump in so we could go to meetings or even jump in if we had a difficult case and simply needed a break. I have moved to SC and want to know if the following is just the "way things are here".
CNA's at my current Hospice...
*carry a caseload as high as 9 patients a day
*cannot go to IDG/inservices/support meetings unless we work a longer day or cancel pt visits(they advise us to do this)
*if a cna is out often the pt is called, told the cna is out (AND WHY THEY ARE OUT) and that they will have NO visit that day because of it-some aides are required to call their pts themselves to tell them they are out and ask them if they want someone else to visit(to save the supervisor the time)
We are exhausted and many are getting burnt out. Call ins are getting ridiculous because of this which of course doesn't help, pt care is going down due to time restraints with caseload or just exhaustion. Speaking to the higher ups about all of this did no good, they have been saying for two years now that they are looking for help, but they don't advertise. I gave it one last shot last week laying our issues all out on the table for them and letting them know that many aides are now actively looking for another job which would make us even shorter. I have an excellent reputation with my nurses and patients and told them I was on the edge of burnout and needed some help. They basically told me to keep up the good work and that things would get better. It was like talking to a wall.
So, was I spoiled by my other job where I carried a load of 5-6 pts a day, was able to attend meetings and know that my pts still received care?

I can't imagine how anyone thinks that is the norm to see 9 people in a day and do what we do. I rely so much on our HHA's as my eyes and ears on the days that I am not there. I also am having a problem with overload/burnout on my own caseload. I am now hitting over 20 clients and having to see average 6-7 with no overtime. That never happens and my question is if anyone knows of an actual medicare regulation/guideline that specifies the normal caseload for the RN or HHA. I may see 7 people a day and then have no room for the emergency or death. It was very upsetting this week as one of my patients died during the day and i was unavailable to pronounce. Another RN did the time of death and left a beautiful message from the family and boyfriend regarding how the client felt about her care. I spoke with the boyfriend who I had most communication. The sister had come to visit from out of town the day before her death so it was a very serene moment to be a part of that with all of them.

tencat · Jun 23, 2008

20 patients????? Good gravy. 9 visits for a HHA in one day????? Wow. I think it's time to 'vote' with your feet and get the heck out of Dodge.......Not possible to keep up and do a good job with that many patients.

CANRN, MSN, RN · Jun 24, 2008

I can't imagine how anyone thinks that is the norm to see 9 people in a day and do what we do. I rely so much on our HHA's as my eyes and ears on the days that I am not there. I also am having a problem with overload/burnout on my own caseload. I am now hitting over 20 clients and having to see average 6-7 with no overtime. That never happens and my question is if anyone knows of an actual medicare regulation/guideline that specifies the normal caseload for the RN or HHA. I may see 7 people a day and then have no room for the emergency or death. It was very upsetting this week as one of my patients died during the day and i was unavailable to pronounce. Another RN did the time of death and left a beautiful message from the family and boyfriend regarding how the client felt about her care. I spoke with the boyfriend who I had most communication. The sister had come to visit from out of town the day before her death so it was a very serene moment to be a part of that with all of them.

I am thinking the case load is 12-14 patients. that is where they try to keep us. It was posted a few years ago, Not sure if it is medicare reg or not. Just the standard. I wish you luck, I don't know how you do it!

Cindy

southcarolina716 · Jun 30, 2008

We have nurses where I work that are also carrying 20 and more at times. They are some of the best nurses I have worked for and I amazed they stay to be honest. I just don't get it at all. I've never worked for a company that truly doesn't care about those of us on the front line. I went to one of our "Support Groups" and two things made me drop my jaw...first they opened the meeting saying this was "not the place to discuss problems or concerns with our work"(???) Then a couple people there started crying as it was the anniversary of a former employees death and they said "lets not discuss that here, but maybe during the day you can talk to those coworkers that didn't know her and tell them about her". I'm sorry but I was dumbfounded, I personally had to shift around a lot of patients for this mandatory meeting. I don't think a support group should be a ***** session, but I do believe if you have a difficult case it should be a place where you could toss ideas around....anyhoo tired of whining on this job I'm actively looking for another, but going to be asking a lot more questions during the interview process this time around. Thank you everyone for letting me know this isn't normal down here.

finn11707 · Aug 11, 2008

Carolina---you were not 'spoiled' by your prior job. 5-6 patients per day is the average expectation of most Hospices truely dedicated to the Hospice work. I encourage you to seek agency where there is an understanding and respect for the work we are committed to in Hospice. Dedicated hospice workers are in high demand.