Hospice Inpatient Unit

sharlynn · Jan 20, 2008

That seems like a very high ratio to me.

Are they always full? How many aides are there, and does the number of aides depend on the census?

Our IPU has 12 beds, but anywhere from three to ten patients at a time since I have worked there. We usually have two nurses, but if the census is low ( four or less), we may staff a nurse and an aide. If the census is over six or seven we usually have an aide, and two aides if it is higher.

I have had as many as three deaths within an hour and a half, but fortunately that is not the norm.

leslie :-D · Jan 20, 2008

we have 1 rn for every 4 beds, and sometimes that is too much.

sometimes all i can handle is 2.

our assignments change on a daily basis.

1:8, in an ipu, sounds totally nuts.

i wouldn't touch it.

leslie

Rnmomajmj · Jan 20, 2008

This is a new IPU opening up. From what I've been told they may have an aid for a portion of the day, just until the baths/linen changes are completed.

I thought that 1:8 was kind of high but haven't done this before. When I worked at a NH a few years ago, we had GIP patients there. I worked 23 NH patients along with any GIP patients we may have. Sometimes there weren't any and others we could have three. That seemed to work well but we could call the hospice if there were "Issues" and their nurse would come to assist. I just don't want to get in over my head. I know charting needs to be completed every two hours on each GIP patient, and I'm sure family dynamics could take up time.

If any of you who work the IPU could give me an idea of a "typical" day it may assist me in making a decision. The 12 hour shifts are drawing me in plus I won't have to worry about driving around the city. (I'm new and not real familiar with getting around yet.)

Thanks!

sharlynn · Jan 21, 2008

I work nights and turned down a day position recently. It just wasn't worth the decrease in pay to work so much harder on day shift!

All three meals are on days. Most, if not all patients need to be fed or at least assisted. Sometimes family members can help.

The doctor rounds on day shift, so all the orders have been carried out before I get there.

Admits come during the day shift. Enough said! Respite patients go home during the day shift, too.

More visitors come during the day or early evening. This means alot of time talking to them when you have a ton of charting to get to.

Baths are shared by both shifts where I work, so that is equal.

Add to all this the three PCA or feeding pumps that run dry at the same time or the call lights for pain pills and you'll meet yourself coming and going!

Sabby_NC · Jan 21, 2008

I'm considering switching to a Hospice Inpatient Unit. It will be 12 hour shifts, three days a week. They have 16 beds and each RN will have 8 patients. Can someone give me an idea of just how crazy it can get? Any information would be greatly appreciated.
Thanks

I do not see how you can effectively give 8 dying patients all the care that they need.

If you have actively dying patients they are going to take up more of your time because they need that love and care.

Personally I would tread carefully.

Ensure you know all that is expected of you before you sign on that dotted line.

Do what your heart tells you.

Ask if you can shadow a staff member for a while and then you can make a better informed decision.

I wish you well Hospice Nursing is awesome. :specs:

Rnmomajmj · Jan 22, 2008

Ok, here is an update. Finally got to speak to the Exec Director today.

15 Beds, although they say that not all beds will be filled in the beginning they plan on each nurse having 4 patients, CNA from 8-5, will also have a nurse manager there who is to jump in if the need is there. Three 12 hour shifts per week. I guess wrong info was given to me last week I believe this sounds better?? Will still have to interview for the position.

Any thoughts with the new information.

leslie :-D · Jan 22, 2008

i think it depends on the acuity levels.

my patients are not only dying, but they're not dying quietly.

many intractible and escalating processes that are challenging to contain.

actually, i do work in an icu for palliative/hospice care.

still, it all depends on the acuity of your pts and how well they are being maintained on their meds.

also, family members take up a big chunk of the shift...

as well as doctors, although ours jump right in to help us.

but yes, 4:1 sounds much more doable.

best of everything.

and keep in touch!

leslie

sharlynn · Jan 24, 2008

I agree that 4:1 sounds much better.

Good luck with your interview!

vwevans, ASN, RN · Jan 29, 2008

We have a 5 bed inpatient unit. I staff 1 RN and 1 CNA on the day shift and one RN and one LVN on the night shift. As the manager, I am also available to help. Our SW is on the unit 20 hrs. per week helps as needed also. I would never have a 1:8 ratio. In order to give quality care and educate families you would never be able to do it well. I find it to be an emotional ride and not just the physical work that you have to deal with.

Allow Mystery · Nov 23, 2008

In reviewing these older postings, I'm getting many answers

Whispera, MSN, RN · Dec 3, 2008

Where I worked the ratio was 1:8. One RN with one aide. I can tell you that it could be extremely busy and overwhelming. While the manager was "available," she often wasn't really available. Admits took about an hour. Meds can be numerous. Pain control can take alot of doing. Emotional support takes lots of time. I think a ratio of 1:8 is too much, but "they" (the people who set such standards nationally) think a ratio of 1:12 is reasonable!