I have been a hospice nurse for eight months now and my caseload just keeps rising and rising. I currently have 16 patients. All of my pts are hospice, my agency does not do home healthcare. We see pts four days a week and do patient care conferences one day per week. We are expected to see pts on meeting day, but since meetings and care planning takes up most of the day...only 1 or 2 pts can be seen that day. I am finding it hard to give these pts what they deserve. I used to see each pt 2-3 times per week, daily if the need was there. Now I see my stable pts once per week and everyone else 2 times per week. It just doesn't seem possible to give the families the emotional support they need when I have to get in and out of a visit within an hour so that I can squeeze in 7 pts in an 8 hour day. I love hospice care, but I am feeling burned out from the load of work. We also have a lot of on-call. I am on-call approximately 5 week days of the month (5p-8a...this is after working 8a-5p) and I am on call for three 12 hr shifts on weekends. Luckily our triage is good and I don't get called out that often...but having to put my own life on hold is getting old.
How many pts do you take care of? How many visits per day do you do? What is the maximum amount of pts that your agency can give you? What is your on-call like? Do you case manage as well as do the visits? Any input would be appreciated. I would like to see how my agency compares with others. I don't know if I am overworked or just not organized enough to keep up.
May 23, '03
I think most nurses are over-worked, in fact I know it.
I used to work hospice, inpt acute care. At first, we had nurse to pt ratio of 1: 3. Pt care, and care of the family was top notch, absolutely the best. Then, the work load kept increasing, up to 9 extremely ill, in crisis, actively dying pts and their very stressed families. On top of that, we got all the after hours phone triage for our entire state in our unit, along with our pts to care for. I don't do home care, but I sympathize with you in your frustration.
May 23, '03
16 patients is a very full load. Our case managers are carrying loads like that right now and we are working to hire more nurses to make the load more manageable and spread the on-call burden. You are right. You can't give the kind of care you need/want to with that heavy a case load. If this is a temporary fluke, that is one thing. But if this is a trend, and your management has made no plans to accomodate a heavier census, something has to change or patient care will suffer and staff will burn out and leave.
May 23, '03
Interesting thread. I am interviewing today for a hospice position. The HR person said the case mangement load was 13 to 17 patients! I thought that sounded over-burdening.
I hope it eases up for you somehow FrankieJean.. maybe a team meeting to see how other nurses are coping? And to think how alone you are in the field to care for their needs. Do try to "pencil in" time for yourself.
May 23, '03
We had a team meeting in Feb. to discuss how the nurses felt. This took place after three nurses, a chaplain, and a social worker all threatened to quit at the same time. Everyone on the team is so overworked...we had people in tears at the meeting. Several nurses have gone off the road while driving because they are so exhausted. At the time of this meeting, my caseload was 13. As you can tell, things have gotten worse, not better. I have one nurse on my team that works in a very rural area...and her pt load is now 18 which is even harder to manage because she has so much driving time between patients. To top it off, they got rid of our LPNs who used to help us out with visits.
I really don't want to quit because I love what I do, but if the caseload continues to be this high...I will have to do something. The manager I have is new. He is very nice and understanding...he used to work in my position. Unfortunately, the upper management is more worried about saving money than it is about pt care. My manager has the ok to hire one new nurse, but so far no one wants the position. Our team actually needs two more full time nurses. Our two part-time nurses carry a load of 10-15 pts. I swear, I'm ready to just get out of nursing. Massage therapy here I come!
May 23, '03
Sounds like you may have some difficult decisions ahead. Look out for your own needs and be firm about it...if you don't, nobody else will. Don't wait until you are at the breakdown point before you take action!
(I have a new motto: Nobody can use you for a doormat if you are standing straight and tall)
May 25, '03
I just interview for hospice. I do not know the total patient load. I will be a per deim relief nurse. I was told that a nurse normally sees 4 patients a day. So if there are couple of admissions, a death or some other thing like this, then the perdeim would likely be called to pick up a couple of the patients. "As the nurse would not be able to handle it all."
May 31, '03
Our facility has just instituted another job for the nurses. We are supposed to call the MDs of our pts with a verbal report (in addition to the written report we already do) and then inquire if they have any other people in need of our services. Do any of you have to actively recruit pts? Our facility already has people whose only job is to recruit and do sign-ups. Of course the nurses are not happy about this. The last thing we want to do is get additional pts when we are having trouble taking care of the ones we have now.
May 31, '03
We do encourage face-to-face contacts between nurses and MD's as much as possible. But to promote overall good relations than rather actively solicit patients. I would think that if you were already calling the MD to notify about major changes in patient condition or to get orders, then calling routine reports would be viewed by them as a nuisance.
Jun 6, '03
I am not telling you anything that you don't know but your patient load is too high. I haven't worked in Hospice for the past 4 years (hope to return soon) and we felt our census was high if we hit 12 or 13 We aimed for around 10. I covered a huge area so it was a struggle to see more than 4 patients a day....5 was really the max.
But what to do? We all know of the nursing shortage and while some employers are just trying to be cheap, others are really struggling to fill positions.
A band-aid solution (won't fix anything but might buy you time) is calling the more stable patients more frequently and "checking In" . Sometimes families can get by without a visit, especially if you have a good volunteer and/or home health aid who can help meet some of the family's psychosocial needs. Also calling in might alert you to some of the issues or concerns so you can hit the ground running when you do get there.
None of this is ideal Hospice care and most of us deeply value the ability to give our patients the kind of care they deserve and it's tough (if not impossible) to do that when you can't slow down to catch your breath.
Take care and let us know how you are.
Jun 7, '03
Hubby runs a hospice and says 16 is high. I am curious is your hospice a non profit or for profit?
Jun 7, '03
Wow, 16 is very high. I am a hospice coordinator, and I try hard not to let anyone's census go above 12, unless all patients are in the same facility. We will on occasion have 12+ patients at our Hospice House. If a nurse see most of her patients in their own home, 10-12 is max. We have an admission nurse who does most of the admits, and two weekend nurses who work every weekend. Our nurses take call 2 weekday evenings from 430-9, and one saturday every 10 weeks.
Jun 21, '03
It's been a while since my first post. 12 is considered a full load. We have a nurse that does admits. A week end nurse, and 2 perdeim nurses that are trained to do it all. (I am perdeim) Our census lately has been around 32. We have 4 case manager nurses.
We have 3 social workers. One is part time and works only brivement, one chaplin. We are working on hiring another, (perdiem I think). We have a part time volunteer coordingator and a secretary, and a medical director. The pharmsist comes from an outside pharmacy but she is considered "ours" as she is the one who serves our patients and she attends the IDT meetings
Our nursing supervisor is actually running two offices, but it works.
We are non profit.
I have learned that hospice is NOT a money maker for anyone and that is why the area beyond my home is not served by anyone including the hospitals that are there. There no hospice available for several hundred miles past where I live though the need in tremdous.
My little community is the geographical cut off.
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