part time Rn casemanager, full caseload and Lvns in office

  1. Scenario 1: hospice nurse part time working 3 days a week. Should it be ok for the manager to make
    that nurse take a full caseload? Caseload of 13. Rn visits twice a week on each pt. Rn is to do both visits.
    Thats 26 visits in 3 days. I know of fulltime Rns who have less pt than that. Anyone want to comment?

    Scenario 2: hospice Lvn who is strictly an office nurse. Ordering meds. Does not do visits, unless absolutely
    has to. No other backup nurse in office. Other Rns are treated the same. Is this similar practice to other hospices
    out there?

    It seems to me that things are going backwards, and have been for a couple of years now. The Lvns
    are staying in the cool, comfy office environment while the Rn "field nurses" are digging the trenches. I'am sorry,
    I just hate the term "field nurse", Iam not a mouse. I am an Rn. And lastly, I am not picking on Lvns because
    of this, this is managements decision, not theirs. But could anyone tell me why this is happeneing?
    Please comment, Thanks
  2. Visit americanTrain profile page

    About americanTrain

    Joined: Jul '08; Posts: 109; Likes: 49
    Nursing; from US
    Specialty: 14 year(s) of experience in ICU, ER, MS, REHAB, HOSP ICE, LTC DON


  3. by   caliotter3
    Well, I'm an LVN who wishes she could get an office job. I guess these agencies can't find RNs to work for low pay.
  4. by   tewdles
    case managing 3 days a week with 13 patients is a lot. My experience is that if you are carrying that load you generally have another nurse, often an LPN, who can assist with visits leaving you to visit patients and attend to the management of their care. 12-15 patients is pretty standard for a FT RN...more if they are in facilities (less drive time).

    Many hospices use LPNs in the office to carry out functions for the case nurses...a secretary cannot reorder a patient's meds (one example), it does not require an RN, and it is nice if they don't have to interrupt the CM for those type of things.
  5. by   americanTrain
    True, but when management keeps saying, we will hire a new nurse when we get our census
    to ---- or ----; and when we reach that limit and over, she changes the numbers on us. I know
    is all about the almighty dollar and when she makes the company money, she looks even better.
    Problem is, the owner of the company knows 1/8 th of what goes on in that office.

    I turned down a medical reviewer position with blue cross and blue shield to stay where I am,
    but now my husband says: dont you regret it now. Yes, I think I do.
  6. by   ErinS
    Yikes! I am super spoiled- we have a large RN office staff, and all full time RNs in the field (no lpns). Our management is trying very hard to had case managers just ahead of growing census. I am currently managing 15 patients and am full time. I think 13 is way too many for a part time nurse, unless most are stable, once a week visits. 5-7 visits a day is comfortable for me, more is pushing it.
  7. by   americanTrain
    I was told that unless I had 7-8 visits a day, I shouldn't ask for a back up nurse. The lVN gets mad everytime
    you ask for them to see pts. LVN wants to stay in the office, looking at facebook, searching internet and downloading pics and music, etc. The other day, she told me that she couldnt see pts, because she was going shopping for a new....../ Now the manager knows this and she is tolerating it. What kind of brown nosing is going on here? All of our Rns are angry about this, whick makes for poor morale in our office. We our tired and overworked. We are planning on getting together for a meeting where this will all be brought out in the open. Even if it means losing my job, I will not take this anymore. Miss nice guy has just gotten to the boiling point.

    And get this, Iam working over 34 hrs a week (this is not part time) and I dont get paid fultime benefits like everyone else. I get the feeling that they are trying to push me hard to make me leave.
  8. by   Hospice Nurse LPN
    Quote from caliotter3
    Well, I'm an LVN who wishes she could get an office job. I guess these agencies can't find RNs to work for low pay.

    I agree! While I love my pts, it would sure be nice to be in the cool office in the summer instead of getting in and out of my car where the thermometer reads 105!
  9. by   Hospice Nurse LPN
    american train--I think I'd be looking for another job if I were you!
  10. by   AtlantaRN
    i wouldn't do it......part time pay for a full time job.....

    don't walk-RUN

  11. by   caliotter3
    Quote from Hospice Nurse LPN
    I agree! While I love my pts, it would sure be nice to be in the cool office in the summer instead of getting in and out of my car where the thermometer reads 105!
    Yeah. I agree. Also, I am good at administrative work and it certainly would suit me to have a steady job with less likelihood that my boss is going to can me on any given workday. Right now I'm sitting on my behind for one whole week because my client is in the hospital. I'm supposed to hold my breath by a phone in case I get the call to run over there at the drop of a hat. Phooey.
  12. by   americanTrain
    While I hate changing jobs, Iam in the process of looking for another job. 8 out of 10 days
    I feel like Michael Douglas in "Falling down" the movie. Just get out of the car and start walking,
    do not look back. Anyone who has seen this movie knows the feeing I'm talking about.
    After a night out with the girls last night and a little advice from them, I know Iam truly burned
    out. At this point I might even consider changing careers, because in the last 8-9 years, I have
    realized that I have never been unhappier with my career, than before I started nursing.
    I thought hospice would be the answer, because it was what I always wanted to do.
    Now, feels more like the med surg floor from an automobile.
  13. by   Leda1st
    American Train: I swear we must work in the same office. I am serious. Unfortunately, I do not feel safe indicating where I work. I, too, am looking for a new job. The director of the company I work for is definitely more interested in the bottom line (and padding her salary) than in patient care, although she puts on a good show when she needs to do so.
    We have one LVN who is very willing to see patients, another who is definitely NOT willing to do so (unless specifically told to do so by the PCC). We also have caseloads of 16+ (which might not be a lot for some people, but literally ALL of the nurses in my office are about a week or more behind with documentation, even when putting in the extra hours) and are expected to take call and do admissions. I always work at least 50+ hours per week (usually more) salary. I and the nurses in my office have stated multiple times that we are overwhelmed and that we need to have more manageable caseloads, but when this concern is addressed, the director mentions the census - basically, the caseloads have to get high enough (too high) that it warrants hiring a new RN, and then the caseloads drop to a manageable level for awhile - and then the cycle begins again.
    It is very sad to me as I truly love hospice and my patients and families (and most of the nurses with whom I work). It just feels as if I am being sucked dry.
    Nursing (especially hospice nursing) IS a "calling", but for me, being a wife and mother is also a calling - and for me personally, it is a higher calling than any career. I just don't feel I have the time and energy to give to my family with this job (and my family confirms this).
    Hopefully, I will be able to find a position at an agency that has more ethics than the one where I currently work - I will, however, have to be very careful when I apply, as every agency is going to claim to be ethical and "patient centered" whether they are or not. American Train, I hope you have had good luck - please wish me the same!
  14. by   tewdles
    you are being sucked dry and you need to move preservation of self. Not all hospices treat their staff in the manner you have experienced.

    I too have experienced the type of management practices you have described here...these are not places where you want to stay for any period of time because it is clear that the field nurses are not valued by the company. You MUST seek other employment if you want to remain emotionally healthy in hospice...IMHO.