How much is too much

We are having trouble keeping our hospice aides. Management then asks nurses if they can bathe patients and this is fine with me if I have the time. The dilemma comes in when I don't have the time, when I have an already full caseload and I can't promise I can bathe a patient. How much of bathing is the case manager's responsibility and how much is this managements responsibility? And if a hospice is not staffed to give adequate care by the interdisciplinary team, isn't that a problem?

There were a couple of times when I went to a patient's home and found the patient in urgent need of cleaning/washing - Of course I would do that with my visit, which does not take that long if you just focus on the urgent need.

However, I did not replace the HHA. A nursing hour is much more expensive than a HHA hour. There must be a reason why HHA leave. Are they getting paid enough? are their patients close together so that driving is not too much? are they being treated with respect?

Generally speaking - if you know that you do not have the time to bath a patient you need to tell the manager straight up that you can not do it because you have a full caseload.

HHAs must be provided as part of the hospice benefit, if the family chooses. The HHAs are usually the most stable employees -- it has always been the nurses who leave quickly in my hospices.

I left my last hospice agency because we went ove 2 months without any HHA - and the Rns were expected to do aide visits with ur RN visits (while still doing a regular caseload of RN visits in a day) it is *impossible* to do both RN and HHA visit on 6-8 patients in a day in under 10 hours. I was working 60+ hour weeks, as were all th eother nurses I worked with. Within a 3 week period, they lost each of us...so they were down to 1 full time on call night nurse, 1 per diem, and 1 part time LPN. It was only them that they managed to find aides to hire!!