Need your input before we all quit.......

tencat · Oct 28, 2007

Thirty?????? ARE THEY CRAZY?????? Holy cow...I struggled with 15. If you are driving to different places during the day, how the he-double hocky sticks can you adequately care for 23-30 hospice patients? Even if they are in one place, you'd be hard pressed to give them the time they deserve. I very nicely (but firmly) told my boss I would really love to be able to take more patients, but I cannot take more than 13 and give them the care they need and deserve as we travel all over God's Green Earth. Some people I work with do well with as many as 15. Maybe you all need to quit to get the message to administration that 23 is WAY too many patients. With too many patients and not enough resources (ie: employees) you end up giving sub-standard care and making patients very unhappy. Then your hospice gets a bad reputation for bad care........then you end up not having referrals......maybe if you can show that the bottom line will be affected the powers that be will listen.

aimeee, BSN, RN · Oct 28, 2007

We staff for caseloads of 10-12. We have gotten as high as 18 at times when census boomed and we couldn't get people hired and trained fast enough. If we have an RN/LPN team it might go as high as 22 between the two of them. An RN/LPN team cannot handle as many as 2 RN's however, because the RN has to spend a lot of time in supervising the LPN and doing the careplanning. We usually use the RN/LPN teams mainly for nursing home patients. Oh, and we have a dedicated oncall team and an admissions team too.

lesrn2005 · Oct 30, 2007

I notice you're in Florida, where? I have a caseload of 10.

Sabby_NC · Oct 30, 2007

I work for a non profit Hospice who is killing their case managers. I manage 20 patients with no other nurse to help me. I also do my own admissions. I have been told I must have 23 patients then I can get a part time LPN to form a team. Other case managers have anywhere from 23-29 patients and they all have full-time LPN's working with them. I was actually belittled on the phone a week ago during a time when I had 2 particularly demanding situations. I asked for one of the PRN nurses to come help me for one day to see some of my stable folks. One of my patients with Lung Ca was transitioning and in a nursing home. Her sweet, devoted husband promised her she could go home to die. The HHA that works with me and myself both spent hours with them daily teaching him how to take care of her at home. This was a Monday when she came home and Friday she expired. This was a true labor of love. They were a beautiful, lovely couple who had been married for 51 years. During the same week, I had a pt transferred from Hospital home on TPN. Dx was stomach ca with mets to liver. I had to teach his extremely nervous CG how to use the pump, manage his meds etc. I went every day at 4pm and spent no less than an hour and a half with them. I even made the visits on my weekend off and after my regular hours when I wasn't on call for continuity of teaching. During this particular week, I had 18 patients. My supervisor's statement to me was "why are you having so much difficulty with 18 patients when other case managers have almost 30"? my answer: "they have an LPN to make visits and I dont". She was nasty to say the least........................so after this very long post my question is please list the amount of patients you are case managing and if you have a nurse that helps you. I am going to take the numbers yall provide and turn them into management. I won't copy any user names. I just need the statistics. Any help will be greatly appreciated.

Oh dear you sound like a very caring and loving person.

Ask yourself how can you honestly care for this many people and give them all the care that they need.

We manage up to 12 for full time Case Manager although I have had 14 and that alone kept me running with CVC's flushes, yadda yadda yadda. I had no help for two weeks with my LPN out on vacation and ended up in tears the last Friday because I WAS EXHAUSTED.

I got help and all worked out well.

Personally I would not work for a company that demanded me to take that many people ESPECIALLY dying people. They need more of your time, your love and your knowledge.

Can you run to another hospice agency?

Non Profit Hospice agency such as the one you are working for sounds to me that they are after as many patients as they can to get that money honey!

You cannot effectively look after up to 30 patients in hospice. That would mean you are doing 6 regular visits a day without the fact that you may need to be at a death, you may need to be admitting a patient to hospital etc.

I think that is most unacceptable to be doing your own admits too, we have admit teams and that works very well.

You are going to be burnt out before you know it.

Please take care of yourself first and formost.

Think- Do you really want to work for a company that works you like a dog.

Don't get me wrong I work hard with my case load but I think yours is very unreasonable.

Bless your heart do let us know what you decide to do. *hugs* s20hug3.gif?t=1193741209

shrinky · Oct 31, 2007

Maybe they, meaning management, need to get back in the field and care for patients again. This is the craziest thing I have heard. I work for a non profit Hospice also, but we case manage 8-10 patients although in my time I have had 15. I have 3-5 patients and do 99% of admissions and we hope to relieve me of my case load so I can be more available for consults, etc. How can anyone give so much of themselves? You all will burn out if they continue to push you so hard, my hat goes off to you and if I had a wig on that also would come off. It seems like they are trying to make a profit by killing you all in the process. Please forward to them if possible. I am glad my bosses are more understanding and stick up for us to administration. We are hospital affiliated and I will not show this to them or they might get stupid ideas.

AtlantaRN, RN · Nov 1, 2007

God BLESS YOU!! I have 14, with 10 of them being in facilities, and two are a husband and wife in the same home. All of mine in facilities are stable, and the home patients fairly stable.

The other nurse is PRN, and she has 10 patients right now, most of them cancer and a few of them alzheimers. She is running her TAIL off! ((I help her)). They say she can't be full time until she is up to 15 patients, and we are admitting 2 tomorrow.

all the while the secretary doesn't show up, or if she shows she is late and leaves early, and administrator is on a 1.5 week vacation......

Normal load is 12-15, but truly I am blessed with stable patients, at this time.

I would be looking for another job, because HOW can you possibly see 23 people and all that driving too? I guess it would be possible if they were all in ONE retirement high rise, where you had no driving, but still; all those calls to family who aren't present, THAT is what REALLY can take up the time.

God bless you dear one, and may God lead you in the right direction.

linda

introspectiveRN · Nov 3, 2007

Before I quit my last hospice, I had a case load of 21 pts...all of them homecare and I was absolutely at the end of myself. The case load you are trying to juggle is insane...I dont care how stable they are (or aren't) or even if they were all in one facility...it's just too darn many. You can not possibly be keeping your documentation even close to up-to-date (I sure wasn't), let alone really being able to be available for your patients. You must be drowning.

I changed hospices and now I am despairing of ever finding a hospice that is what I am looking for. (that's another conversation).

Here is the trend I see that you are currently battling with:

Just like any other business, hospice maximizes profit (even "non-profits" make a profit BTW) by increasing billiable patient caseloads and decreasing staff. This hits the case manager hardest. They also maximize profit by minimizing other costs like supplies and pharms. This also hits the case manager the hardest. They also maximize profit by recerting people or even admitting people that are NOT hospice eligible even according to medicare guidlines. I was actually told by my last PCC that I was not allowed to discharge anyone until I had a referrral for a new pt. :angryfire. Oh, and yes, the marketers make the money for the referrals that I am generating. BTW that is MY license on the line if I recert someone who is not eligible. The hospice I work for takes the financial kick in the teeth...but I take the legal (and ethical) hit if I recert someone who does not qualify. I would like to add that your manager probably generates bonuses for him or herself by proving that they have reduced cost. My manager made bonuses depending on our census (if it was high enough) as well as our overall operating costs (if they were low enough). IMHO you are wasting your time to try and show a manager that your caseload is untenable. She already knows that. She does not care.

I think the case load that you currently have is nothing short of abusive. You are an RN for goodness sake! you can get a job a.n.y.w.h.e.r.e.... (preaching to myself here too).

Good luck, dear. :balloons:

Allow Mystery · Nov 4, 2007

Dear introspective,

ditto....ditto....ditto.... I share your exact thoughts. I had resigned for

5-6 weeks, pondering a new career, but was begged back and felt responsible for leaving patients in a lurch. At lunch with one of the owners I shared my concern about losing my license because of a recert/admit that didn't meet criteria for Hospice, and I was told that

this would never happen, that the agency would be the one to incur the punishment with fines. I'm still uneasy about it, and this may be a good time to get other opinions/clarification.

ray2512 · Nov 6, 2007

Maybe its time to start a National Hospice Nurses Union!

introspectiveRN · Nov 7, 2007

nope. :nono: no way. :nono: no how... :nono:

because:

in order to start a union we would have to do more paperwork. :lol2: :lol2: :lol2:

KJB_65 · Nov 8, 2007

Thanks for all of your replies. I have compiled the average number of patients that you all said you manage and have given it to my administrator & supervisor who by the way just put in her resignation. Nothing I give them will change the situation and I am actively looking for a new job. We are certificate of need and only 2 hospice agencies in my city. I may have to go back to home care which makes me want to throw up. I'm just not sure what I want to do. I'm disenchanted with my career to say the least. Thank you again.