Normal Working Conditions for Hospice RN Case Managers?

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Hello,

First post here. I started my nursing career in private duty home health and after a year started working in Tele at a local hospital. I dreaded each shift, it was far too busy, and most nights I was not getting home until 2200. I left after 8 months and took a good hard look at what I wanted out of nursing. I didn't have a lot of experience, but I applied to Hospice companies as I have always agreed with the hospice philosophy and was attracted to, what appeared to be, a 9-5 M-F gig.

I have been with my hospice company for 6 months now and I have never been so over-worked and exhausted in my entire life. It started out fine, but within a month I was working 10-20 hours of over time a week, with maybe a week or two where I actually worked 40 hours. I'm salary so all this extra work is just that - extra work. A large part of the problem is that I would have 8-10 patients in one area, and then 4-5 that are scattered about the Phoenix metro, which makes for a lot of additional travel time and mileage on my personal vehicle. And if one of those patients transitions, has a fall, or something else comes up - i have to rearrange my whole schedule in order to accommodate a visit, which has caused issues with other patients, but there simply aren't enough hours in the day. I'm lucky if I get any kind of break during the day, save for a quick 5 minute run to the bathroom. I usually finish around 2000 or 2100, leaving me hardly any time at all to have a life outside of work. Our company recognizes 6 holidays, but forces you to use your accumulated PTO to take the day off. You are not allowed to work if you weren't selected to cover the holiday. My two days off a week I spend mostly laying in bed, hoping I have enough energy to conquer the next week and keep my patients and their families happy and comfortable.

Basically, these working conditions are not sustainable. I absolutely love caring for these patients and their families but I can't take the over time or the lack of a life anymore. Are these conditions unique for a hospice case manager or is this simply the norm in this specialty? I fear that things will not be different at any other company and my days in nursing will come to an end. There are so many more careers that are as equally rewarding and do not demand so much sacrifice.

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I work in hospice and some days are ok but most of my days are pretty crazy. I have a huge territory, generally have 2-3 patients always declining or dying, and frequently have emergencies. We are expected to see at least 5 patients a day but 6 is preferred. Im generally always done with visits by 5 but then i chart...We also take call. No, its not really sustainable.

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Specializes in Primary Care, LTC, Private Duty.

I love hospice work (i.e. the actual nursing care for hospice patients), but I swore I'd never go back after what I saw while working (very, very briefly) as an RN Case Manager in hospice. Sadly, like so many other avenues of nursing, hospice nurses are overworked, underpaid (especially if on salary), and unappreciated by the Powers That Be (administration, etc)---especially with these huge, multi-state corporate hospice companies where the only policy that counts is "easy come, easy go" with their staff.

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Specializes in Nurse Leader specializing in Labor & Delivery.

What's your current case load and how many patients do you see in an average day?

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Right now I have 13 patients, all but one are 2x wk and I have one I'm seeing every day. Most days are 6-7 patient loads, with Wednesday having 4 to "accommodate" staff meetings (who am I kidding, this is the day I finish the latest). These are new patients however, they've changed my assignment at least five times, and I've only been here six months. It's mostly been due to staff coming and going so quickly, which has been a common theme in this thread. It's very difficult to adjust to 12-14 patients all at once every few weeks and go through the motions of introducing myself to family, doing med recs, form audits, supply lists, etc. The first few weeks always takes extra time anyways due to all the aforementioned, and then they give me a whole new bunch in another few weeks. Sometimes I wonder if they want me to quit.

I actually told my boss once that my goal was to have ALL my work done at five so I can actually plan a life for myself outside of work. She just smiled and nodded. I frequently hear the "I love what I do so I don't mind" mantra. Obviously I understand that sometimes I'm going to have overtime, and I'm ok with sometimes, but not ALL the time.

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Specializes in Geriatrics, Dialysis.

I don't work Hospice home care, but I have a few friends that do. My case manger friend left for exactly the reasons you are complaining about. She expected as a case manager her work would be primarily Monday through Friday 9-5 and as you are finding out the reality is far from that. Between wildly fluctuating census, the massive amounts of after hours documentation and the not openly disclosed amount of regular nursing shifts she was expected to cover when no other nurse was available she was consistently putting in at least 50 hour weeks and more commonly 60 hours or more. Those complaints don't even cover the physical territory she was responsible for. Tons of driving time frequently involving bad weather, construction or just plain bad to nearly nonexistent roads for the most rural of her patients. She lasted less than 6 months before she left and I don't blame her a bit, being salary that was just too much free work she was giving her employer. Things might have been different if she was paid hourly and at least got compensated for all the overtime she put in.

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Specializes in Med/Surg/Infection Control/Geriatrics.
Hello,

First post here. I started my nursing career in private duty home health and after a year started working in Tele at a local hospital. I dreaded each shift, it was far too busy, and most nights I was not getting home until 2200. I left after 8 months and took a good hard look at what I wanted out of nursing. I didn't have a lot of experience, but I applied to Hospice companies as I have always agreed with the hospice philosophy and was attracted to, what appeared to be, a 9-5 M-F gig.

I have been with my hospice company for 6 months now and I have never been so over-worked and exhausted in my entire life. It started out fine, but within a month I was working 10-20 hours of over time a week, with maybe a week or two where I actually worked 40 hours. I'm salary so all this extra work is just that - extra work. A large part of the problem is that I would have 8-10 patients in one area, and then 4-5 that are scattered about the Phoenix metro, which makes for a lot of additional travel time and mileage on my personal vehicle. And if one of those patients transitions, has a fall, or something else comes up - i have to rearrange my whole schedule in order to accommodate a visit, which has caused issues with other patients, but there simply aren't enough hours in the day. I'm lucky if I get any kind of break during the day, save for a quick 5 minute run to the bathroom. I usually finish around 2000 or 2100, leaving me hardly any time at all to have a life outside of work. Our company recognizes 6 holidays, but forces you to use your accumulated PTO to take the day off. You are not allowed to work if you weren't selected to cover the holiday. My two days off a week I spend mostly laying in bed, hoping I have enough energy to conquer the next week and keep my patients and their families happy and comfortable.

Basically, these working conditions are not sustainable. I absolutely love caring for these patients and their families but I can't take the over time or the lack of a life anymore. Are these conditions unique for a hospice case manager or is this simply the norm in this specialty? I fear that things will not be different at any other company and my days in nursing will come to an end. There are so many more careers that are as equally rewarding and do not demand so much sacrifice.

This is why I no longer do Case Management. It might be wise to sit down with your nurse manager and share your concerns. If they can't reduce your case load or at least keep you in a certain radius, it might be time to leave before you become physically ill.

If you enjoy Home Health or Hospice could you perhaps offer to be hourly or PRN? It sounds as though they have enough cases to keep you busy and you could refuse certain cases if you were PRN. When not needed for PRN, you could do some visits for Home Health and possible full time. Just a thought....

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Specializes in Travel, Home Health, Med-Surg.

This is exactly why I left Home Health. Never enough time between running around and seeing patients (wear and tear/gas and time spent driving), calling Physicians/ PT/OT/ pharmacy etc., charting (charting!!), taking phone calls, it seemed never ending and was definitely not worth what I was being paid. I would try to speak to admin/DON first because you never know, they might decease your load a little, but if that doesn't work and you decide to leave, next time bring up the time factor in your interview and be clear how many hours you are able/willing to work. However, I am afraid most nursing jobs are like this but hopefully you can either make this work for you or find something better for you. Good luck!

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