Is it me, or is this job too much?

  1. I'm an experienced LTC resident care manager with a case load of 40 residents right now, 13 of whom are skilled/rehab patients, another 12 are young adults with drug/ETOH/failed suicide/psychiatric issues, and the rest are long-term ICF residents. I've been putting in 50-60 hour weeks, taking work home, and every time I get even close to catching up I get 2 or 3 admits in one day. On top of this, I'm expected to drive the nutrition-at-risk committee, attend meetings every day (sometimes as many as 3, and some of these last 2 hours or more), help the charge nurse out on the floor, do 1 1/2 hours in the dining rooms once a week, and do complete skin assessments & documentation on everyone with skin issues (that's at least 8 residents right now). THEN, in my spare time, I have to investigate each and every incident report (roughly 20 or more per week with the young adult unit and the 2 or 3 residents who fall every couple of days).

    Honestly, if I worked 80 hours a week, I don't think I could do everything this job requires of me. I'm such a perfectionist about getting my paperwork in on time, but I'm so far behind now I don't think I'll ever catch up. State surveyors are expected any day now, and I KNOW things are a mess, but I can't do all of this myself. The administrator and DON keep saying they're going to hire another RCM (there are only 2 of us for 88 residents) and to hang in there, but it hasn't happened yet, and there doesn't seem to be any real motivation to speed up the process. Then, when something ISN'T done, guess who gets the a**-chewing?!

    I've never been afraid to work hard, but I feel like I'm drowning. I've been told by several consultants that no RCM should be responsible for more than 30-35 residents, and if you're in charge of the skilled unit, 20 should be the maximum because of the frequency of assessments and other government-required paperwork. So if that's true, I've got twice as many as I should........but nobody in upper management seems to be listening. In the meantime, I'm on the verge of a nervous breakdown, I barely have time to see my husband or my kids except on weekends (and sometimes I have to go in even then), and I can't stop stress-eating---I've gained 12 pounds in the three months I've been at this job. I make good money, but at this point I'm almost ready for a job where the biggest responsibility is remembering to say "DIDYA WANT FRIES WITH THAT?".

    Please help me figure out where I'm going wrong before I have a stroke from all the damned stress. Thanx!!!
  2. Visit VivaLasViejas profile page

    About VivaLasViejas, ASN, RN Guide

    Joined: Sep '02; Posts: 26,951; Likes: 44,648
    RN and blogger extraordinaire; from OR , US
    Specialty: 20 year(s) of experience in LTC, assisted living, med-surg, psych


  3. by   tiredernurse
    Boy do I feel for you. I did that job for 6 months. I had 60!! residents in a skilled unit (but 30 were long term residents). It was pure hell. I'll spare you the details, but I think if you are the least bit conscientious you will feel like you are drowning. I'm not afraid to work hard but that job got to be too much. I also was constantly taking work home, spending too much time in meetings, etc...... I feel for you and NO it isn't you, it's the system. Good luck!
  4. by   VivaLasViejas
    Thanks, tiredernurse......I appreciate the feedback, and it's good to know that it could be worse. Of course, your answer that it's the SYSTEM is exactly what I feared, and I'm also afraid that it's no better anyplace else. The last place I worked, I had only 25-30 residents including skilled, but I left there because the owner/administrator was a psycho who delighted in pitting all the managers against one another, and then telling us that our co-workers had come to him with accusations about some kind of serious offense (like falsifying documents, being late with our work, covering up mistakes etc.). None of it was true, either--the guy just liked playing head games with us. He made us all completely paranoid, and I'm still trying to recover from it, so it's good for me to hear an unbiased opinion in this area. Thanks again!
  5. by   renerian
    I hear you....................LTC/SNF is a hard place to work. It is not you the system is set up to burn up employees and spit them out. I could not keep doing it.I left home health for the same reason,. 60 to 70 hour a week job, 3 weeks without a day off......

    Good luck. I would at least consider looking elsewhere....... You must be a salaried worker right?

  6. by   Youda
    I can feel my stress level raising just READING your post! I would hate to be living it!

    The biggest danger I see coming your way is the state inspectors. If your admin is anything like the ones I've been around, then when the state gives a few deficiencies, admin will make you the scapegoat.

    The best advice I could give you is to give admin a timeframe. "If I don't have help by {whenever}, then I will be forced to resign." Or maybe go to admin and say, "I have time to do A,B,C, but not X,Y,Z. Your expectations are unrealistic." (They know that, but they'll let you try to do it until you say No. Time for a sit-down with your admin and some personal "plan of correction" before they burn you completely out! No one else is going to stand up for you but you.

    Sorry that you're going through this. Wish I could be more help.
    Last edit by Youda on Oct 6, '02
  7. by   micro

    boy do I hear you.........
    I could not do it...........
    you have the answer

  8. by   VivaLasViejas
    renerian, youda, guys are lifesavers!!! I so appreciate your time and advice. This morning before I went online I'd been thinking about doing exactly as Youda suggested, talking to my admin and DNS and drawing the line. I just haven't figured out where it's going to be, like working 4 10-hour days or taking comp time when I go over even though the company doesn't provide for it. I know I'm the only one who can stand up for me, and Lord knows I wouldn't have any trouble finding another job with the nursing shortage, but the hell of it is, I really don't want to leave. I like most of the people I work with, and I enjoy being an RCM; it's just too much for one person to do. I'm planning to sit down at some point with the other RCM and see if we can present a united front; she too is feeling overwhelmed with 49 ICF residents, but then, she just took 2 weeks off, right after starting the job. And I haven't noticed the admin or the DNS having any trouble leaving at 5 PM either, even though they both say they're working too hard as well. What I'd love more than almost anything is to take a short leave of absence to regroup and figure out what I really want to do, but my husband doesn't make enough money for us to live on even for a month and I just can't afford to do this. Oh, well.........
    Last edit by VivaLasViejas on Oct 6, '02
  9. by   Youda
    mjlrn97, I don't know how long you've been there. But, if you've been there for a year, you can take the Family and Medical Leave Act. The law provides that you can use your accrued sick AND vacation time (so it turns out not to be an unpaid leave if you have any benefits accrued). You don't have to tell them why you're on leave. You don't have to give them anymore notice than you are able to give. They can't refuse or deny it.

    FMLA can be used for nurse burnout, according to the definitions in the law. It says any "serious mental or physical condition." And burnout definitely qualifies for that!

    Some employers also allow a personal leave. But, the FMLA protects you in every possible way. They can't even count it as an "absence!"

    Hope you've been there a year. Then you can take some time to regroup!
  10. by   VivaLasViejas
    I should be so lucky, Youda----I just finished my 90-day probationary period :-( What I should've done was take a vacation in between jobs when I quit my last position, but I couldn't afford even a week off then, so I left one job on Friday and went straight to the new one on Monday. Oh well, live and learn. Thank you anyway!
  11. by   rnherbal
    i am tired and stressed just reading your post ----- please take care of yourself...

    it sounds impossible to do all of those things.... my head is spinning at the thought of even attempting it.

    my last job was similar. i felt like i was a hamster running on a treadmill. i kept running and running and running - you get the picture.... it was like i didn't know what to do but keep on trying to keep on trying to keep up.

    finally, the bottom fell out. i was sitting at my desk and next thing you know my leg became all numb and tingly. it got worse, next it was my arms and then my throat and mouth. i was terrified.

    i spent the next two years going from doctor to doctor (neuro's) to see if i had ms! i was a basket case. still no dx but this was the "wake-up call" i quit my job and found something low stress where i could work at home and control my own life. no more running on that treadmill anymore. still have some symptoms but i can deal. please don't wait for a wake up call like mine. it is not worth it. i know a lot of nurses are totally stressed out these days and it really concerns me because of what happened to me.
    i hope my story can help encourage you and other nurses to take a long hard objective look at your current situation. there are other alternatives - you may have to search hard but they are out there. life is to short! cathy- "free at last"!
  12. by   VivaLasViejas
    RNherbal: What kind of job did you find that you can do at home? Working at home sounds like heaven on earth.....does it involve nursing? I do love what I do, but the stress is literally killing me. My blood pressure is out of control again even on several meds, I can't stop stress-eating (and I've never been anywhere close to thin in 20 years), and I'm on an antidepressant AND an anxiolytic. Problem is, I'm still raising kids and my husband makes only $9 an hour, so I literally am the only thing standing between us and the food-stamp line. If there is another way that I can make a decent living without all the stress, I'm taking suggestions!

    Thanks so much to all of you who have responded to my posts; it helps a great deal to know I'm not just being a whiner. I guess I'd lost my perspective; I was actually beginning to think it WAS me and not the job that was the problem. Love to y'all!
    Last edit by VivaLasViejas on Oct 10, '02
  13. by   shabookitty
    I have such a tremondous amount of respect for what you do. LTC is a hard place to be...lord only knows you are there ALOT!You guys are angels.
    I wish I had an answer for you. I can only agree with the rest. Put your foot down...they will only take advantage of you as long as you let them. Plead health decline. There is NO reason that they should do this to you. If all else fails can be happy and do what you love...remember that. I can feel your stress by merely reading your post, imagine what your family and patients must be one wants to see you so pressured. Except your coworkers of course They have to realize that this is taking an effect on you. Keep us filled in...I am curious of what becomes of this
  14. by   VivaLasViejas
    Hi everyone.......I just got back from a 2-day training session that has me just about convinced that I can NOT keep doing this job much longer. My company will foot the bill for a $150/night hotel room, free meals, expensive goodies, etc. but will not hire the staff we need to meet the needs of all the admissions they want us to take regardless of how complex they are or how severe the behaviors. They think an RCM is some kind of machine, that can handle all the crap we already do PLUS the extra paperwork they just handed us at the seminar.
    I wonder what planet these people are from???

    On a more positive note, my administrator and DNS ganged up on me last Monday and told me I have to start going home at 5 PM, leaving the building for lunch, and delegating some of the charge nurse work I've been doing back to the charge nurses. Easier said than done, and I'm behind in my work big time (which is really difficult since I'm so anal about deadlines), but I'm also being encouraged to try to restructure my job so I can live with it.
    Even with this help, I'm not sure I even want to do this work anymore---LTC is tough all over, and I don't have the energy to try to change the system. But then again, I don't know what I DO want to do; my physical condition is such that I can't do floor nursing (especially with those 12-hr. shifts), and I need to make a steady income, so part-time or agency work is out of the question.

    I guess I'm stuck until I can figure all of this out, but I'm not happy about it. At this point I'm making almost fifty grand a year, which makes the decision even harder since there aren't a whole lot of nursing positions in my part of the country that pay anywhere near that much. Of course, as was pointed out to me by both my bosses and my family, that money won't do any good if I'm not around, but what the hell do you do when you've got 3 kids still in school, a mortgage, a husband who makes nine bucks an hour (and may get laid off any day now), and a drawerful of bills?

    If any of you have any ideas as to how I can help myself out of this mess, please let me know...........I'm normally pretty sure of myself, but right now I literally can't see the forest for all the @#**&!! trees.