Overworked hospice nurse

tewdles, RN · Sep 30, 2010

6 months is a short time to have a 25 patient caseload! However, an RN/LPN/MSW/CP team should be able to comfortably manage 25 patients.

The fact that you are working so many hours says several things to me...

first...you may not be receiving the support you require from your manager and clinical support staff.

second...you are very possibly not delegating things to other team members when you could (a common problem for new case nurses) thereby creating overwhelming amounts of work.

third...it WILL get better...but, dependent upon your company and your management team it may never get "good". Remember that when you begin a new specialty in nursing the rule of thumb is that it takes 6 months before you don't feel dangerous and a year before you feel pretty comfortable with most situations.

Take a deep breath...take a few days off. Ask you manager for some tips on getting and staying organized. Pick the brains of your experienced co-workers...how do they prioritize?...how do they stay on top of the needs of their patients and families. There is no need to reinvent the wheel. I encourage you to consider your mental and emotional health a priority just now...this is important if you want to have a successful and healthy hospice career. If your management team is not supportive of your needs then you should look for another hospice provider to work with.

Take care of yourself and good luck.

caliotter3 · Sep 30, 2010

I also agree that you should take some time off. Do not be concerned with things piling up while you spend a day or even two sleeping and eating. You need this. And also take the other advice to ask for advice. If you run into negative attitudes, reevaluate if this is the hospice agency you want to work with.

momorn · Sep 30, 2010

Thank you so much for your replies! I feel much better already! It is VERY SLOWLY getting easier overall. It's mainly the endless paperwork! I'll figure out what I can dump on other people and try to get more rest.

Thanks again!

AtlantaRN, RN · Sep 30, 2010

25 is an outrageous caseload, even with a lvn backup.....if you split it, it's like 12-13 patients each....how many are only one visit a week? not many, i'm sure if you are stressing. as a patient declines, visits go up to 2x/week-3x/week, to daily when imminent. deligate deligate deligate as much as you can. Alot of times when patients are stressing out, they will ask for extra nursing visits, but is this REALLY what they need? sometimes they need the chaplain and social workers for end of life concerns, not necessarily the nurse. We max out at 16 on our caseloads, and unless they are all stable, our m-f nurses have a hard time keeping up. Recently, one of our case managers was down to 10 patients, but NONE of them were only 1 visit a week, and her driving was taking most of her time......she broke down many times in tears because she would get into midtown atlanta, and get a call from the office that a patient in the suburbs wanted a visit that day, and she had just left the area an hour before..........This is one of the reasons i went to the weekend on call position. our census is 50-60 at times, but at least i only have to go out to "put out fires," and do admissions and follow up visits.

Bless you dear one. I feel for you.

momorn · Oct 1, 2010

AtlanaRN,

Thank you for your reply. Many times I have a days where I'm driving back and forth over the same roads. I live near Los Angeles and the traffic is horrendeous! The company doesn't take drivng time or paper work time into consideration. All of the nurses have to do stacks of paper work on their own time with no pay for that. We all work 50 to 60 hours a week but generally only get paid for 40.

Just this morning I thought I would see if I could talk to my superviser about doing weekend on call work. I just hate not having a life!

tewdles, RN · Oct 1, 2010

momorn...sounds like a miserable job, honestly. I think I would also be looking to change the situation.

just out of curiosity...do you work for a for profit or not for profit hospice?

momorn · Oct 4, 2010

The company i work for is for profit.

momorn · Nov 20, 2010

Yeah, I'm the weekend on call nurse, now!!!!I worked for 8 months as a case manager and just couldn't take it any more. I went into see my supervisor and give her my resignation. She told me she didn't want to lose me (which was real nice to hear) and offered me the weekend on call position! I've been doing the weekends for a couple of weeks now and I just LOVE it. Thank you everyone! I love my life now.

AtlantaRN, RN · Nov 20, 2010

Good for you momorn!!!! I do weekend call, and although today i was out at 8am, and just got home a few minutes ago, 530pm, it is soooooo much better than monday-friday. My job is to put out fires and do admissions, and pronouncements....I don't get the life sucked out of me. Granted, I don't sleep all that well when i can't take my sleep meds, but at least i'm OFF, completely OFF....monday 9ish after giving report.....until 445p on friday. Granted, my boss will text me asking me if i want to do extra, which i do frequently, but i know what you mean.....NOW you have a life!!!

tyler3222 · Mar 27, 2011

I know you posted that a while ago, just curios if your situation has improved any. I am a Hospice nurse looking to move out west. Just curious what hospice you work at. Feel free to private email me if u like. [email protected]