jharper

My hospice has asked a group of us to put together a procedure/ set of rules on boundaries with patients. They want to establish a uniform way of allowing patient contact. In the room, the group is all over the board, some of us give out cell phone numbers to certain patients, others refuse in any case. What started this is that over the last few months we have had a couple incidents. A nurse that recently retired went to visit a former Patient, and gave that patient medical advice contrary to the plan of care; another case was when our one male nurse took his brother to the patient's house on a visit. Our clinical director has flipped out!! I would too!! But this goes back to boundary issues. How can the retired nurse (23 years) not know the damage she can cause? I am so upset by this, that I recommended that we all sign a "No contact" agreement that kicks in if we resign/retire, but others in my group think that they need to be able to maintain contact. Anybody have any thoughts? I will you let me know what we sort out. J

Funny, got into a lively debate a week or so ago at a meeting and we agreed on only one thing: Stereotypes run rampant out there. For Profits are greedy and don't provide care. Non-Profits are sloppy because if they do poorly they have a fundraiser. Neither is always true. I think it is all about the program, the mission, the leadership, the staff, and expectations being managed. One for-profit I talked to did 5% of their gross as charity, and a non-profit was proud to announce that they kept their charitable care below 2% by aggressive management of admissions. The for-profit took out a loan, the non-profit had millions in the bank. Another for-profit had RN caseloads of 21 on average. A non-profit at 13 (my hospice is currently at 12) Yes, we non-profits do have a built-in advantage, and yes, the for-profits might be able to recruit superior staff, but the exact opposite can be true too. It is a lively debate, but it seems to me that it is about spin for marketing, or our personal pride in our programs (or a bad taste from a bad program). Is it to naive to think we would be better served to make every company, regardless of IRS status, raise its standards in order to be competitive - and weed out the bad programs? Its like when I play my harp, sometimes a bad artist can destroy a beautiful piece of music.

I have been offered an opportunity to take a weekend shift for the hospice I work for. The deal would be that I work from 4pm Friday till 8am monday morning. I get paid my 40 hours pay, mileage, etc. but no pager money or per visit money. I would do scheduled admissions (I know for sure we have 2-4 every weekend) and calls/visits from pts and families. There would be no scheduled routine visits, and I would have backup if I get swamped. My coordinator has told me that I must call for help if I find that I am not getting enough sleep, though she sounded more concerned about patient care than me (ha!). Our hospice is suburban and has about 70 pts. This seems like a pretty good deal for me. Anybody have experience or an opinion of the $$$. What do I need to ask about?

No -- I have 8 right now (everyone has about 7-10) I think. If I work a weekend, I am covering another Case manager's patients if the call in. So, yeah, I could talk to a lot mote than just mine but I don't manage those cases.

I'm sorry I wasn't clear. If you have chosen not to participate in the weekend work for whatever reason, the on-call or PRN nurse takes the call. There are nightime nurses assigned, though sometimes, depending on the patient, I want to be called so I have the choice to go out. Of course some days I work more than 8 hours, some days less. It all works out. If I have to go out and I think it is outside of my "normal" duties, I get paid for a PRN visit. We get paid a flat fee for a PRN routine Visit (about 2-2.5 pay) and a more if it is an Admit (3 hours). The nurses here all agree that this is an "honor system" and nobody has ever not been paid for a PRN.

We are doing about 20 patients an hour in the IDT. We recently started bringing in the volunteer coordinator too, incase the CM might want some services.

Our Hospice tries to target 9 patients per equivilant full time RN and does not use LPNs for continuity reasons. But the math is a bit different. Some RNs want to work a few hours extra on Weekends to make 20 hours pay a week extra for on call, though management won't let an RN work two weekends in a row because they are afraid of burnout without time off. So if you have 2 RNs, each working a regular week (which is salaried) and trade off every other weekend on call, that is 3 equivilent RNs so there is a load of 27 between the 2 RNs, but we get some extra pay if we want it. The hospice does not REQUIRE any on call for its staff. We think this is pretty fair for everybody. The hospice is "for profit" What do you all think?