Hospice4me

Our secretary just completed our office newletter with the saying : "Attitudes are Contagious. Is Yours Worth Catching?". When I read it I told her that I was glad that I wasn't the only one who felt the negativity had gone too far. We had a group of nurses sitting in our conference room the other day. One said "I don't know about you guys, but if they ask me to take another patient in _______ area I'm telling them to take the patient theirselves". Of course, next thing your know they are all saying "me too" "yeah, I agree" "Nobody cares"..........I just looked at them and said "I don't know about your guys, but if I needed help in my area I would expect those nurses to help me, so why wouldn't I help them" "If you guys won't help those other nurses, I'll do it, but don't expect them to be willing to help you when YOU need it".........Of course, it got a little quiet and some backtracked and said that they would help. It's amazing how when the table is turned, attitudes change! What's amazing is, those nurses including me, just got a BIG FAT RAISE because the director felt they were underpaid and overworked! I thought "I'm thankful to have a job where the management CARES" I'll work harder for someone who is an employee oriented manager and feel it is unfair to the manager to continue to be negative after her hard work getting all of us such a big raise. Jeeeeeeeeeeeeezzzzzze What a bunch of Bi((hes!!!!

Is anyone else experiencing this? We are having a problem with negativity in our office. :smiley_ab :argue: It seems that if one nurse says something negative, then they all jump on the bandwagon. It seems that it is all just one big gripe session. I think that there are very few of us that avoid it altogether. I believe that negativity breeds negativity and that attitudes are catching (good or bad). Does anyone have any idea what would be helpful in pulling our group together? Or is it a lost cause of negative b**chy nurses? Is it working with a 99% female staff? To be honest I am SICK OF LISTENING TO PEOPLE WHINE!!!! :angryfire

I decided to go back to school 5 years after graduating high school. When I considered what to go back to school for, I looked in the newspaper and saw many ads for RNs. I thought "I could do that" and that was that. I was off to nursing school. I graduated and immediately started working in CCU on night shift and loved it, but I never found my true calling until I started working as hospice nurse. I can't imagine doing anything else.

Much of what you say is true. We do continue to take on additional patients without considering the staffing. We have asked many times at what point they would stop admitting. Unfortunately, the way we are set up, the department admitting is separate from the side taking care of the patients. The admission side has the attitude that it is our problem not theirs to make sure we are staffed. Fortunately, we are finally getting the chance to voice our opinions. Finally, they are realizing that RETENTION is horrible here and there must be a reason AND something must be done NOW! Yes, the salaries will continue once we are staffed. We have placed comment cards out for everyone so that they can give thier comments or concerns and we are forwarding them to our CEO. Unfortunately for our Administrator, the tools needed to hire and keep nurses have not been given up until now. Our Administrator, however, is not the sit back and take it kind of person. She has said enough is enough. She is tired of carrying caseloads in addition to her duties, she is tired of hiring and training good nurse only to lose them to other agencies who offer better pay, caseloads, benefits etc. We have at least 10 other Hospices in the area, so YES competition is very stiff for any experienced hospice nurse. Also, the administrator was given permission to hire MORE nurses than we need because of projected growth, but the competion is so great that we have been unable to hire enough nurses. That is why they are increasing our pay above the average to help recruit. Anyway, with some luck we will be staffed soon. Decreasing our standard caseload from 15 to 12 is our next project!! Thanks for all your comments.

I don't know what state you are in, but if you were surveyed by our state and they found that you were having such a bare bones IDT, you would receive a condition. The purpose of IDT is to CAREPLAN on patient problems, add interventions, and allow the team members to make suggestions! Not just for recert purposes. Our IDT's last 2-3 1/2 hours depending on the team who is meeting and the number of patients. We usually go over about 25 patients in an hour.

We are on salary, so we do not get overtime. Of course, that means that all of the nurses are working over 40 for no additional money. However, because we are salaried, it allows us to be very flexible with our time (when our caseloads are at the right level). Part of our problem is growth and we have had some nurses go to home health/other hospices in management positions or QI/QA positions that paid considerably more money. Like you said it takes time to recruit, hire, and train. The bad thing is, we have been in this cycle for 2 years. When we finally see light at the end of the tunnel, someone resigns! Very frustrating for us left to take on extra patients!

Penny4URthoughts......Fortunately, we do not have that problem. Our policy is that EVERY death or impending death requires the presence of the RN/RN on-call. We also provide 200-400 hours of continuous time care per month for dying patients. I am thankful that the care of our dying patients is truly a priority. Unfortunately, because the nurses are so overwhelmed, the "stable" patients do not get the time they deserve. Anyway, I am truly sorry that you had such an awful experience. Thankfully, this is not the norm for us.

Unfortunately, at a caseload of 15 or more it is all the RN can do the make the minimum visits. Heaven forbid someone is not doing well and needs extra attention. I feel like the all need extra attention!! Req Read you are right that it seems like they come through in a cloud of dust.......run in, run out. Even our most caring nurses given minimal attention to the "stable" patients and have to prioritize just to meet basic needs. I am trying to make it clear to our company that patient care suffers. We have grown not by advertising but by word or mouth because of good care; however, now I am afraid that "word of mouth" will be negative instead of positive. When you have these caseloads, even the best nurse can't hide the fact that she is pressed to go onto the next visit. I had a patient say "I liked it better when you could spend more time with me" I was heart broken!!! Now I am on the warpath so to speak and will not sit back and let this continue without a fight. Anyone who has any opinions on staffing and caseloads please post for me. I will be taking quotes from them and putting them together with comments from our nurses to forward to our home office. Thanks everyone!

Wow, I guess some places can afford to get applications and not hire anyone but not here! I think that the lack of slots in nursing programs is a major problem. We are not graduating enough nurses to keep up with the need. We are short staffed now. We have had 4 applications in 3 months. 3 of 4 have been offered positions and 1 was not because she job hopped so much. (2-4 months then changed jobs, 2-4 months then changed again and so on) Of course, all had interviewed at other places and had 2 or 3 other offers. Our applicants are usually nurses fed up with hospital nursing and are looking for a change.All we can do here is try to make better offers than everyone else. I hate to hear a new nurse saying they can't get a job! I just can't believe it!! I can understand specialities but medsurg in a hospital is where many nurses get their start. If they are so short staffed why not hire new grads? A new grad should be turning down offers!

I am glad to hear that I am not the only one that thinks 10-12 is the ideal caseload. I posted the question to get some confirmation that our caseloads are too high. I have had as many as 23 patients by myself! As far as the question of weekly assessments, our state regs say that a LPN cannot make assessments, only gather information and report to the RN; therefore, the LPN may only make a visit every other week. The RN must make a full assessment everyother week and is responsible for assessments on any pt with an acute change. What that means is, generally, the RN visits half the caseload one week and half the caseload the next. She is responsible for all recerts, careplanning, etc. So, if she has a 24 caseload, she will be responsible for 12 assessments (plus any additional acute change visits,deaths etc) but be responsible for 24 patient's charts. Personally, I would rather have 23 patients myself. Not that I have any problem with LPNs, I just feel that I don't know all that is going on with my patients and it is easy miss important careplan changes if you do not have an LPN that communicates well with you.

What is the ideal caseload for a RNCM? What if you have a LPN to help you?? I think they overwhelm the nurses where I work. We have 25 patients per RN with a LPN. We have 15 patients per RN without a LPN. We do you guys think?

Unfortunately, I already have been doing what you have suggested for years now. I even give a questionaire that can be sent confidentially to our VP. I have not received a negative comment other than that the nurse were offered more money and NO on-call. We are increasing salaries to above average for our area and working on a better on-call routine. I truly think it is so competitive, that we have to do something unusual. Above increased salaries, high bonuses, and changes in our on call. I am interested to see what nurse posting here enjoy about the Hospice they work for and any "outside the box" ideas. We are growing and unfortunately all it takes is 2 nurses to quit and growth of 10 patients and we are down 3 nurses. (snowball effect) Of course, this causes stress among the nurses who are left.....they start thinking well maybe nurse so and so had the right idea..........then there you go another has left. ARRRGH!!!!!

I do work for a for profit, however, I have worked for them from the time they were a tiny new hospice and can say that they do care about the patients and the staff. I feel that the ideas and feelings of the staff are being listened to and I am working on several proposals to make staffing better. To be honest our president suggested an increase in pay that was significantly above the other hospices in the area. The real problem is we GREW TOO FAST in a short period of time and just haven't been able to keep up with the staffing. I am never asked to cut costs/services for the sake of profit. I think there is a misconception that all for profits are uncaring money hungry companies that do not care about pts or staff. They are out there....I know people who work for them, but not all are like that. I do agree that Medicare will crack down and the Hospices who are following the regs and providing good care and HONEST will be the ones left standing, for profit or not. By the way, we have a not for profit here that CUT HHA visits to patients because of staffing instead of paying extra/increasing base pay to recruit! Sometimes not for profits are just as bad. Bad Administration is Bad Administration. It does matter what you are classified as.

Oh...I wanted to say that I worked in a critical care unit (pre-hospice years) and we used Diprovan only on intubated patients. We also used it in surgery for general anesthesia. I have never heard of it used for pain control in a non-intubated patient. Can anyone clarify?

I cared for a close friend's father for the last few months of his life as his hospice nurse. One day I was called to the home as he was restless and agitated. I knew he was actively dying. My friend who also is a hospice nurse was at his bedside. I received an order for Roxanol and administered the smaller of the 2 dose strengths I could have given. After 45 minutes he was still very uncomfortable and restless. I gave him the 2nd dose. Immediately after he began to relax. We held his hands and cried together. He died 15 minutes after the last dose of Roxanol. I remember leaving, thinking Did the Roxanol cause he to pass away sooner? Would my friend think I hastened his death? As it turned out, my friend later said the same thing. She said I wander if the Roxanol made him pass away quicker? She said "if it did, I don't care, he was so peaceful. That is the way he would want it".