sherpa

I fully agree with the first poster. I was told I would have a thorough orientation, and that consisted of someone spending an hour with me for three days then throwing me on the floor with 20 patients and a book full of treatments and medications to give. Ridiculous. If a company isn't willing to invest in their staff then in my opinion, they are not worth working for-and you shouldn't want to be affiliated with such a careless organization. Clinical excellence is still out there, and I would look for private pay facilities, privately held companies, and others that aren't governed by outside sources, because they have a lot more freedom to make better staffing decisions, alot less regulatory nonsense, and generally are better known in the community as being higher end facilities with happier employees that stay. Tenure is important. If the five people on your unit are all brand new, yet the facility has been open for 30 years, you have to wonder why...

A vaseline ball is when you roll vaseline in a ball and freeze it, and it serves as a good cure for constipation, (given rectally).

Hi, I don't know about a specific acuity tool, however I can describe my day and why I am working at least 50-60 hours every week? First, I love my hospice job, I am an rn case manager, in a growing office. We have had difficulty finding and keeping dedicated people, because, well, it's hospice and a very stressful job. It's not for everyone. My immediate boss is the rock we all stand on. She is so stressed, as she is trying to make sure our people all get taken care of, and take care of a growing staff, which currently is short by a 1/2 dozen people. Not easy. That being said, my caseload varies between 16-20 people, plus recerts (I may see other case managers patients to do recertification visits, we split those evenly.) Our standard is to see everyone twice a week, and we do our own admissions, although we have a part time "admission nurse" but she is rarely available to us-and the families need us when they need us...sometimes our patients come in at night, sometimes they come on in the middle of the day and it's not scheduled. I have been seeing 8 patients a day, plus meetings, family calls, and idt, admits, and recerts. This is not manageable. I say this because we have computers, we are supposed to document at bedside with, and there is about 8-10 forms for each patient plus a narrative note to be filled in on the computer for every patient, and it takes upwards of 10-40 minutes just to do that and put your md orders into computer, medication reconciliation, etc. Also, when there is a patient doing poorly, well scratch everything I just said, and I am with the patient and family and md all day, coordinating social worker, chaplain, volunteer, and hospice aid support around me. I am not a one man team, and our team works awesome together. So, I have patients in three locations, about 31 miles and 6 miles from each other. So let's do the math. I spend an hour plus on the road, so that knocks my "working" time to 7 hours. Then I spend at least another hour on the phone ordering equipment, giving/getting report, and organizing myself for the day. 6 hours. Spend another 1/2 to an hour on the phone with family members who need updates, and you are at 5 hours. Now I have a facility meeting today, which can run another 1.5 hours. I'm left with 3.5 hours. Now, providing I don't have a very sick patient, (which with 18+ patients is very unusual), and I don't get an admission, and the facility nurses don't collaborate with me, and I don't have last weeks or yesturday's work to catch up on, I go see my patients. The vital signs, reading the chart, and documenting takes up the better part of 45 minutes. That leaves 2.75 hours for 7 more patients. Maybe I can see four more, then I am in overtime. And half of them by that time will have family visiting them, which means I'll be hugging family and talking to them about their nana's illness, which means maybe I'll see two. So I am ending my day, leaving two or more patients unseen, and it's 7 pm. Now I have to go and print all my documentation and fill the charts, and make sure my care plans are up to date based on the collaboration with staff, mds, and families and patients that went on during the day. These people are sick, their acuity and their needs change in the blink of an eye. So most of the nurses in my office, they use their "day off" to do their work, if you scheduled some kind of family function or had your kids basketball game, well, 7 out of 10 times you are not going to be there. Sometimes, my boss will call me at 3 pm, and tell me there's an admission at 4, or possibly later. An admission takes 5 to 8 hours to complete. I love Hospice, but it is truly a broken system. The point of hospice was to be able to have the time to spend with patients and families, to be able to provide comfort care, and to be an extra hand to the nurses caring for these patients. Now we have become a medical model, governed by the same medicare/medicaid laws that have regular nursing overworked and frazzled. It doesn't work. I would like to see whoever makes the budgeting decisions for medicare or for the staffing of the hospice agency try to do any person's job in my office for a week. Oh, and btw, you get weekends off, unless you decide to take on-call. But people still call you all weekend, your hospice aids who might be on for the weekend, mds, families, and on-call nurses who aren't familiar with your patients. Oh, and btw also, I am a 40 hour salaried nurse. I have never worked just "40" hours since I started. It cannot be done. It cannot be done in 50, sometimes 60. I carry work over from the week before, nearly every week. This week, I have lost four patients. I am still working on last Tuesday's work. Sometimes, it feels you will never catch up. All the while, I get emails all day long from our auditors telling me I haven't put this one's orders in, or I need to redo this or that, as documentation has to be absolutely perfect or medicare will not pay the bill. It's a hard, hard job. But when I get to spend the time holding a patient's hand. Hugging and supporting the wife who is falling to pieces losing her husband, and knowing that you did everything you could to make that person's passing a beautiful, peaceful experience surrounded by love, then none of the other stuff matters. I only wish, I could be home when I'm home, and spend more time with my family, as my family life has suffered dramatically, so I cannot see myself in this position for a long time. My office seems to have a major turnover, nobody stays for long term, we only have one nurse who has been there for a long time, out of 7. Hospice needs to be looked at, it is only getting worse, the level of work vs the ability to do it, it is humanly impossible, even on my best week. Good luck to all who get into this business, and I hope the wind is always at your back, and your caseload never exceeds 12.

Oh, no doubt, and of course documenting at the bedside is not always happening, we are leaving paper contact notes for that type of day, which happens about 2x a week, then documenting at home on the computer until 8 or 9 at night-then printing and feeding charts the next day, hence the extra hours put in. I am actually documenting right now on my work computer and blogging on this one..but it is crazy, then you get on the phone or in meetings with family and time flies! I think seeing each patient for a half an hour is usually more than enough to check meds, get report, do vitals, visit patient, make recs, etc.. but sometimes if a family call is made, or MD consult...then you can up that to an hour...plus documenting, which I like the computer for, as I type faster and faster the more I do it, but I can document on someone including care plan in 5-15 minutes depending on patient's acuity.

Hi all, I currently manage 16, one home care the rest ltc. That being said, we are down a couple of nurses and so I have been covering their patients (2-6 a week) when needed. We all work together to try and cover the shortages, and I too have a requirement to see everyone twice a week, my home care is 5 visits a week. We do all our own admissions, and recertifications. I am 40 hour salaried, but end up doing about 50 every week. It's ok because alot I can do from home (computer/paperwork) so it's not too bad. I see 5-12 patients a day, depending on whether I have family meetings, facility meetings or an admission/recert to work on that day. Hope that helps!!

Hi, first let me say congrats! and it's funny as I just came on this forum to ask about rn case manager positions, as I have been working in a LTC facility and am now starting an RN case manager position next week, and wondering what that is going to be like. As for the LTC, alot of the facilities are not profitable at this point, due to the economy, rising costs and no increase from medicare. It depends on the % of private pay versus medicare patients. That being said, they are staffed accordingly. At my facility, I have 21 patients. No matter what is going on with them, I do not have enough time in my day to finish my work. There is always something to be done. And mind you we don't have a desk nurse, sometimes no manager, and are down CNAs alot of the time too. The budget at this facility is tight tight tight! And it reflects in the level of dressing supplies, the way things are run and stocked, even the gloves we use. Things have gone downhill in the last two years. But the patients are wonderful. You just get attached to them and it is very fulfilling, if not extremely exhausting! The typical day consists of getting report, auditing labs, doing a 2-4 hour med pass, doing dressings, helping with meals, following up on labs and new orders, another med pass, CBGs, insulin injections, booking transport for patients to go out, dealing with families, another med pass...you'll feel like a giant pill bottle. Then finishing any treatments, toileting patients after meals and upon waking, delegating to your CNAs, who without them you just simply cannot do your job, and answering calls. THEN you will write your notes, every medicare patient has to have a note each day, as well as any patient with a change in condition or anything note worthy, then doing a nursing summary, which is a focused assessment on one patient, then cleaning and re-stocking your medicine cart, making copies, taping report for the next shift, then counting off the narcotics (taking inventory.) all this in 8 hours? I usually do 12s, as it literally takes me every bit of 12 hours to do all of this. Nobody usually gets breaks, although we are supposed to take them, there's simply no time. If you take a break, you know you will not be in compliance or you are going to neglect someone or something. It's grueling and thankless as administration often forgets how difficult this pace is, you need to be super organized, delegate constantly, and just be on your toes. There's often no time to call home to check on your family, lol. If your facility is on computers, this may be alot different, mine is not. Everything is documented in five places by hand, notes all by hand, medications are on cards and you pop them out into cups. There are also showers, weights, rehab services, dietary changes and other consults to make during the day, hospice visits as well... hope that helps!!

Hi there, I thought I read in your original post that Quincy College was accepting applications for Jan. 08? But you said 09, that being the case that would be almost two years, so perhaps you would be in by then. I know it is so confusing, it is such a hard decision!! I have heard from my LPN classmates that the LPN program went by so fast and was alot easier then they think the RN program is now. That being said, you are of course limited to what facilities will take you as an LPN. Mostly I think you are limited to working nursing homes and the like, but if that's what you want to do then that might be for you! Quincy has started a few online courses as well, and I think they are planning on adding more, so that may be of assistance as you pick away at the pre-requisites you have left. If I can be of any help, don't hesitate to pick my brain if you have any questions about the program! Right now I am going Monday and Tuesday nights, clinical runs from 3-10, and class is 4-8:30. So on class days you still have most of the day to work, go to appointments and the like.. that is a benefit. Take care, Juliagoolia7777

Hi, I understand that you're having a difficult time with this decision, it is basically giving your life up for 2-2.5 years. I am a student finishing up Quincy College right now, and I applied in 1/03 and started doing pre-requisites, and I will graduate 1/18/08. The thing with Quincy is that there is a two year waiting list for the program, you are welcome to apply, but there are around 30 seats and usually 400+ applicants every fall. And while you can take your pre-requisites while you are waiting, if you already have most of yours done then what will you do with that time? The thing a few of my classmates did which worked out well for them is they took the 10 month LPN course, got jobs working as nurses (making 25-32.00 hourly,not too shabby..), then came back to finish out the additional year to become RNs. You don't get the exact same study base as you do if you go RN the whole way through, but you are able to enter the workforce and defray the cost while also having the advantage of being in the exact setting that you are studying about. The average RN student in my class is barely passing with around a 73-76 average. The average LPN in my class is pulling 80s. Food for thought-if I had it to do over again, I would have chosen this route, as I have been broke for years now between tuition, books and taking time away from work to study! The second year is around 30 hours a week in independent study time, and about 12.5 hours of class/clinical time. Yes, it is only two nights a week and the clinicals are flexible so if you are put into a clinical that is a bad night to care for your mom, chances are you'll be able to switch your clinical night with one of the other 20 something people in your class, however there is approximately 10-15 chapters in several different textbooks that is required reading every week. If you don't read, you won't pass the tests. The tests are sooo much harder than any prerequisite course, I was pulling A's in all my classes and now I am a C- student, and I'm going at full steam doing all the studying. The benefit is, that that two 1/2 years flies by, I feel like I just started. But if you already have acceptance into a school without the waiting list, that is half the hurdle right there, just getting in!!! Good luck, I hope I haven't made things even worse for you!! take care, Juliagoolia7777