indianahope

I quit my job a little over a year ago for exactly the reasons you site in your post. I was with the company 10 years, and the last three were literally *#ll on earth. I kept thinking it would get better and I wanted it to get better.... but it just got worse. They started firing senior nurses and I saw the writing on the wall...I took early retirement before they had a chance to fire me. There were some really talented nurses... as well as our medical director that ended up in the ER with cardiac symptoms, GI symptoms, etc. Not good. All were stress/fatigue related. It took me almost a year to recover physically and emotionally. My heart goes out to you and I hope you find the answer that is right for you. I am now reconsidering retirement and am toying with the idea of working only part time...but I will never again put myself in harms way....

Wow. I read every thread and have come to the conclusion that I am working for one of the bad ones. The comments about how we are degraded/demoralized really hit home. This is truly sad. I've been at it for ten years and kept hoping it would get better, but it gets worse every week. I'm happy, though, that some of you have rewarding positions. As of this minute, I am going to find one!

We're now working about a 54 hour week, taking call 4-5 times in 6 weeks and doing admissions after hours on-call. It's getting rough. Been at this over 10 years and have never seen it like this. Wondering how long I can do it. If I'm not staying late at the office, I'm coming home to cook a dinner....then do paperwork at home. Weekends off are spent recouping for yet another round. I'm frustrated and exhausted. There, I said it. Not looking for sympathy....just needed to whine and vent a bit. Losing perspective and I'm disappointed and angry at the system.

Just wondering about what other RN's working out in the field are wearing.....Street clothes/Lab jackets? Scrubs?

They like us to cary 12, we've had as many as 14-16. We usually don't have to do our own admissions unless there is no other way. We also take call and sometimes do admissions on-call.

Does anybody know what the new regs require regarding the timing of the every 15 day Comp Updates related to reporting in IDG? i.e. the Comp Update must be completed no earlier or later than x amount of days before an IDG, or it must be completed within x amount of hours before IDG? The reason I ask is this: Hypothetically, if an IDG meets on a Tuesday, for instance, then technically the week spans from Tues to Tues. If the office is normally closed on Sat and Sunday, then wouldn't all the patients need to be seen on Monday for Tuesday's meeting? I realize it can potentially be worked out so that about half of the patient load would only fall into any given week, unless, of course you had a change in level of care or some other non-routine event... How do you do it where you work?

This really gets me going..I've posted about this before. After almost 9 years, I think I've hit the wall. I work 40+ a week as case manager...take primary call 4 weekday nights and backup call 1 weekend day,then primary call 1 weekend night...... on a 6 week rotation. My census just hit 8, down from 12 last week. We sometimes must do our own admissions. A few weeks ago I worked all day, had a really wicked call that night...only got 2 hours fragmented sleep, then had to go back to work the next day and finally crashed at noon. Actually felt dizzy on my feet...it was horrible. On call we only get pay if we leave our homes...we could be on the phone all night and put in time for the necessary documentation.... and get only our beeper pay of $2.00/hr. Management won't consider any other options. We hear stuff like, well, way back when we used to have to cover blah, blah, blah territory...look how good you have it now. Well, back in the old days, if you took call and were tired the next day, they allowed time off. Now, if we work and are exhausted, we have to use our PTO time to take off. Really, I pray every day I can get up and do it again. I have loved my "Job" for years....but now just wondering how on earth will I survive. There's my rant....sorry.....For the rest of you, my thoughts and prayers are with you that you will be safe.

Patient keeps loaded gun in holster at side. Would you refuse to visit?

I was talking to coworkers about the MAC requirement in the new COP's and was told there was no such requirement.... Does anybody know specifically where this is in the regs so I can quote it to them? Thanks. By the way, I'm only a nurse, not a manager.....:)

What if you don't actually go out but do the work from home on the telephone? Are you paid for the time you spent on the phone and the time you spend charting?

In a similar case, we had good response with dilaudid/bupivicaine intrathecal....

Well, we did ask about compensation above our beeper pay of $2.00/hr for any work we did on the telephone and received the response that any symptom management/triage/consultations...Anything done on the telephone was covered by our $2.00/hr beeper pay and we would not be compensated beyond that. I still can't believe it.

OP: I'm so glad you brought up this topic....I've been at it 7 years now and have done poorly at setting limits and am now also facing burnout. It's kind of crazy...we have had inservices about burnout and what to do to avoid it, but when we start to try to set limits management really doesn't like it. Missed personal appointments scheduled well after the time I should be off work when I've been sent out to make visits, etc. are occuring more frequently. As a result I end up getting home late, too tired to cook so we eat out..then it's late and so I don't exercise or walk..then I'm resentful and don't sleep well...around and around. Then the next day at work I hear from management: "You were out late last night so you have to leave early today" (so they don't have to pay overtime). It's pretty sneaky, in a way, not to use the on-call nurse in that situation because she would get time and a half for on-call visit. They're smart enough to send a nurse not on call then make him/her leave early the next day. Heck, they don't even do comp time right. We really should get comped at time and a half, but we don't. This week rather than go back to the office after my visits I drove to a nearby park and sat in my car and did charting/phone calls. Got way more done than I would have back in the office. It was wonderful. I've decided to stop checking my voicemails after I leave work. Not doing too well with this one, but I'm going to keep trying. :) I'm going to stop answering my home phone when I'm not on-call. I'm not sure What I will do the next time I'm not on-call and they ask me to go make a visit 15 minutes before I'm supposed to go home. I've been told by some of the other nurses to say, "I'm sorry, but I already have plans at such and such so it won't be possible for me to do that." In other words, no. We are expected to attend bereavement services several times a year to support our families...a couple of hours here and there at no compensation. I do lot's of job-related research on the computer at home at night...It is rather insidious how all-consuming this job can become. (if we let it) When I reread my post I'm astounded and almost embarrassed at how angry I sound and almost erased the whole thing but maybe it needs to come out. Seeing it in print really makes me realize that changes must be made if I am to continue... It doesn't feel good to be this resentful and I want to function at my best, profesionally. And, I want my life back, to some extent. I miss my old hobbies. I miss my friends. I'm sure my husband is sick of hearing the same old stuff every day....I've become such a whiner! Anyway, I wish you the Very Best and hope you are able to make some changes before it's too late. It sounds like you really like hospice nursing and it would be a shame to lose you. I hope you will post back and let us know how you are doing.

We have no on-call team but take turns. Weekdays on-call starts at 4:30pm to 8am. Sat or Sun call is 8-8 for 24 hours. We usually get 4 days through the week and 1 weekend day in a 6 week schedule plus we all have rotating assigned holidays to cover. We are paid $2.00/hr. to carry beeper and it is the same for any call day regardless of weekend/holiday/etc. We do phone triage and get no compensation for phone time/charting of these calls. They say it is part of being "on-call and is covered under the $2/hr beeper pay. If we go out we get D-D mileage and time and a half our hourly rate regardless if it is an admission, death, or skilled nurse visit..... It is interesting to read about the various on-call compensation structures.

I had a patient on intrathecal hydromorphone who also had Fentora for BTP when she had maxed out her bolus doses. We used it to tide us through until she could get her implanted pump reprogrammed. It is expensive, and it did work. Her 2 complaints: 1. Irritation to buccal mucosa. 2. Sometimes didn't dissolve. We worked on having her use various buccal areas to minimize using the same spot all of the time. We also moistened the area before using the Fentora which helped. We had to get the Fentora through a local pharmacy and it was not included in the per diem through H.P. She also used Actiq which she found helpful, but had a concern that her dogs would somehow get ahold of the sucker....she was more comfortable with the idea of Fentora.