elimayrn

Yes, I accepted their offer and start Nov. 5th. I am thoroughly excited and want to prepare for this paradigm shift in my nursing career to foster my success. CMS does have great general information on CPC+ but none specific to the care manager position even though this role appears to be a requirement of participation. If anyone has information on resources I would be forever grateful!

I am expecting an offer from a primary care within a large Hospital in the Kansas City area. My background is hospice cm and Home Health with some long-term care. I am looking for a ce activity on CPC+ and Care Management in the primary care setting. I have found some activities that were 10-20 hours which is great but at upwards to $250. Has anybody come acrossed CEs at a more reasonable cost?

I did accept the possition and will start Feb. 5th so we shall see! I have 3 years with hospice as a CM and 4 years with HH as an LPN. That should help.

Thanks for all the information, it is very helpful! I definately see your point on improving patient care and efficiency.

Thank you for your reply. That makes sense. Am not understanding the PTO example you gave. Is this to make up for too few visits?

Also how are "pay per visit" RNs compensated for meetings, inservice, on-call hours etc? I will be going from a hospice case manager on a salary to Home Health case manager so this is a big decision for me!

I recently applied as a home health case manager and received a phone call last night saying she would call tomorrow with an offer. The company in Kansas City Missouri pays per visit. I am not sure how to convert my requested annual salary to a per visit number! I have tried dividing annual salary down to daily pay but I'm not sure if visits will be made 5 days a week 52 weeks in a year, so I am worried about accepting their offer not knowing.

Thank you Nursylinda, This is exactly why I'm leaving hospice. The money isn't worth the trade off for me. I don't want to live to work, just work to live a decent life.

Update: 2 years later. I've learned so much in 2 years working as a RN CM with hospice, many in-depth lessons about nursing in general and have gotten in closer touch with my family and myself! Unfortunately the reality is hospice is taking a huge toll on me physically, mentally and emotionally. I love my patients and families, even the feisty ones.. Love working autonomously and my IDT. The core problem is the hours and conditions. In short I feel taken advantage of for the profit of our agency. Therw are few 40 hour weeks and many are 50 to 60 hours. We are salary so get little compensation for weekly overtime. We are always short 1 or 2 case managers with too few LPNs to rescue us with visits. By the time the weekend comes I'm exhausted so catching up on home responsibilities leaves little time for me and my partner, grandkids or friends. I'm 57 years old and feel I'm drifting away from the things that matter MOST to me. I live in the KC, MO area and nearly every hospice agency in the area is advertising for case managers. I have worked for 2 agencies now. It's a crying shame. I know this is a lucrative business but it seems as though greed drives most agencies to hire the minimum number of nurses, provide the minimum benefits then drive them until we give out. I'm not sure what else I can do other then leave hospice and find another area of nursing where I can leave work at work at the end of the day and live my life.

Hello to all and thank you in advance, I am currently a RN hospice case manager X 2+ years. Prior to this I was an LPN working LTC and 3+ years in home health. I loved home health and I love hospice most of the time but now I want to return to home health. I miss the healing aspect of nursing and what is pushing me over the edge is the hours in hospice. It is rare that we work a 40 hour week, many times over 50 hours and many of these hours are the charting hours which fall after 5p.m. plus on-call hours Q 4-5 weeks and late admits that must be entered that evening. Plus most if not all the hospice agencies in my area are salary, so I'm not compensated for those extra hours. I've checked job boards and almost every hospice agency in the KC area are advertising for RNs. It has wrecked my work/life balance and I feel alienated from my family. My question is do home health RN's have 8 hour days? Can you leave it at work when you go home? I'm not naïve and not opposed to occasional over-time but as a rule are the hours more manageable?

This gets complicated for me also. Where i have trouble is when the facility staff are not providing the best care such as not turning my Pt through the night or wound dressings are not changed. You would think the nurses would want to know and correct the problem and most of them do but often after mentioning the issue my relationship with the facility is damaged.

Shortness of air. Many at least in my area have gotten away from SOB.

She has no dysphagia, a&o x 3. She's currently taking Roxanol 10mg 3 to 4 times daily and 15mg at hs. I discussed the ms contin with her but daughter said they tried them before and she was loopy so they cut the dose in half and still loopy. That's what I don't understand I've had other patients I've tried to switch to extended relief morphine and they don't tolerate it but can tolerate roxanol all day. Also she doesn't tolerate Lorazepam for her severe SOA.

Thanks for your reply! I've spoken with my patient and she is willing to try this, I will be calling her doctor today. Thanks for the link I have been looking at this and will be ordering it.

I've worked as a hospice case manager for 1 year now and still have lots of questions. I have a COPD patient that can't tolerate Lorazepam but gets relief with Roxanol 0.5ml 4-5 x daily. Lately she is waking up SOA and having to take extra doses in the A.M. I'm curious if anyone has seen MS Contin used for SOA. Wondering if 1 at HS may help her get trough until morning?? I asked another more experienced nurse and her concern was the patient may not be able to swallow pills at end of life, but the Roxanol could still be PRN.

Please repost without all caps. I would like to respond as I have had a very similar past 12 months, state and all.

Thank you for replting. No, no involvement in unethical things. To tell you the truth the supervisors/owner are beating around the bush but I know 4 of the dings were HHA related and some management issue. They actually are telling us there is not yet a copy of the survey for us to see. They say they won't know what needs fixed until this Friday. I've been there for 7 months and it's my first hospice experience. I feel my patient care is high standard and my documentation is thorough. My SIL may have said this because we don't know what the infractions are. I'm not too worried about it now. I know I've done nothing wrong knowingly.

Out hospice company failed state survey miserably, then failed the follow-up visit. They will return again in a few weeks. Management says state has never shut down a hospice? My sister in law, a nurse for 30 years, is afraid if they do shut us down and prohibit serving medicare patient that each of us nurses' licenses may be personally affected, that we may also be prohibited from working with medicare patients. Does anyone know if my license is at risk in any way?

Wanted to let you all know the patient transitioned to the ms contin fine with no adverse se. He had some withdrawl sx, diarrhea and restless legs, due to him withholding the roxanol a full day prior to the switch - which Noone asked him to do. These sx resolved throughout the first day on the new med. Thank you for your feedback. I really needed the reassurance at that time.

Thank you for replying 4boysmama. Yes he has a known history of drug abuse. While he does have copd he's not on dependant, he has some labored breathing and so with exertion. I don't see true dyspnea. I believe he came onto service way too early. He administers his own meds and says he forgets to take it alot. We feel he has become addicted and is abusing the morphine, to be blunt. He doesn't appear to be in that degree of pain. When I've talked about trying longer acting meds he says they are "like spitting in the wind" and they wouldn't be strong enough. I've brought up the fentanyl patch and he says he once had the same hallucinations with it. I appreciate your thoughts on using the prn IR and will certainly recommend it as soon as it looks like he may need it. No liver DX on file.

I'm a new hospice nurse (3 months). I was an LPN for 8 years, now an RN x 1 year. So here's my problem. I have a pt DX COPD, who has been taking Roxanol 1ml at least 6-7 times daily for several months for back pain, generalized pain and he even c/o "organ pain". He's a new pt to me and I'm not sure why it went this far but I understand that 3 months ago the nurse got an order for ms contain 15 mg q 12 and he says he went crazy and was hallucinating the second day. He also admits he didn't stop the roxanol at that time so he was taking both. I spoke with his MD today and he ordered ms contain 45 mg q 12, D/C the Roxanol, and add MS IR 15mg q4 prn. The MD assured me he could not have a true reaction to the ms contain because he is already taking morphine. He said no to having narcan on hand as it would put him in withdrawal. This is to begin day after tomorrow and I will be spending 3-4 hours with him to be sure he does OK. TBH I'm more than a little nervous. Has anyone heard of someone tolerating morphine intensol but not slow release? They are chemically identical. Could he not be getting rid of it? What if he reacts again. He'll be off the roxanol 4 hours prior to first dose.

Update on new job, day 4 of orientation and I love it. The company is super supportive, well staffed and Organized. My confidence is peeking out with hope!

Thank you for your replys and excellent advise! Ill definately apply it. Im reading the Hospice Companion which is very good, teaches the responsibility of the IDT at each patient stage, documentation and symptom management. Its great to read your encouraging posts!

I was just hired as Rn case manager with a locally owned company. I'm so excited, I tried for 8 months to get it! I was an LPN for 8 years and now an RN for 1. I want to soak all the knowledge up I can and get up to par and productive as quickly as reasonably possible. My background is LTC and 3 years in home health. It's a great company, locally owned and very well respected! While I have read many recommended books listed here about nursing experiences, history and philosophy of hospice, etc. I am nervous about assessing for symptoms r/t specific terminal diseases. Not having hospital experience plays into that I'm sure. I wish I could find a book about nursing for end-stage disease processes with palliative care and assessment specifics. I know I will learn mostly from experience but am concerned for my first patients. I want to be able to anticipate complications for them. Any wisdom or advice would be greatly appreciated!

Great news, I spoke with a mentor for the company, the figures were wrong, the real numbers are better, competitive. I'm relieved and more excited about the prospect. I shadow tomorrow and will know by Friday if I'm hired. :yes!: