nyx1121

I work for a hospital based NFP hospice with an average community census of 150 and an inpatient census of approx 8 to 16. Our case managers carry a caseload of 12-18 patients and are responsible for their own admissions. We have a huge coverage area approximately 200 miles. Recently we hired 2 on-call nurses to cover evenings with CM back-up M-Sun, 7days on, 7 days off with 16 hour shifts.One of those nurses just quit. We also have 1 nurse who covers daytime weekend call with 1 CM backup days with the afterhours nurse working alone 8p-8a. I have 12 case managers on staff, with 3 PRN RNs who work on average 3 to 4 days per week. Our on-call is brutal. After hour calls range between 10-15 calls per night, with approx 7 visits and atleast one after hours admission. The alternate week that we do not have a designated after hours nurse we are forced to pull from our case management team. They are currently seeing as many as 6 to 8 visits per day. They are overwhelmed, exhausted and very frustrated. Understandably so! I am looking for a feasible solution to easing stress and improving morale. We plan to meet with the nurses next week to discuss their ideas on how to best relieve the additional call that they will be responsible for with the loss of our after hours nurse. I am curious what other hospices are doing and how they retaining staff and reducing burnout. We have a phenomenal staff who work tirelessly. I am frustrated for our nurses, social workers, aids, and chaplains as they all carry enormous loads and do a remarkable job. I will be very open to hear what has worked for folks out there or what has failed. Thank you:)

Thank you for your feedback. This one turned out to be an interesting case. Thanks, nyx1121

I'm a nursing student working on a care plan for a MSSA bacteremia infected sternal wound following CABG. This is what I've come up with so far. I've tried to break it down from most important to least important. Would there be anything you would add or delete? I'm mostly looking for input from a professional who handles these type of questions q.d. Thank you! Decreased cardiac output r/t dysrhythmia, depressed cardiac function, increased systemic vascular resistance. Risk for ineffective tissue perfusion: peripheral r/t prolonged immobility, decreased coughing, decreased deep breathing Risk for infection r/t presence of bacteria (MSSA) Acute pain r/t open sternal wounds Excess fluid volume r/t impaired excretion of sodium and water Impaired tissue integrity r/t wound, presence of infection Risk for infection; spread of r/t imbalanced nutrition less than body requirements Ineffective coping r/t hospitalization and disease process