pt. load for case managers

[holiday2525]

Case managers - tell me, how many patients are you managing on any given week? How many visits do you do in an average week? Does your hospice have a separate admissions nurse? :paw:

[ToniFranseen]

HI, we are suppossed to have 4 visits/day; 12-14 pt caseload. We have prn's do our admissions a lot, tho casemanagers also do admissions. "our greatest challenge is the average 80-120 miles/day with the visits.

I worked another agency that had 15-19 pts and we did admissions; had to bump our pts to do them. All about the numbers! I left there.

We had LPN's do the follow up 2nd day visit, and the coninouts care coverage also. Hate CC...

we also do onccall which can really challenge the days.

12-14 is the best caseload of all.

[angieRN]

My question is with a caseload of 12-18 does your agency require a minimum of 2 visits per patient per week? I have this requirement, so with a caseload of only 14, my weekly visits are at 34! There are some that could certainly get by with one weekly visit to ease the pain, but I'm not allowed to decrease them. I have 2 that need 3x week and one that is 5x week.

[AtlantaRN, RN]

Why aren't you allowed to decrease your visits if the patients don't need them? We have a facility that one nurse sees 8-9 patients a week-usually on a tuesday, then makes a "call" by phone and speaks with each nurse about said patients.......Especially if patients are at a facility. You are the case manager. When a patient first starts with our service, it is normal for the first visit as the "admission" visit that takes 2+ hrs with all the paperwork, then day 2 is a follow up visit, then day 3 is a phone call. Stable patients start 1x/week with a home health aide 1-2 times a week-I take into account how many baths a week the patient normally has. Granted, some facilities want an aide 7days/week (that is not gonna happen on my watch)==if they need that kind of intensive care or are having frequent bm's, they can go to our IPU.

anywhoo, rant mode off.

linda

[angieRN]

I can't decrease them because of company policy saying that we must provide 2 visits/week to facility patients to help communication and coordination of care. I think it's a bunch of bull if you ask me. We're supposed to provided the same level of care to home and facility patients, but essentially, we're giving a higher level of care to our facility patients.

[KateRNCHPN]

I used to post on here as an LVN long ago but it couldn't find my username! Weird!!

I avg between 10-16 patients, depending on census. We're required to see 5 per day. I'd rather have the higher number, unless I have CC patients. Then it gets to be hard to manage my day. When the patient's accuity goes up, my visits to that patient increase.

Kate

[tewdles, RN]

Tewdles, do you make all nursing visits on those 12-15 patients, or do you also have an LPN?

I'm just trying to figure out what to expect at my new job. (I also need to learn to assert myself with my new employer so I don't end up in a situation similar to the one in which I now find myself.)

I do not currently work with an LPN on my team. So I make the vast majority of the nursing visits for my case load. I do have access to per diem RNs who can make routine visits, but I only use them very occasionally. I do have the option of visiting my "stable" and symptom controlled patients weekly, which helps. I appreciate that my employer does not impose an arbitrary visit requirement, they allow us to use our nursing judgement for our frequency.

[sherpa]

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!!

[tewdles, RN]

12 patient visits per day? That is crazy!!

[sherpa]

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.

[MarciCRN]

I do not case manage, I am an Evaluator and admissions ns. But the gals I work with are carrying a load of 23 more or less and they are all crying! 23 is too many, and have to travel the county to see them all. Its very difficult and they are stressed. We have had an active turnover of nurses in the last year, and I believe that is why. I think 12-14 is national average, and should be instituted.

The agency I am at now is not huge on the numbers, as in you "have " to see 30 a week. But one I was working at in another state, was big on 30 a week or you do extra. be it on call or w/e. You girls work hard and should be compensated well.

[tewdles, RN]

case managing more than 20 patients outside of a facility is crazy!

I am sure that you will continue to lose professional staff, and your patients will suffer the consequences of that, until your management demonstrates that they value their staff as much as they do the money.

[MarciCRN]

Thanks tewdles, my sentiments exactly. I wish they would see the light.