Putting myself at your mercy...

Specialties Hospice

Published

Alright, please don't chuckle, but since y'all are hospice nurses and I can't get a straight answer out of mine, I'm coming to you for help.

I believe our hospice (31 census this morning, 18 months in business), has a serious staffing issue.

The problem is that I'm an owner and a "money guy" and our adminsitrating co-owner is a nurse who I believe way overstaffs us. I now represent 52% of the shares and am about to make some major changes, but I want to make sure I'm not TOO out of line.

Here's what we have on staff, as far as nursing and administration:

DON ($80,000/yr) - does some admissions

ADON ($60,000/yr) - doesn't take call and rarely sees patients - basically office staff

Field RN ($65,000/yr) - does most of the admissions

Field RN ($62,500/yr)

Field LVN (per hour, makes about $50,000/yr)

Field LVN ($45,000/yr)

On-call nurse (about $1,200 month)

Administrator (an owner who is an RN - $48,000 salary plus her share of the company)

Assistant administrator (daughter who is a PTA - split with her HHA - $36,000/yr)

None of these people do billing or scheduling or anything, and we have aides ($16/visit, which is about to change also - going salary), so this is JUST our nursing/administration staff. I think we're overstaffed in other areas too, but as this is a nursing forum, I'm only asking about the nursing (and I think administrator and assistant can and should be part of that).

My feeling is that with 30 patients we are WAY overstaffed. The DON should be titled as Assistant Administrator, and the Administrator is an owner and RN with 20 years of experience and should call herself the ADON.

I also think we're one field nurse heavy.

So let me just ask, with 30 patients what do y'all think? We have $125,000+ each month in revenue and in 18 months we haven't turned a profit. I think we're just being milked to provide salaries to the administrator and assistant administrator, and we're letting the DON overstaff us to keep her (and that of her friends who she recommended we hire) workload down.

Maybe I'm being greedy, but we literally have never distributed a penny of profit and I think it's because we have too many nurses and too much duplication of administration which is leading to a WAY inflated salary structure. Other hospices in my area with this level of census don't have nearly the staff we do.

What says the group?

Thanks in advance for your help and your responses!

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And just to clarify, I'm not trying to be the national company that works its nurses to the bone and burns them out, and I want a happy staff, but I don't want to be paying a bunch of people to sit around doing nothing while the agency is breaking even in a good month, and requiring cash infusions in bad months, especially with 30 patients after a year and a half.

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Just a cursory reading gives me the impression you may be overstaffed. Bet you could make do with half the staff until census picks up. Your one "office" nurse could be part time, like in an agency I know with a similar census.

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My hospice has a similar census with 2 FT Field RNs, 1 FT Field LVN, and 2 on-call RNs for evenings and weekends. The FT Field RNs also take call occasionally. Most of the time, this works out great but we do occasionally have periods where we are getting referrals out the wazoo and can barely keep up. The RNs take turns doing admissions, so no Admissions Nurse, per se. We have had a lot of nurse turnover in the past because of unrealistic expectations of the DON and administrators but our current staffing/system seems to be working out great. Retaining trained employees is key to keeping things running smoothly, imho. You may have some wiggle room to reduce staffing though. Our trouble in the past often stemmed from "office" RNs/administrators who were overloading the field nurses so they that could stay comfy in their offices. One of my past supervisors wouldn't even answer an office call- just passed them all to the field staff and expected us to stop what we were doing to answer calls and document. With that agency, I was working 55-80 hrs/wk- NEVER again.

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Specializes in NICU, PICU, Transport, L&D, Hospice.

Why do you require a DON and an ADON with that census? Is that a state or regional requirement?

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Yeah it seems like you are overstaffed higher up on the ladder...you don't need a DON and a ADON...2 field nurses for 30 patients is good..that is 15 patients per case load...and you could reduce down to just 1 LVN..you would need 3-4 CNAs for that type of census, since most patients require more CNA visits than they do NRSG visits......

So 1 ADMIN

1 DON

1 office administrative assistant (answer phones and do office work..about $18-25/hr)

2 RNs

1 LVN

3 CNAs

2 SWs

2 chaplains and so forth..when you get to a census of 45 then you can hire a clinical coordinator and another field RN...try to keep the RN's case load around 15, that is reasonable and they can provide better care than if they had a higher load, such as 20.

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Specializes in NICU, PICU, Transport, L&D, Hospice.
Yeah it seems like you are overstaffed higher up on the ladder...you don't need a DON and a ADON...2 field nurses for 30 patients is good..that is 15 patients per case load...and you could reduce down to just 1 LVN..you would need 3-4 CNAs for that type of census, since most patients require more CNA visits than they do NRSG visits......

So 1 ADMIN

1 DON

1 office administrative assistant (answer phones and do office work..about $18-25/hr)

2 RNs

1 LVN

3 CNAs

2 SWs

2 chaplains and so forth..when you get to a census of 45 then you can hire a clinical coordinator and another field RN...try to keep the RN's case load around 15, that is reasonable and they can provide better care than if they had a higher load, such as 20.

This recipe provides 4 RNs to manage the 24/7 oncall needs of the agency.

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Yeah you are right , I forgot to figure in the on call staff , but as far as regular staffing that works , well at least that's how my hospice does It

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