Starting as a hospice case manager...

finn11707 · Oct 2, 2008

I have never heard of seeing Hospice patients only every other week--unless they are quite stable and have been with Hospice for a while. Do you mean other RNs are making visits for your patient too? In a 9 year period, I have worked both on laptop and on paper for 3 different Hospice agencies. Here goes...the best jobs were when I was not case managing, but worked 3 days per week seeing patients, followed by 3 nights per week doing death visits and crisis calls (this was a combined night call for the Home Health patients on pumps and Hospice patients; except once per month I had a 4 day weekend off. I have case managed for 7 years of my Hospice experience. Your support team makes a very big difference. Is the MSW/chaplain team visiting regularly to address the psychosocial journey? If not, this will fall to you in one form or another. How does the whole team function to support you? Is there time for talking about problems/solutions or is it just report off time to the management team...I really like visiting weekly...when things are going well--there is the life reflection part of the journey that is so important to this work. Read the good books out there. The thread on 'recommended reads' is good---don't limit yourself to symptom management. It is very important but not what the heart of Hospice is. Welcome!!! PS--Be kind to yourself, we all reflectively noted an adjustment period of around a year to learn the job. How interesting that you are interested in a jump from births to deaths! My mom was a L&D and Newborn Nursery nurse for most of her career and she always asked as I jumped to another aspect of nursing (Why don't you try happy nursing, Honey, and go to L&D and newborn nursery...) How I wish mom had shared my joy of Hospice. She had the kind spirit that would have found joy here too.

rnboysmom · Oct 2, 2008

I agree with finn11707, it is quite unusual to only see your patients every two weeks--are LPN's seeing them in the interim? What does your caseload look like? I have done the whole spectrum in hospice nursing, case management, QA, Admissions and now hold an administrative position, but, my heart is with the patients. I stiil take call to see patients and keep my skills current. Skills required for hospice nursing? Symptom management for pain (often, deep, severe pain, not L&D--forget it after the birth pain), dyspnea, fatigue, N&V, etc. A good hospice, even a small one, will have symptom control protocols, if not, the NHPCO website has some excellent tools you can purchase fairly reasonably. Next, find a good, seasoned mentor in your company who knows symptom control and is organized (look fo rthe one with the car that looks like a small ambulance !!!). Hospice nursing is as much about psychosocial issues as symptom control, rely on your team chaplain and social services to help you will this, you will be busy enough just answering basic questions for families and patients about the process and with symptom control education. Become familiar with the stages of grief, they rear their head frequently and invade every aspect of the nursing process.

The very best advice I can offer:

1. keep organized--what works for someone else may not work for you ( I went through about seven systems over about a year before I found one that worked for me).

2. stay current on your paperwork

3. stay current on your paperwork and

4.stay current on your paperwork.

See a recurring theme? Paperwork will "eat you alive" unless you stay on top of it. The rest is just good nursing, a kind heart, compassion, and the awesome feeling of satisfaction you get from being so very close to that "window" when a patient passes in your presence and the family is rejoicing their life instead of mourning their death--again--awesome!

Good Luck!

Barb

TNlearner1 · Oct 21, 2008

Thank you both so much for answering my post. I have been doing this for 3 weeks now. My first week was in the office...KILLER!!! My second week I rode with the other disciplines in the office to see what their role is exactly (CNA, HHA, LPN, MSW and BCC). This week I am with another case manager. I have been hit with some difficulties already. I have never dealt with wounds before (none of those in L&D). My first patient has got 15 wounds with three of them being 4th degree. She has a daughter that has Downs and her husband is just plain ole mean. They are moving her to GIP and getting APS involved. Hospice is a whole new world for me. Please tell me that this gets easier once I finally figure out what I am actually doing. As for the other questions, the LPN's cover on the days that the RN cant see the pt. I have about 12 patients that I am scheduled to see. They are in about a 250 mile radius of each other. They are letting me group them together so that I can cover the south one day and north the next. LOTS MORE TO LEARN!!!!

rnboysmom · Oct 21, 2008

TN

I am not sure that the job gets any "easier", you just get better at it. You will get very familiar with APS. I often wondered why it seemed that every single patient that our company signed on(or at least at some times, it seemed like every single one) were families with "issues". One of my social services employees made a comment that made a lot of sense. A lot of families that "have it together" have already made plans;they have been planning for years about who will take care of mom or dad and they have a "plan in place". So, it makes sense that we get a bigger proportion of those that do not have any plans or have never planned or thought about taking care of a fmaily member who is critically ill or dying. You will quickly learn what is normal grief, and what needs to be reported--your social services department will help you with all of this. It helps to remember, that your job is not to "fix" things, but to help this family, this person walk their own walk. We are just "travel agents" of sorts!! They have the ticket and get to determine the route and the mode of transport. This is not to say that every family that chooses hospice has not made any plans, but I would estimate that we get a larger proportion of families that have made no other plans--not that they are any less capable, by any means. And, as I have stated several times, grief and loss literally causes people to "do things" that they would never do at any other time in their life. It sounds like you have a large area to cover--if you suspect problems with a family--notify your other core members early so you can get a good assessment on the situation. Never, never, never go into a home alone that you are not comfortable with. I know this is basic safety, but things can escalate quickly, and murphy's law says that they will escalate at three in the morning when you are 60 miles from help! Good Luck! :nurse:

LPN30 · Oct 23, 2008

hey. I just left hospice not to long ago. And I agree with the other nurses that it is unusual to see pts once every other week. Are the the sup over the LPN case manager that has that actual caseload? Thats how it was were i came from. The RN did supervisory visits q 2 weeks. I left hospice because it was arbout that damn paperwork and keeping the census up and not about the pts. Paperwork is no joke. If u dont keep up u will b doing paperwork at home. But it can b very rewarding.

rnboysmom · Oct 23, 2008

Re the "paperwork"

Yep--paperwork is a nightmare and will consume you if you don't stay on top of it. However...paperwork is the necessary evil of the government and federal regulations and is a necessary part of the job so we can all be paid for what we do. Ther ARE companies out there that recognize that the patient is the primary focus. I am going to be the optimist here and say that the majority of hospices hope they are doing the right thing for the patient. There are a minority of hospices that see the patient as a $$$$$, and thus, have you seeing as many patients a day that they can load on you and don't account for the paperwork. I just keep reiterizing in all of my posts that YOU DO HAVE OPTIONS!!! If we all choose not to work for those types of companies that are only in business to "make a buck", then they can't survive. Problem is, that these types of companies usually mask that behavior by offering high salaries, high on-call pay, bonuses and outrageous vacation time. Then, once you are in and attached to your patients and co-workers, you realize, only too late that you are working 150 hours a pay for 80 hours of salaried pay and are still not taking good care of your patients because of their systems and philosophy. Choose your company carefully.....interview THEM as they interview YOU. I have each job candidates meet with my staff in their profession for a question and answer session without management staff persent before they chosen for final hire. It is a closed door session, and private, and both my staff and the job candidate are free to ask questions. It has literally kept our rentention rate at almost 100% and nobody has terminated for employment from not understanding what the job entailed. Really, most companies do try to focus on the patient as the most important aspect of the company. Find them and support them!:heartbeat