Support for field RNCM

Hi,

I want to start this post with saying that I like what I am doing, home hospice and palliative is a great field, gives me satisfaction, I can use all my nursing skills I have acquired over the years, a lot of teaching to patients and relatives.

What I am struggling is the lack of support for the field. Shortly after I started it got clear to me that although being paid for a specific amount of time the agency expects regularly working more than that, expects everybody to be willing to jump in, having good boundaries is very important but also hard because management pushes against it.

Due to chronic short staffing there are only certain days when extra help with per diem RN is available. This means that if there is a day when there are more than the regularly planned visits due to symptom exacerbation/ end-of-life care or others - the RN does not always get support and it is "shrugged off" - there are only so many visits the RN can do and is paid for.

There is a need for more RN but it is a bit like a revolving door when RR get hired.

The other problem I see is that the supporting service like social work is not fully engaged, which means that RN also have to worry about SW tasks.

Don't get me wrong - I understand fluctuating census, acuity and work load but it is not manageable without extra work every day and other RN state the same.

I wish there was a better system in which the RN CM can actually do the CM job besides just crisis management and putting out fires. There is so much to update in EMR and which is last priority.

Can anybody relate in home hospice - if yes got problems solved?

Is it the "system" of home hospice care that is dysfunctional and counts on RN supporting the not well functioning system by working overtime daily / regularly and not getting paid for it?

What are your experiences?