Was my "initial" reaction wrong?

[Kitty Hawk, ADN, RN]

Okay, as usual I only find the time to come here when things go haywire!

First the setup to the weekend. I worked Labor Day, not a big deal, I was only called out during the day for 2 visits. (but as you all know, there's stress for watching the phones)

I had a usual stressful week and was informed mid week I would have a new employee that would be with me the upcoming week so that was stressful. From Thur to Sat I found out my census was going from 15 to 19 and one of them would require a qd visit at the local hospital for in-pt status. These 4 all require prep work as I create index cards, review meds, hx etc...So I'm ready for the patient. I did all this on Sat from home as I knew Monday I wouldn't have my usual cushion with the new employee present, plus I attend a weekly Monday meeting at the facility that I also serve.

Okay, Sat was fairly uneventful, I was not called out during the day at all as we have 2 LPN's working, one weekend RN til 430p and an admission nurse til 9pm (who can also do visits) The office leaves at 430p (or more like rolls the phones to the answering service from 430pm-7p for me to then get, and our IPU's pick up the calls after 7p to 7a)

I typically won't eat dinner until after 7p because that's the "safe time" that I will only get calls if I need to go out because the unit can triage problems for us. I have IBS that for the most part is okay, but when I'm nervous, it's just not a wise idea to eat! I got a call at 650pm for a CTB around an hour away. I head out and return home after 11pm and finally ate dinner at 1145pm went to bed and averaged 2-3hrs of broken sleep because on top of the usual stress, my phone kept randomly shutting down (new one on order) so I gave the unit my personal cell but it is far quieter than work phone and I don't sleep anyway.

Uneventful evening and Sunday morning arrives. I was already pre-scheduled to go out for an admission with our sw that was planned for a late afternoon with a wild family that could only accept 2 hour time frame. Our sw's don't usually work Sundays, but this was planned by upper management.

I was still in good frame of mind, ready if need be to do visits prior that were in and out types. I'm not the fastest at admissions because field nurses don't do them all that often, usually only when on call which averages 4x month,weekend on call is generally q other month for us.

I got word at 10am there was a "possible" admission over an hour away and then approx 45min from the planned one, well I went into an anxious panic. I found out one of the LPN's was not called in because she had yet another excuse for being ill. (she is on call q other month as is known to "get out of her day on call" and refuses to work overnight with an insomnia excuse, so another LPN picks up for her from 830pm to 8a.

I was upset figuring staff wasn't being utilized in best way. We do not have an admission nurse on Sunday as previously we did not accept admissions on Sundays/Holidays however that has changed in recent months without a direct knowledge just more, "we all were figuring it out".

From my perspective, I had 2 hours of sleep, I was being sent for a mess admission ( I was foretold the family is v wild) and to do another right before it which to me, the exhaustion level of what an admission does to me (of not in July,I had back to back admissions that took 12hours total) not sure if I would be able to comfortably complete one (not knowing family acceptance etc...) before going to the crazy one. And also there was back and forth that morning because it wasn't even known if the insurance was okay!

Back and forth phone calls were made by mean to my back up admin who also did not give me a direct order to go because she was also upset the one LPN faked getting out of work (she said it happens all the time) and that she would let me know. I tried calling my main boss who is supposed to always be avail to us, but her mailbox was full.

This could have been nipped by her saying, look, you need to go. But understand, I physically felt I couldn't, I really felt close to a breakdown and like I was expected to be a machine after 2 to 3 hours of non quality sleep, driving 3 to 4 hours of drive time (also exhausting) the brain power to do proper admissions, I mean our 12 hour admission nurses usually average 3 or 4 per day, it just seemed really unreasonable.

I let my "big boss" know I was avail to talk if she wanted to know what happened from my stance, in other words, I was not hiding from anyone and actively trying to get direction. I also know my physical capabilities and felt that I was treading v close to a bronchitis from being run into the ground, little sleep, stress.

Also of note, we are notoriously busy on Sundays from 7p to 8am Monday with high probability of being called out. I should mention, they did send another nurse that was filling in for us during the day to the first admission. I did not know she had previously arranged to work light that day. As I offered to take the 4 visit from her, I just couldn't fathom a brain exhausting admission, so I wasn't trying to get out of work at all.

I did get a call at 130 am for a CTB an hour away, I was headed out for that when barely out of my neighborhood I was told not to come as family funeral home could be there in 10min and family just wanted rest asap, fine...I still had to close out the case type a note so another total 1 hour.

Monday was a disaster with the boss, suffice to say it didn't go well, but I didn't really find out how bad until a day later.

My immediate boss was in my corner saying that on call previously for the weekends was a v grey area, the office person sending everyone out also agreed it is v grey and they don't always know who to call.

But because this has been an ongoing problem, with nurses refusing to go out on the weekends (I did NOT refuse, I was just questioning if we all were being utilized in the bet way) and previously our immediate boss would sometimes get upset if an RN was sent for something that they could send an LPN for as we cost more to send out as this is all overtime for us after working our normal 40hour week. So all of this was too swirling in my head as I've gotten questioned before on going out for a CTB instead of using the LPN when I didn't know where that person lived and maybe wasn't thinking clearly at 2am!

So I've spent the last week in more tear than not. I have been told by my immediate boss that I am an excellent nurse, I do not call off, I have not even used any vacation time yet (which is also a problem for my burnout level) but I have some time coming up next weekend. My big boss does not really know me, nor my work ethic v well. We are all strong Christians who work there as that sets us apart from other agencies ( not that others aren't, we are just known for it)

Also of note, the person that does the schedules even thought she was putting me in a predicament of working Labor Day before that with the weekend but the weekend was already in place and she did call me to okay if I could do Labor Day and I told her I would. I figured it would be like a tidal wave that I wouldn't have time to dread the weekend (as I usually do because they have been v hard lately) and I was right, it was over and done before I could think about it.

Lastly we are a census of 200 covering 7 counties. It feels especially daunting to cover that for 48hours even though we have a couple LPN's the main county that is over an hour from me is usually the problem one and I am always the closest scheduled q time the LPN's were each a 1/2 hour further from me.

So I still feel crummy as my immediate boss still needs to talk to my big boss to take care of any reprimands other than a verbal (which in itself is crushing as I have a strong work ethic) The big boss feels I refused, which I did not, I was questioning but in hindsight, I see it was not my business to question anything even though I have been a doormat in the past and want to avoid that.

That's the funny thing, I now feel in the wrong, that I just should have went and sucked it up though that's the funny thing about hindsight, it seemed so unreasonable at the time. I learned I can do an admission in about an hour, 1 1/2 in the home and leave to do paperwork part, med check etc...

I also feel I failed God in that, I try to be a good disciple and do all with a servant's heart, so I see I failed God in that he was calling me to go and I put up a roadblock.

I just feel sometimes we are expected to be machines. My husband thought it was crazy what they expect of us....but idk, maybe this is just hospice? I'm still rather new (little over a year) and still learning. This is why my immediate boss, along with knowing my heart is willing to defend me. I'm just sick if it's not good enough for the big boss.

If you got through this novel, I thank you! It's my weekend and I still feel sick over this, so was my initial reaction normal or wrong in the hospice world?

[lantanaRN]

Welcome to the "new" hospice model Been doing this for 10years for a top 11 in the country large not for profit All was good until 2 years ago when they started transitioning with another hospice and another county Total census over 200 covering multiple counties When previously my load was 12-15it has steadiy creeped to as many as 28 All in homes, spend at least 3 hours in commute time, and the higher the load the more I feel like I am doing "hit and run" visits which is not what I want to provide The families and patients deserve so much more, yes some visits can take 30 minutes or less but soetie way more. Thank goodness we have admissions nurses who do only that But I do do CTB which can also take several hours as the goal is to get them out and into an inpt bed or home on crisis care. But it is still so emotionally/spiritually rewarding that even tho I get frustrated over the corporate bs at the end of the day it's all about making the transition rewarding at best, comfortable and at peace

[Kitty Hawk, ADN, RN]

Thanks! (and sorry that was SO long, I didn't realize until I saw it!) I agree it's about what you get out of this job that exceeds what you give sometimes. I think we just had a crazy September, all worked out and we even had 2 other nurses that had melt downs, one snapped on another nurse and ending up leaving their post for the day (office position) and another was upset over the constant changes and resigned but later realized it was a rash judgement after a stressful on call weekend and retracted the resignation which they accepted.

I'm hoping they see that all this overload is causing people who otherwise can handle the job and stress calmly are hitting breaking points and they do work on getting us an on call team for evenings and weekends. I'm willing to wait as this is the first job with the exception of on call, that I absolutely love.

[toomuchbaloney]

Yup

some agencies will work you to the bone.

they will chew you up and spit you out.

if you work when over tired and make a mistake they will throw you under the bus.

if you drive impaired by lack of quality sleep and have an accident they will drug test you and criticize your choice to drive while that tired.

but if you actually make a professional and responsible decision to say enuf is enuf and it is not safe for me to do you will be reprimanded and encouraged to be more professional and more of a team player.

sorry it is happening to you.

[softrbreeze]

Find yourself a smaller hospice, sweetie. I don't know why for-profit hospices get thrown under the bus so often but I wouldn't let that be a determinate. I've worked for 2 hospices, both for profit, one large, one small. VASTLY different experiences. Trust your instincts when you go for the interview and meet the people you will be working for. Those little warning lights in your head go off for a reason (Trust me, I learned the hard way!). You want to work for an employer that WANTS to keep your hours at 40 or below and that is willing to pay hourly, not salary. Your off-time is and should be precious to both you and your employer. A wise employer knows you can't give your best work when your stressed, hungry, and running on fumes.

[nutella, MSN, RN]

I am sorry that you are so stressed out!

The hospice scene is changing and I guess everybody is feeling the pressure.

The fact is that no administration really wants to deal with complaining employees who are overworked. While there is some kind of standard when you work in facilities, working for agencies in "home care" or "home hospice" appears to be a field "where everything goes". People who speak up against work conditions are in danger of being labeled as "no team workers", "insubordinate" and similar. Especially in home care I feel that there is a grey area because smaller companies do not have the same resources for dealing with fluctuating business, call outs, and changing acuity.

Perhaps you want to start looking around to see what else is out there in terms of jobs. It does not hurt to get an idea of other opportunities and to prepare your resume in case you want a change.