Worried about new job

[Halinja, BSN, RN]

I recently accepted a case manager position in hospice. I've been on a few calls so far, including a death call, and the work itself i think I would love, and certainly don't see any difficulties in handling the load.

Here's what bothers me though...

When I interviewed the NM said...and if I notice you're looking burned out, I put a bottle of bubble bath on your desk as a hint to go on home and take some time for yourself. She also mentioned that we would be on call every fifth weekend. And an 'occasional' night of call for admitting.

Fast forward to the actual job.

First of all...we don't have desks. Nope. So it's going to be pretty hard to put a bottle of bubble bath on it. Warning bells started ringing in the back of my head.

The other day the NM went over the call schedule, and she was talking pretty fast, but there was the every fifth weekend all right, and every other monday and thursday. Er? Back up for the admitting nurse...during the day, it's okay.

Well...

Today I asked the case manager I was shadowing about call.

The deal is...every fifth weekend is for admitting. We have a policy that we HAVE to admit within three hours. So...admits can be night or day. Every other monday and thursday is 24 hour on call for everything. Death calls. Facilities wanting orders changed. Families that want help. Phone triage. Plus your normal work-day and normal case load. Now...I haven't had to do it so maybe it isn't as bad as it feels. But I'm nervous. And I haven't gotten my first paycheck yet, so now I'm beginning to wonder about the hourly pay promised. What if that isn't QUITE what was stated either?

An office person I was shadowing early on said, "we sure have been burning through the case managers." I'm beginning to get the glimmering of an idea why.

Okay...I've ranted a little. Now I'm wondering...is this a normal call schedule? It seems messed up to me. I was told they had a night nurse for call when I interviewed. So why is a case manager on call?

I would really love this work. I can see myself doing it, and being proud of the job I would do. But I'm old enough that I am not willing to kill myself for a job. I still have a son at home. I have a husband that I love and enjoy being with. I don't do well with lack of sleep. Am I in the wrong job? Have I just screwed up ROYALLY???

[rngolfer53]

Finding and keeping night nurses is a challenge. So, perhaps the CMs get to fill in when there are vacant night positions open.

The schedule when there is full staffing can be very different than the one that's actually lived.

Where I work (night home visits, btw) we've had two new after-hours hires who have quit and one who moved to a different shift in the last year. All for different reasons, such as thinking the schedule they got hired for would change, another who didn't feel hospice was the practice she wanted at this point.

[DelanaRN, MSN, APRN, NP]

I am an RN case manager during the day, but am on call at least 2 nights each week from 1630 through 0830 the next morning plus back up call every other week. I work about 40-45 hours on average each week before any call...so I feel stretched thin sometimes.

[calledtodo]

It's hard to say if you are in the wrong job. Sometimes you don't know untill you are physically trying to move on from the place. I think you should keep the job for now but apply at other places. What can it hurt. You already know what you don't want to deal with. If you have the time seek out another job. Go on the interview and take it a day at a time. Do all of this if you are able to afford to that is. I was at a place that I knew wasn't a good fit for me and I fought myself every day on moving on but it was the best thing I could have ever done because I am at a place now where there is more potential. I can't say it is easier or harder. I just know that I have room for growth and better options. Good luck and I think that you will know soon enough what the best thing is to do. Also I think that you should ask yourself why you are there. What is keeping you from leaving? Do you have a plan that may require you to hang in there?

[americanTrain]

I would say that if this is really what you want to do, give it at least 6 months. I felt the

exact way you did when I first started. I had a hard time transitioning to 5day work week

schedule. Im on call every other week (all week long) from Friday to the next Friday. ( 1st call)

with a backup; just in case. I take all the 2am calls to pronounce, since it must be an RN.

I also work 32-40 hours during the work week.

I wouldnt worry so much as long as they shoot you straight. I think the bubble bath comment was

just meant as a caring jesture and not sarcasm. But I would ponder a little on the case manager

burn out. Not so long that youve scared yourself out of an opportunity to learn something new,

but just keep one eye open; if you know what I mean. You will know soon enough why it was said

whether it was true or not. Are there other case managers that you can talk with to get their

view on their job?

[tewdles, RN]

I worked for a hospice that required the full time case managers to take up to 150 hours on call /month. That included the day shift call (scheduled visits plus whatever emergency comes up) every 2nd or 3rd weekend (depending upon vacations etc). The company paid $3/hr to "carry the pager" but cheaped out by dropping the $3/hr when you actually went out on a visit (as if you weren't still on call and carrying the pager). Because the nurse manager (team leader) is a micro-manager the case managers submit schedules for their regular visits but are plagued by additional work assigned. That hospice uses their contingent staff to case manager as well, rather than to cover vacations, paid time off, sick time, etc. They recently accepted the 2 week notice for 2 case RNs. This means that in the past 4 years they have completely replaced their RN staff...with the exception of on RN who works 24hr/week although that nurse is miserable and frequently feels "picked on" (with good reason).

My recommendation to you is to maintain a positive attitude about who you are as a nurse and team member, but keep your eyes and ears open. Try to develop a very open relationship with your manager so that you can be honest with her about when you are feeling burnt. Know this, it IS possible to have GOOD work in hospice. Take care of yourself!

[Halinja, BSN, RN]

LOL, posted once and it disappeared into cyberspace, let's see if I have better luck with this one...

Update:

I found out a little more about call. What it boils down (with the hiring of two new RN's, one of whom is me) to in the end is doing weekday/night call per month, and then call every fifth weekend. I can DO that!

I tend to panic a little when something is new, and I'm feeling overwhelmed. But as the days pass, it's settling out. I like it so far.

Thank you for the replies!!!