Hospice Advisors Case Study
Title: Strengthening the Core
Company: Several Hospices
Date: March 29, 2015
Problem: Nurse Case Manager Retention
Presenting Issues/Challenges:Nurse burn-out causing them to leave the organization
Plan of Action: Many hospice companies I work with struggle at lessening burn-out and keeping Nurse Case Managers in the organization. The job of a hospice nurse is demanding as we all know. With the additional responsibilities of handling after-hour and weekend call and doing admissions can heighten the stressful job of managing a case of 11, 12 or 13 patients.
Working with these hospices we explored several strategies to “strengthen the core” and implement which are outlined below:
- There is an on-call company that specializes in handling after hours and weekend hospice calls. Hospice-On-Call is a Chicago based company that works with dozens of hospices across the country to handle after hours calls. They can alleviate calls going to your on call staff as about 60% of after-hours and weekend calls are non-clinical in nature and they process those independent of your staff. Of the other 40% which are clinical calls 30-40% are triaged so as to prevent involvement of the on call staff which can make them more effective and achieve better outcomes. The cost for this service is $12 per patient per week or $1.72 PPD. I not only view this as a good, cost effective service, but a nurse retention device at a reasonable expense to ensure a strong core staff. It is a strategy worth exploring.
- The other core building strategy applies to those hospices who have a census approaching 60 to 70. These hospices are in a position to develop an admission nurse function which does a few things. One, eases the pressure for Nurse Care Managers from having to do an admission. An admission function would handle 70% to 80% of the admissions. Case Managers will be able to focus more on managing their 12 to 14 patient caseloads. These factors will also help enhance retention. The other benefit of having a dedicated admission function is an ability to get a patient admitted sooner. If a Case Manager gets an admission request at the end of the day or Friday afternoon, there is a chance that admission will be pushed off a day or two. This is not only a loss of revenue but an opportunity to serve a patient and family in need. Case Managers recognize this and it contributes to their stress and burn-out and potential leaving the organization.
Here are a few preliminary results:
- Several hospices did note an increase in nurse retention and ratification.
- With a dedicated admission function, an increase in monthly admissions did occur along with weekend admissions.
- The core of Nurse Case Managers were able to care a strong case load and deliver responsive quality care.