I’ve been a hospice nurse for over six years and am writing this article. Over the years, I’ve seen unintentional time management mistakes that pushed outstanding hospice staff to leave the field after feeling “burnt out.” I want to revisit this topic with the hope that if you, as the reader, are feeling burnt out in the field of hospice and can implement some of the tips in this article, you will have an improved life-work balance so that you remain in the field.
Hospice visiting staff face a caseload that can sometimes change several times within the week (patients dying lowering the caseload, new admissions, helping fellow team members who are on paid-time-off, changes of a condition requiring a visit, patients with various and changing acuities requiring more frequent visits). While this part is always true, I recommend creating a scheduling framework before the week starts to help give you an idea of the days ahead and how to serve each patient best.
Framework for the Week Ahead
As a hospice nurse, you are responsible for providing compassionate and quality care to patients facing the end of life. You also have the challenge of managing your time efficiently and effectively, as you may have a large caseload and a wide geographic area to cover. To help you plan your week, here are some steps you can follow:
Review all cases and update a journal you keep for your patients that tracks the start of care dates and associated clinical data (height, weight, BMI, MUAC, KPS/PPS, FAST, and related) along with significant changes that will be fleshed out upon recertification documentation. This will help you monitor your patient’s condition and progress and identify any issues or needs that require your attention. It will also help you prepare for the necessary documentation and reporting for hospice care.
Review acuity and recent events for patients that may indicate they need to be seen sooner rather than later in the week. Also, review any recent work emails for on-call activity for patients that may indicate they need to be done sooner rather than later. For each patient, especially if you’ve been visiting with them, ballpark the onsite visit time. This will help you prioritize your visits based on the urgency and complexity of each patient’s situation. It will also help you estimate how much time you will need to spend with each patient and how to allocate your resources accordingly.
Review where everyone lives in relation to one another so you can group patients first on acuity and special needs based on where they live in relation to one another. This will help you optimize travel time and mileage and reduce stress and fatigue. It will also help you coordinate your visits with other hospice team members, such as social workers, chaplains, volunteers, and bereavement counselors.
The next step is to assign the day and position within the day for each patient. For example, John Smith will be seen twice a week on a Monday/Thursday, and Jane Doe on a Tuesday/Friday, Norma Layla is on EOL for daily visits, Tom Yoe is on Monday, Wednesday, Friday, and for each patient 1st visit, 2nd visit, 3rd visit in the day and so on. Your days and weeks will look different from mine as I try to see my first patient around 7:15 to 7:30 AM to avoid getting home too late. The nursing priority system (i.e., seeing the most critical patient first) is crucial as dying is not an emergency (we are not EMS/911). So, unless you are 100% sure you can do something that can include soothing the patient and family, ensure they are seen earlier in the week, more often, and not necessarily your first visit on your journey. You want to avoid creating situations where you are zig-zagging around the area. This will help you create a realistic and flexible schedule that meets the needs of your patients and yourself. It will also help you balance your workload and avoid burnout.
Following these steps, you can create a framework for the week ahead to help you manage your time effectively and efficiently. Remember, time management is not only about doing things faster but also about doing things better. As a hospice nurse, you can make a difference in the lives of your patients and their families and provide them with comfort, dignity, and peace. By managing your time well, you can also care for yourself and enjoy your work.
Day Framework
As a hospice nurse, you are responsible for providing compassionate and quality care to patients facing the end of life. You also have the challenge of managing your time efficiently and effectively, as you may have a large caseload and a wide geographic area to cover. To help you plan your day, here are some steps you can follow:
For each visit, you should know key areas to review, discuss, etc. These may include the patient’s physical, emotional, spiritual, and social needs in addition to the needs of the family and caregivers. You should also review the patient’s care plan, goals, and preferences and make any necessary adjustments or referrals. It would be best to document your findings and interventions promptly and accurately.
Every visit should include education on preparing the patient, family, and caregivers for the patient to experience a Good Death. A Good Death is a term that describes a death that is consistent with the patient’s values, wishes, and beliefs. You should provide information and support on symptom management, advance directives, hospice philosophy, grief, and coping strategies. It would help if you also addressed any questions or concerns the patient, family, and caregivers may have.
Every visit should include key areas to assess. These may consist of the patient’s pain, nausea, dyspnea, anxiety, depression, delirium, constipation, skin integrity, nutrition, hydration, and functional status. You should use appropriate tools and scales to measure and monitor these symptoms and provide interventions as needed. You should also assess the patient’s safety, comfort, and quality of life and ensure that the patient has adequate supplies and equipment.
By following these steps, you can create a day framework that will help you provide effective and compassionate care to your patients and their families. Remember, as a hospice nurse, you can make a difference in the lives of your patients and their families and provide them with comfort, dignity, and peace.
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Framework for the Visit
As a hospice nurse, you are responsible for providing compassionate and quality care to patients facing the end of life. You also have the challenge of managing your time efficiently and effectively, as you may have a large caseload and a wide geographic area to cover. To help you plan your visit, here are some steps you can follow:
Remember that for each visit, you should know key areas to review, discuss, etc. These may include the patient’s physical, emotional, spiritual, and social needs in addition to the needs of the family and caregivers. You should also review the patient’s plan of care, goals, and preferences and make any necessary adjustments or referrals. It would help if you documented your findings and interventions promptly and accurately.
Every visit should include education on preparing the patient, family, and caregivers for the patient to experience a Good Death. A Good Death is a term that describes a death that is consistent with the patient’s values, wishes, and beliefs. You should provide information and support on symptom management, advance directives, hospice philosophy, grief, and coping strategies. It would help if you also addressed any questions or concerns the patient, family, and caregivers may have.
Every visit should include key areas to assess. These may consist of the patient’s pain, nausea, dyspnea, anxiety, depression, delirium, constipation, skin integrity, nutrition, hydration, and functional status. You should use appropriate tools and scales to measure and monitor these symptoms and provide interventions as needed. You should also assess the patient’s safety, comfort, and quality of life and ensure that the patient has adequate supplies and equipment.
Evidence-based practice is that before you leave the visit, all of your documentation should be complete except for admission visits, where there is typically one to several hours of additional documentation and work to be completed. Since documentation can be considered a mechanical task that takes away from demonstrating compassion towards the patient, the family, and caregivers, I typically start off the visit with conversation and compassion before diving into the mechanical aspects of the visit and, then ending the visit with phone calls, documentation, and education (a sandwich approach). Once you develop a routine (which I strongly encourage as part of putting suitable time management skills into practice), it will become easier to complete everything within the visit and therefore have little to no work to take home with you (the most significant complaint I hear from fellow hospice nurses is charting at home).
By following these steps, you can create a framework for the visit that will help you provide effective and compassionate care to your patients and their families.
Know When to say “No” and When to Negotiate
As a hospice nurse, you are responsible for providing compassionate and quality care to patients facing the end of life. You also have the challenge of managing your time efficiently and effectively, as you may have a large caseload and a wide geographic area to cover. Sometimes, you may encounter situations where you must say no or negotiate with your manager, colleagues, or patients and their families. Here are some tips on how to handle these situations:
You need to develop the ability to say “No, I cannot make an extra visit,” “No, I cannot do an admission,” and the like, as well as “To say yes to your request, I will need ___________.” Saying no can be challenging, especially when you want to help others and do your best. However, saying yes to everything can lead to stress, burnout, and poor quality of care. Therefore, you must set boundaries and prioritize your tasks based on availability, workload, and patient needs. It would help if you also communicated clearly and respectfully with your manager, colleagues, or patients and their families about why you are saying no and what you can offer instead. For example, you can say, “I’m sorry, I cannot take on another admission today, as I already have six scheduled visits and need to finish my documentation. Can you please assign it to someone else or postpone it until tomorrow?” or “I understand that you want me to visit your loved one every day, but I have other patients who also need my care. How about we arrange for a hospice aide or a volunteer to come on the days that I’m not here?”
Sometimes, saying no is not an option, and you must negotiate with your manager, colleagues, or patients and their families. Negotiation is finding a mutually acceptable solution that meets the needs and interests of both parties. Negotiation can help you resolve conflicts, build relationships, and achieve goals. You need to prepare, listen, empathize, and propose to negotiate effectively. For example, you can say, “I want to say yes, and to do so, I will need ___________.” Then you can explain what you need and why and ask the other party what they need and why. You can also suggest alternatives or trade-offs that can benefit both sides. For example, you can say, “I want to say yes to taking on these three high-acuity patients, and to do so, I will need to reschedule or delegate four of my routine visits. Can you please help me with that?” or “I want to say yes to visiting your loved one today and to do so I will need to shorten my visit time with another patient. Can you please understand and respect that?”
By knowing when to say no and when to negotiate, you can manage your time effectively and efficiently.
Additional Tips to Enhance Your Time Management Skills
Set Clear Boundaries
One of the most essential skills for hospice nurses is to set clear boundaries with their patients, families, and team members. This will help you maintain a manageable workload and avoid taking on more than you can handle. Setting boundaries also means respecting your time and space and communicating your availability when not on duty. This will prevent interruptions and distractions during your off hours and allow you to focus on your needs and well-being. Remember, you cannot care for others if you do not care for yourself. Therefore, prioritize self-care and allocate time for rest and rejuvenation. This will help you prevent stress, burnout, and compassion fatigue and enhance your productivity and performance.
Streamline Documentation Processes
Documentation is essential to hospice care, as it provides evidence of the services and interventions you provide and supports the quality and continuity of care. However, documentation can also be time-consuming and tedious and take away from your direct patient care. Therefore, you need to develop a systematic approach to documentation that minimizes the time spent on paperwork and maximizes the time spent on patient care. One way to do this is to utilize technology tools, such as electronic health records or mobile apps, to streamline documentation processes and access patient information efficiently. These tools can help you record, store, retrieve, and share data securely and conveniently, reducing errors and duplication. Another way to streamline documentation is to complete it during or immediately after the visit while the information is fresh in your mind. This will help you avoid accumulating paperwork at home and improve the accuracy and completeness of your documentation.
Delegate Tasks Appropriately
As a hospice nurse, you are part of an interdisciplinary team that includes other nurses, physicians, social workers, chaplains, and volunteers. Each team member has a unique role and expertise and can contribute to the care of the patient and the family. Therefore, you need to identify tasks that can be delegated to other team members, such as nursing assistants or social workers, who can perform them safely and competently. Delegating tasks can help you free up your time and energy for tasks that require your specialized skills and knowledge and improve efficiency and quality of care. However, delegating tasks requires effective communication with your team members, ensuring they understand the tasks and expectations and providing feedback and supervision as needed. You must also regularly review and reassess the delegation process and adjust based on the patient’s and team’s changing needs and situations.
Prioritize Patient Visits
As a hospice nurse, you may have many patients with different acuity levels and needs. Therefore, you must prioritize your patient visits based on the urgency and complexity of each patient’s situation and the required frequency and duration. To help you prioritize your patient visits, you can consider the following factors:
The patient’s physical, emotional, spiritual, and social needs, and the patient’s and family’s goals and preferences.
The patient’s symptoms, such as pain, nausea, dyspnea, anxiety, depression, delirium, constipation, skin integrity, nutrition, hydration, and functional status, and the interventions needed to manage them.
The patient’s stage of illness, such as stable, unstable, deteriorating, or terminal, and the prognosis and expected outcomes.
The patient’s safety, comfort, quality of life, and the availability and adequacy of supplies and equipment.
The patient’s location, such as home, nursing home, hospital, or inpatient hospice unit, and the accessibility and convenience of the site.
The patient’s family and caregiver situation, such as the level of support, involvement, and coping, and the need for education and bereavement services.
Based on these factors, you can assign each patient a priority level, such as high, medium, or low, and schedule your visits accordingly. You can also group your patients geographically to minimize travel time between visits and optimize your mileage and fuel costs. It would help if you prioritized patients with higher acuity or requiring more frequent visits to address their needs promptly. You should also be flexible and adaptable and adjust your schedule based on your patients’ changing conditions and situations.
Practice Effective Communication
Communication is vital for hospice nurses, enabling them to exchange information, coordinate care, and build rapport with their team members, patients, and families. Effective communication can help you save time, reduce errors, and improve outcomes. To practice effective communication, you need to:
Maintain open lines of communication with your team members, including nurses, physicians, social workers, and chaplains. Communicate regularly and clearly and update them on the status and progress of your patients. Share your observations, concerns, and recommendations, and seek their input and feedback. Consult with them on complex or challenging cases and collaborate with them on developing and implementing the plan of care.
Use efficient communication methods like email or instant messaging to relay essential information and reduce unnecessary interruptions. Choose the appropriate method based on the urgency and importance of the message, as well as the preference and availability of the recipient. Be concise and specific, and avoid jargon and ambiguity. Use professional and respectful language and avoid emotional or personalized comments. Follow up and confirm the receipt and understanding of the message and respond promptly and appropriately to any queries or requests.
Foster collaborative relationships with your team, encouraging effective teamwork and mutual support. Respect each team member’s roles and expertise and acknowledge their contributions and achievements. Express appreciation and gratitude and offer praise and recognition. Provide constructive feedback and suggestions and accept feedback and criticism gracefully. Resolve conflicts or disagreements respectfully and constructively and seek mediation or arbitration if needed.
Effective communication can improve your time management skills and patient care. Remember, as a hospice nurse, you can make a difference in the lives of your patients and their families and provide them with comfort, dignity, and peace. By managing your time well, you can also care for yourself and enjoy your work.
Conclusion
Time management is a crucial skill for hospice nurses, as it enables them to provide compassionate and quality care to patients facing the end of life while taking care of themselves and their personal and professional obligations. To enhance their time management skills, hospice nurses can follow some strategies, such as setting clear boundaries, streamlining documentation processes, delegating tasks appropriately, prioritizing patient visits, and practicing effective communication. By following these strategies, hospice nurses can optimize their efficiency and productivity, reduce stress and burnout, and improve their satisfaction and performance.
