Over the last year I have learned that, not only am I passionate about taking great care of hospice patients, but I have developed a strong passion to help nurses avoid burnout when doing this work.
To every hospice nurse reading this blog I say to you, “I believe in you! You can do this! You can be a great hospice nurse, take excellent care of your patients and still have great work/life balance.” I believe this with all my heart, and I have dedicated this blog to helping you get there.
There are two major themes throughout this series that I believe are paramount to avoiding burnout. Those themes are maintaining work/life balance and using bedside charting to help accomplish this. I believe both of these items are essential in avoiding burnout.
Failure is a great instructor
Last Monday, before I went to bed, I had my Tuesday completely planned out. I knew what time I needed to make my first visit, and I knew what time I needed to arrive at my last visit. I had five visits on my plate, and there would be a lot of driving.
I got up Tuesday morning like usual. I had my coffee and turned on my work phone just like I usually do. I discovered that my last visit of the day really wanted me to be there an hour earlier than we had planned. Rather than maintaining healthy boundaries, I agreed to move up the visit. Due to this change, I also decided to move a visit from Wednesday to Tuesday. Now I had 6 visits, but I was convinced this was a great idea.
My clinical director even offered to get someone to see one of my visits. I was almost indignant! I remember messaging her and explaining that I could get this done on my own, and I even mentioned I just wanted the mileage back home anyway.
By the end of the day I had pulled it all off. I was done by five-thirty and all charting was completed. It was a thing of beauty, but I wasn’t done there. In a stroke of absolute bafoonery, I took my schedule from the day and posted it on the nurses support group I am a member of on Facebook.
I was proud! Let the accolades begin. Now everyone can see how 6 visits can be done in a single day, and all charting done as well. This will convince even more nurses to read my blog and get the help they need! And everyone will think I’m awesome!
Okay, I do get delusions of grandeur at times. Anyway, here is what I posted for all to see.
My schedule today and charting.
6 patients who will be known as 1-6
All Charting completed at the bedside.
Patient 1 – 8:00am – 8:45am (no new orders)
Travel 43 miles
Patient 2 – 9:30am – 10:30am (Actively dying)
Travel 30 miles
Patient 3 – 11:15am – 12:00pm (pillbox)
Travel 0 (same building)
Patient 4 – 12:00pm – 1:00pm (pillbox)
Travel 25 miles
Patient 5 – 1:30pm – 2:30pm (new orders)
Travel 23 miles
Patient 6 – 3:00pm – 4:00pm (no new orders)
Drive 5 miles to where my daughter works to pick her up since her car is in the shop. She gets off at 5:30pm.
Worked from 4:00pm-5:30pm to do Recert notes on patients 5 and 6 above. Also completed IDT notes on 3 patients for a nurse who is out sick.
Start nice and early. Chart at the bedside. Be intentional!
You may be reading this so far thinking, “Okay, what’s the big deal, James? This looks like amazing time-management skills to me?”
Maybe instead you’re thinking, “Geez, that just seems very impersonal. And who lives like that? This guy didn’t take any breaks or even eat lunch!”
This pretty much sums up many of the responses I got on facebook. After over 100 comments and twice as many reactions, I began to wonder if I achieved my intended goal. I even remember seeing a couple members say, “This isn’t an example to follow.”
Now, in a group that big, there will be a wide variety of responses. I should not take anything too personal. I got plenty of positive responses and accolades. I probably shouldn’t take the negative feedback to personal. The thing is, I’m just not wired that way. I easily take everything personally. It’s just who I am and how I’m made.
To help clear things up, I started to reach out to a few people whose opinion I trust and know their feedback will be honest no matter how much it might hurt.
So, with this in mind, I started with my administrator. She will tell it straight.
”James, you came across as a little arrogant and kind of like a showoff.”
Well, that felt good, but she was right. I was showing off a little.
Next I decided to message another member of the group who had contacted me a while back. She had thanked me for this series. She is an administrator as well.
”I think people do need a break but that’s how I do it. I started early and charted at bedside. But maybe 9.5 hrs is too much.”
She was totally right. In my excitement to share my day, I never even bothered to look at my schedule objectively. It was 9.5 hours of constant movement. No stops to take lunch. No stops to catch my breath. I completely did it to myself, and I was proud of it.
I have been doing this to the nurses I have been training as well. In fact, I’ve developed a reputation of not taking bathroom breaks or stopping for lunch.
Here I am trying to write an entire series on work/life balance, and I can’t even stop long enough to let someone riding with me to eat or get a bathroom break.
The second administrator also said something else to me that gave me pause.
“Those yellows and greens hate it…reds and blues love it.”
I had no clue what she was talking about. After some web searches I discovered she was referencing personality types.
As I looked over the 4 personality types, and her point sunk in. The green and yellow personality types are more emotional about their activities, while the blue and red are more analytical.
I have always viewed hospice through a more psychosocial standpoint. I love the relationship building part of the services that hospice provides. I have an entire training program built around the psychosocial needs of hospice patients and caregivers. I almost yelled out loud, “I’m not red or blue! I’m yellow and green!”
The fact is it takes all 4 colors to be successful in hospice. It’s when we try to live in any individual color that we get into trouble.
For an entire day I operated in red and green only. Good care at 100 miles per hour. I traveled Kansas City from East to North to back East to South, and then back East again. I took no breaks. I didn’t stop to eat. I went non-stop for 9.5 hours. My patients got good care, but I didn’t. Then I posted my spectacular achievement on Facebook for all the world to see.
They big takeaway from this experience? We all have to work our way to the center of the color wheel above. We need to do it right. We need to do it now. We need to do it in a caring way. We need to do it together.
When we depend on a certain color, or fail to see the value in all the colors, that is when we get lost, and we find ourselves working towards burnout.
In light of this new information, here are some questions we should ask ourselves every day.
1. Am I operating in a caring way?
None of us would be in this work if we didn’t feel like we operate in a caring way. We still need to make sure our visits are patient centric. All of my visits on Tuesday were forty-five minutes to one hour long. I believe I was caring towards my patients. It could have easily become something else. I just got lucky.
2. Am I allowing others to help me?
My supervisor tried to get me some help. I declined that help. I should not have needed help at all. If you remember from above, one of the visits I imposed on myself. I could have easily left that visit for the following day.
Do any of you find yourself doing this same thing? I did six visits on Tuesday, and only 2 visits on Wednesday. I made Tuesday hard on myself for no reason whatsoever.
3. Am I doing it right?
This is imperative. There are right and wrong ways to do this work. As much as compliance can be boring and tedious, we still have rules and regulations to follow. There is best practice for visit frequencies and end of life care. We have deadlines for payroll and documentation. Leadership has expectations of us, and we have to step up to meet the challenge.
4. Am I doing it now?
Much of the debate in the nurses group had to do with how many hours I worked on Tuesday. There was some legitimate concern. I worked 9.5 hours without a real break. Do 9.5 hour days happen to us sometimes? Yes they do! Should we do them to ourselves? No we should not!
I did this to myself! I added a visit that didn’t need to be added. Then I ignored pleads from my team to help me. We all need to be smart enough to move visits around to make our days easier, not harder.
I will stand by one of my decisions from that day: I was at my first visit by start of day.
Whatever your company’s business hours are, that is the time you should be at the office or your fist visit. If you worked at a clinic from 8:00-4:30 daily, you wouldn’t wait till 8:00am to leave your home. You would leave your home early enough to be at work by your scheduled start time. Nobody gets paid for their commute to work. It’s the same in Hospice. I didn’t somehow work ten or eleven hours because I left my house early enough to be at my first visit by start of the business day. Even if my first patient was an hour from my house, I would leave early enough to see them by start of business day. That’s what “do it now really means.” Starting early is huge in hospice. Our day can get away from us quickly. We can’t be running out of our house at 9:00am in the morning and expect to have a successful day. Especially if we are going to mismanage our schedule the way I did on Tuesday.
Let’s end this weeks post by engaging in some self reflection.
- As you review the color wheel above, do you find yourself operating in one color more than the other three?
- Do you often find yourself ignoring the yellow color and trying to do everything yourself?
- Are you so obsessed with compliance, that you forget about the heart of what hospice is all about?
- Are you in a big rush like I was last Tuesday, and you forget to take care of yourself?
- Are your visits all about the relationship you have with your patients, and you neglect charting and collaboration with your teammates?
The hardest thing any of us will ever do is engage the person in the mirror. I was forced to do some self reflection this week. I hope you will join me in the experience. I believe it will serve you as well as it has me.
Visit The Hospice Nursing Community for more assistance in avoiding hospice burnout.
There is a lot to be said for self-reflection because without it, we never change. If we never change, we never grow. And if we never grow, we never become better human beings. There is more that I could say in that vein, but you have already said it in this blog, James.
Thank you, my friend!
I appreciate your transparency. I’m also a bit relieved to see that this Tuesday was not your normal. It had me wondering where I was falling short. Keep up the good work.
Yeah, that was an error as well. I should have pointed out how unusual it was to have a day like that. In a crunch it can still be done, but it makes for a long busy day.