On Call Safety Issues In HH

hoolahan, ASN, RN · Jun 26, 2001

I have worked for 2 agencies. MY present agency has a hospice, so those are the calls we get, to pronuonce. I don't work hospice, it is funded differently, so it is a seperate employer under the same umbrella. We also have regularly scheduled call nurses, so no regualr FT PT or per diem staff have to take call (YEAH!)

I am also not on the IV team, so again, no call, they are also a seperate company, but I am not sure how they handle it.

First of all, it quite simply starts with your intake department. They should refuse to accept pm cases. That's what my former agency did. The pt would have to be d/c first thing in the am, or after their pm dose of AB. We just simply said, we do not have the resources (staff) to accept this case, period!)

And we did not have an escort,, so we especially refused if it was in a bad area.

Secondly, this seems very easily solved, you need an evening shift . Or an 11a- 7p shift. Of course no one would want to do it, but isn't that easier than all that call? You could work 11a -7p or 2p-10 p, or whatever you all decide, on your call day, then maybe your workload would be more reasonable, at least you wouldn't be working from 8a to 10p!!. It sounds like they are piling up too many cases from the beginning of the day, which is impossible for you to get done. They are going to burn you all out, and they will have no staff! When will they ever get it??

You will get no where alone. Everyone needs to speak up, I am assuming you aren't the only nurse fed up with so much call. As for writing up the supervisor, she should be held accountable to the same standards as everyone else!

mgmaniac45 · Jul 10, 2001

As a Home Health Agency Nursing Supervisor, I get the joy of on-call. Luckily, the agency is small enough to make it manageable by myself. When I came here, admits were booked whenever they came in. It was a big problem. We as an agency made the decision NOT to take admits after 3pm, unless they were to be admitted early the next day, and not to take a weekend admit after 3pm on Friday, unless they could be admitted early on Monday. Unfortunately, unless we all do the same, the Hospitals will continue to dump their patients on Fridays to allow the Hospital to have less staffing on the weekends. It may help the agency to hire some staff to do staggered rotating work hours, like 2p-10p when they need to be on-call, or a permanent 2-10p shift. After all, most of us did rotating shifts when we worked in the hospital. Also, a rotating weekend schedule of one weekend /month may help too, if the Nurse can be given a day off during the week to compensate. One agency I worked at did Baylor shifts on the weekends, 12 hours Sat and Sun, and paid for 36 hours. That may not be cost effective for some agencies. An IV Supervisor should be on-call at all times, and have final say in IV decisions. IV cases are too prone to mistakes unless there is consistent decision making by one or two knowledgeable people. If the agency decides to do IV's, the extra salary/pay burden is just an additional cost of doing that type of business. Forcing Nurses to work 14/16 hours a day WILL result in mistakes and burnout, which may result in more Nurses opening flower shops, and less Nurses out doing the job we wanted to do when we started.

Home Health Columnist / Guide · Jul 10, 2001

I would discuss this situation with your other staff nurses, come up with ideas fro on-call and request a meeting with management. Often as an established agency, no one ever reviews policys and procedures re oncall/ week end staffing, until critical incident occurs. People know your doing more work, having more evening visits etc but no DOCUMENTAION occurs; esp is no management changes

In my current agency, they had two supervisors & two clerks in the city office--intake dept knew they got 60% of agency referrals; suburban office had 4 supervisors & 3 clerks ( older edtablished office). City staff were chronically late getting out and severly stressed. DOn was told but no documentation done. Finally a city supervisor left; DON changed postion and took over City office. New DON appointed (employee from intake dept). Within 2 months, new supervisor postion created. DON doccumented two months apart stats re amount of patients & staff supervisors accountable for---now 4th supervisor postion created in city due to VOLUME documented.

They also realized majority of referrals taken on friday for WE openings: 50-70 new admits each weekend. Created 12 hr positions (Baylor plan) along with 12N- 8 PM position so late afternoon admits could be covered.

Put your thinking caps on! Let us know the outcome.

MayeRN · Oct 18, 2001

Member T, my heart goes out to you. At our agency, each nurse has to take his/her turn at being on-call. We use to do it for a week at a time - BURNOUT!! We complained and now 2 nurses split the week between them and still do their own caseloads! It an ongoing problem everywhere in homecare - I don't know what the answers are.

We are on-call for a large area and it's very difficult toassess over the phone - nurses should never do that but it is not a perfect world. Generally the staff that is working on the weekends will help out. Our on-call nurse is supposed to be a last resort person or in the case of an emergency. Some of the coordinators at our agency often forget this and call us for everything.

We are only allowed to do 44 visits/week (we get paid per visit) but when we are on-call the agency suddenly says that this doesn't matter! Of course it does because no nurse should be working who is overtired - that puts the patient and the nurse at risk! One time when I was taking my turn I reached the magic 44 days before I was to finish call - I went to my supervisor and refused to do anymore! It had been a very rough week and I was fed-up! They got someone to take the remainder of my call.

We once approached the boss with the suggestion that someone be hired for on-call purposes - they refused saying that no one would want that job.

With this issue we have to stand-up for ourselves and for the patients. It's scary when you think of all the mistakes that could happen!