Hi, I am currently an on call RN for a large nation wide for profit company. I have experienced burnout and have taken one LOA earlier this year. At that time I was a case manager for the same hospice company.
After returning to work from 3 weeks off to de-stress, the on call position opened up and I applied for it. I was interviewed internally and offered the job...very happy with the new hours....(i work 5 12hr shifts on call at night from 8p-830a Sunday night through Thursday night...62.5 hrs a week for a 40hr salary...which is ok)Then about 90 days into the new position I was called into the office by my don and administrator who pulled out a list of calls that weren't handled to thier expectations.
Respectfully, I obliged with their new expectations including me going out on EVERY call, yes, every call. Their rantionale was that we need to be present and improve the after hours service based on surveys etc....Did I mention nursing judgement doesn't come into play here at all...in fact a huge part of the reason for my increasing amount of stress as a case manager was due to the fact that every single visit note and IDT recert was constantly being scoured for imperfection. Everyday it was something new and I cracked...I told my supervisor "I seriously don't know what you want from me anymore?" That being said I still have no say in how I determine to operate as the nightshift on call nurse.
I am expected to attend deaths in SNF's wether family is present to not. After they have already been pronounced, and regardless of the distance from my home. I have been asked not to rely on the "support staff" that a re also on call with me. I was told "they are already stretched too thin, only call them if you are tied up". I must visit SNF'S every time they call, even if they have already handled the situation...The full time case managers pick up on call on weekends and they rotate....but they are not held to these stringent rules....why? Because its overtime for them, but I am salary.
Ok...so then last week, my supervisor sits me down and says "we have come up with a plan to eliminate the case managers from being on call"....great! (they need to be able to focus on thier duties instead of covering a 150 pt census on weekends, I was there...) My "new" schedule was handed to me....what they did was take 125 hrs of on call responsibility...divide by two FT RN's and they have created a rotating schedule where...picture this...I would start work thurs 5p-830a...fri same shift, off sat and sun, back to work Monday 5p-830a, tues, and wed too...off thurs and fri, then on call sat starting at 830 am all the way through to Monday at 830 am....then returning to the rotation on Thursday. Let me remind you all I am off every weekend and holiday. I currently work 12hr shifts. This means I need to work every other weekend now...unfortunately PA is an at will state so what they are doing is completely legal.
So....once again I start feeling increased stress of the uncertainty of where I will end up...I can't work those hours for so many reasons. (involved in a contract also...they paid for my BSN....stuck as well as screwed) I had a panick attack in the middle of my shift and seriously considered driving to er instead of the pt...called off the next night because I was still having a major panic attack....never this bad though...I was crying terribly for the better part of 12 hrs. (hx of anxiety and panic disorder)
So...I sought counseling and he pointed out some very scary things that I really never thought of. I have been doing as they say...whenever I questioned it have been shunned and treated terribly and rudely in front of co-workers...He says it smells like fraud...billing for medically unnecessary nursing visits to SNF's...now I'm so confused, in hindsight soooooo many things make sense now! And let me tell you I'm terrified. I want to do the right thing, but I'm not 100% sure that we are out of compliance.
I did ask my supervisor..."why is it that I have to attend all these calls and deaths in the SNF's but the case managers on weekends don't?" she replied "you don't need to worry about what is expected of everyone else, you worry about your job expectations! And next time you have a question like this you come to me!" so I reply " I am asking you now"...she says scoffingly "yea after you went and talked to everyone else!" I was speechless at that point because our reports are recorded and retrieved by general voicemail...I hear how they handle thier calls.
I'm not trying to get out of working or sit at home and triage for a FT RN salary...but what it going on here? And now that in hindsight soo many things from my past in case management make sense...all the recert and IDT notes that I was asked to change...."get creative" with...? I guess I could go on and on...thank you for reading and any advice/opinions welcome and extremely needed at this time. God Bless
