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- by goldberryRN Oct 17, '11HI! I am new to hospice, have almost five months under my belt (and love it) I've been an RN for 24 years, had worked mostly in acute care medicine before taking many years off raising children. I took a refresher before re-entering the workforce.
That's my background, here is my question: I have recently volunteered to switch from case managing to being on-call Monday thru Friday nights from 1630-0800. I will do any late admissions or visits that fall in that time period as well. We have a census of about 50 in a semi-rural area.
It seems like it should be a tolerable schedule, but some, more experienced people have said I won't be able to do it for very long, that I will burn out on it, etc. That makes me nervous. I've been on call before but not this much of it.
Am I being overly optimistic that this can work well for me and my family?
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- Oct 17, '11 by tewdlesYou have to decide what is doable for you and then set clear boundaries with your employer. Do they have a back-up plan for you if you have a really busy night?
- Oct 20, '11 by goldberryRNThey'll back me up, but there is no set plan that I know of. Halfway through the first week of it and it's been ok, but I'm tired. Thanks for your advice!
- Oct 21, '11 by westieluvAt the hospice that I used to work for, I worked on-call 12 hr. nights and I was the only on-call nurse for 220+ patients in the field. We also had a triage nurse, though. The most visits I ever had in one night was four, believe it or not. You don't say if you have a triage nurse, but since your hospice is roughly the same size as the one that I work for now and we don't have one, I will assume that you don't either. In that case, and if you're taking all of the phone calls yourself, then I think that good triage skills are the key. Not that you shouldn't go out and make a visit if a patient or family are requesting one or obviously if there is a death, but I discovered when working for the larger hospice that a lot of symptom management issues can be handled over the phone. Does your hospice have standing orders? When I did phone triage, so many of the "My mom's in pain and can't fall asleep" calls could be handled with calm reassurance and medication instructions given over the phone based on standing orders. Again, go if they are requesting it or there is something bad going on, such as the time that I went out to do a dressing change for someone whose tumor that had eaten through her skin was bleeding uncontrollably. But so many times they just want to hear a reassuring voice and get some solid instructions on what to do.
- Oct 21, '11 by goldberryRNWe don't have a triage nurse, and I agree, so often families just want to hear some reassurance. The calls aren't that many, usually, what's making me tired is that I'm doing the late admissions too, which is ok, it's just been a busier-than-normal week for admissions.
Oh well it's Friday, my work week is almost over!
- Oct 26, '11 by Ginapixiour census is around 150 and we have changed our evening on call nurse hours to 12 - the 16 hr on call can be quiet but can be nonstop and exhausting! we used to have one evening RN on overlapping with on call nights until 2300; now we have 2 full time evening staff and on call nights Mo-Thu 2000-0820 and a weekend on call for the same hours; our on call RNs do no longer do new admissions, thus 2 Evening RNs Mo-Fr 1500-2300 and we need it! more and more admissions are after 1700 and we had Fridays where 3 RNs were out doing admissions; needless to say we complain, because we also need to cover phone calls--- IMHO 16 hr shifts with new admissions is too much, but it all depends how many admissions they expect you to do; tewdles put it very well: set clear boundaries! if you burn out it is not helping any one!
- Dec 12, '11 by goldberryRNUpdate: I plan on throwing in the towel on my life of being the weeknight on-call nurse.
Started out doing five nights a week. Too much. Cut it to four. Still too much. 62 hours of call a week. Many times having an admission or a late routine visit (or two...or three). It's just too much. I can't deal with starting out the evening saddled with a bunch of stuff to get done and then having calls as well.
It's good we have a lot going on and a lot of admissions but there need to be more staff to deal with it. It was good experience, and I'll still have to take my turn at being on call but it will be more like once a week instead of four times a week.
I'm supposed to be part-time.....setting boundaries and sticking to them.....not so easy.
- Dec 12, '11 by netglowSee, it is it's own type of monster. Some hospices don't do this to staff. But mine did and I left.
- Dec 13, '11 by Ginapixigood for you! set boundaries! yes! i am still learning to do that myself - if the job eats you alive it is not right, no matter how much you want to do the job! and if you are ON CALL you should not have visits planned for you already, be it routine visits or admissions; on call should NEVER have to do admissions! ours had to do one once in a great while, now that we have 2 evening RNs on call only does an admission if she fills in outside her on call; our weekend on call never does admissions;
don't let them abuse you!!!
- Dec 13, '11 by goldberryRNSee, here's the thing, I thought they'd be nice because they (the administration) really wanted this to work.....we didn't have anyone doing "just call" before I tried this. All the CMs had to share it, and that was causing much overtime, so this was supposed to alleviate it for the full-time CMs, make their lives easier, etc. Most, if not all, of them voiced enthusiasm for the plan.
Anyway, one would think they'd (the bosses) try to make the workload reasonable so that I could survive this over the long term, but it hasn't happened that way. I was naive, I freely admit it. ugh, you'd think I'm old enough to know better than that!!