Hospice On Call Compensation Structure

rnboysmom · Feb 11, 2009

Dear LaRn

NOBODY but you can allow the practice of "working you for free". Hospice is one of those wierd areas where the nurse is actually considered to be a manager (as she is "managing" the core team and her health aides). Most hospice nurses are considered "salaried exempt". YOUR hospice may choose to employ these practices, and by continuing to allow it to happen, you foster their sense of security that "this is an okay way to treat valued employees". There are either one of two things going on in your company

1) they are struggling financially. Hospices took a hit Oct 1, 2008 with new reimbursement rates and the beginning of the loss of protection from rate cuts. It depends on the area you live in, but some hospices got hit pretty hard. Our hospice personally lost about $4/day/patient on service. We can still take care of patients at this rate, but we had to take a hard look at where we are spending our monies.

OR

2)they are raking in profits and don't care about their staff (and in this case your opinion!) Signs include excessive patient loads and a distinct difference between managment and clinical wages (and, in one writer's case--the unwillingness of office staff to "pitch in" and help lessen the load of the clinical nurses) If your company is raking in profits at your expense (and your patients), shame on them!

Really, there aren't many scenarios in between. Now, you just have to figure out what is going on in your company and decide if you want to stay. If you really do believe they are a good company and are struggling with rate cuts and high gas prices,not to mention soaring pharmacy prices, and a struggling economy--- and if you feel that their bottom line is to take care of patients properly and they are making cuts or holding purse strings to keep afloat until, hopefully, lawmakers see the crimes of the CMS cuts, then you may choose to stick it out and ride out the storm with them. Gosh, you will know,in your heart of hearts, if you are in this company. Goals are optimal patient care and you will see everyone tightening their belts.

NOW, if it is company number two you work for, and you choose to continue to work for this type of company, then I don't know what to say to make it better--except that---if we choose, as a profession, to allow this type of behavior to perpetuate, then we are as much at fault as the"people at the top". If you read any of my previous posts, it is obvious this topic is my soapbox. Why do we allow this type of exploitation??? Good hospice nurses are in high demand. BTW, if you are a good hospice nurse, you are probably a good nurse in general, and could probably gain employment anywhere. If you work for hospice number 2, and it is your only choice, just wait, there will be competition soon. There are SEVERAL national long term care facility chains that are starting their own hospices within their corporations. Good luck!!

youngheartoldhead · Feb 11, 2009

just because a nurse is salaried doesn't mean she is exempt from overtime. If she is being paid an hourly rate (example: a monthly salary is $800, but on your paystub it states $5.00 per hour). If you miss a day during the week and you are docked for that time. ....you are NOT salaried, you are hourly, therefore entitled to overtime at 1.5 times your regular hourly pay. (being absent for an entire week and not getting paid for it is okay for them to do and you can still be classified as salaried). Keep good records of your time worked....daily timesheets...mileage. some agencies are hip to that and dont want you indicating all those hours of charting on your timesheet...just visits. thats okay, give them one like that, but keep a record of the REAL time sheet. I believe you can go back 2 years for overtime owed, in some cases longer. If you can prove that they knowingly and willingly evaded the labor laws (making you change timesheets) there are some instances where the business has to pay double or more of what is owed to you. It's a penalty type deal, but the money is awarded to you. So keep your timesheets.

rnboysmom · Feb 12, 2009

I don't know that I agree with keeping one set of timesheets and turning in a different one to your employer. You may be able to use that in the event of a lawsuit, but their defense would be all over you about why you intentionally kept separate records. I could just hear their defense attorney in court--"our poor compassionate hospice company didn't know these poor nurses were working this hard and didn't give us the opportunity to change things. How were we supposed to know that they were working like this if they intentionally deceived us on their timesheets??!!!" Some of these huge companies keep a barrage of attorneys just to deal with these types of lawsuits (BTW, hospice is paid on a daily rate per patient and only on a daily rate per patient, so these lawyers are ultimately being paid out of the patient's per diem!) Hospices call their nursing staff "case managers" for a reason. Labor laws are the weakest and most vague regarding overtime pay for "management" and healthcare--especially nursing (especially LPN salaries) and in most cases, any "management" nursing positions are considered salaried or salaried exempt (unless you have specific documentation that you were promised otherwise). Lawsuits are won, but a lot of times wage and hour has to back you in the suit so that their corporate lawyers don't exhaust you and your finances. If you are hourly, and the agreement when you hired was hourly, then definitely, keep records, turn in your timesheets and document all conversations with management regarding your attempts to resolve the issue; times, dates and others present during the conversations---and report the issue to management as soon as you see that you are being paid salary and think you should be paid hourly. Some companies clearly state on their checks that,by cashing them, you are in agreement that your pay is correct.

Just trying to say that a lot of these companies that are doing this type of underhanded thing are quite knowledgeable about the labor laws--and are quite aware of what they can get away with! :twocents:

dlxrn · Feb 19, 2009

I get paid a hourly rate ($30/hr) to do 30hrs triage/night visits on the weekends. Flat rate of $200 during week for evening of oncall-whether you have a visit or not. If one has more than 3 visits during shift, each additional visit is compensated at $75/hr. After hours admissions are compensated at $150/visit...but there is an admissions team already in place.

Melinurse · Feb 21, 2009

I get $2.00 an hour weekend/weekday/holiday plus .45 cents per mile and $ 25.00 for each call I have to go out on so if the call takes 2 hours I get $50 for that call. If it's an after hours admit or a death call we get $ 75.

Melissa29 · Jun 28, 2010

We pay our RN's $5/hr for beeper pay. There are 3 of them that alternate nights Mon thru Thursday. On Tuesday's and Thursday's we have a "runner", so those nights they just do triage. The nights they "run" also, they get paid their hourly rate from the start of the call until they get home from the visit. If it puts them over 40 hours, it's time and a half. From Friday at 4:30pm to Monday at 8am, we have a FT salaried/benefited RN who does on call. Our current hospice census is 36, but we also have home health. The FT weekend RN covers both sides...so a total of about 100 patients.

In reading the other replies, it sounds like my nurses have it pretty good. However, I don't think they feel that way.

doran002 · Aug 19, 2011

I work FT as RNCM m-f 8-5pm and make $33.00hr, we are expected to be the back up RN 1-2x a month. We have a nurse who works 3-11p 11p-8 am M-F, and we only get called if they are swamped. When we are on call we get $35.00 regardless if we are called out. If we get called out we get our $35 plus whatever amount of hours we worked. Mileage is 57cents a mile. Oncall u get mileage door to door. Now if you work 11p-8am you get a guarantee of 5hours wheather you get called out or not. Oh and admission you get paid hourly rate. Which you could bill for no more than 4hours w/o raising any questions. i live in san diego and have less than a year of professional experience

HappyGoLuckyRN · Aug 31, 2011

Just curious WHICH hospice you work for and in WHAT area?

mbrown0430 · May 2, 2012

I have seen it done several ways: 1. 4 full time case managers. Each case manager rotates 1 week of 7 on call and that particular week of 7 on that dayshift nurse does not work in the daytime. The nurses are salaried and then get paid a rate of $4 per phone call, $50 death call, $200 admission $50 routine visit 2. 2 on call 7 on 7 off nurses and dont interfere with day case managers. This pay scale I have seen done two ways 1) flat salary 2) a base salary 25,000 and then reimbursed per each visit or phone call made. 3) 3 full time and 1 part time case managers and each nurse rotates 1 night a week of call and then every 4th weekend with the DON as back up call ie nurse A takes call every Monday night and every 4th weekend. These nurses are also salaried and then paid a flat fee for being on call ($40 night and $130 weekend) and then a rate per visit or phone call made. 4) 4 case managers and 1 night time 7 on 7 off nurse. The day shift case managers then only take call once a weeknight every other week when the 7 on night nurse is off and then rotate thru the weekends. The 7 on nurse is salaried. The dayshift nurses are salaried and then are paid for being on call and reimbursed per visit/call made. So nurse A would take call every 7-8 weekend and then two weeknights a month