On call?

Specialties Hospice

Published

Specializes in School Nursing.

How does your company handle on-call for case managers? I haven't been with my company very long, but I learned today that if the after hours, on-call nurse calls in sick or takes a day off and there is nobody else willing to do the shift (or 24 hours on Sat/Sun) the CM is required to make visits if one of their patients has an emergency/decline/death. Is this pretty much accepted policy for hospice companies? I was kind of taken back by this as I was never told about this policy (nor is it written) when I was hired, and I was only made aware of it through a "such and such is off this day and if nobody volunteers, you're responsible for your patients".

I love being a hospice nurse, but I didn't expect to ever be made responsible for my patients 24 hours day. I feel like a dork for assuming the administration had a back up plan for when on-call calls in. Am I wrong for expecting them to have told me this expectation up front? Or is this part of being a CM and I should have known?

Specializes in Gyn Onc, OB, L&D, HH/Hospice/Palliative.

That's not how we do it. If on call is off or sick and no one takes the shift , sometimes it's shared/split 4p to 12 and 12 to 8a. Makes it easier to cover. Push comes to shove and there no one volunteers the supervisor ends up having to take the on call. No CM are made to cover their pts. Our Baylors (me) cover on call Sat and Sunday 8a to 4 p while doing our SOCs, revisits, etc.

No, and since they didnt inform you ahead its not right to insist you take on-call. Yes they should have had a back -up plan. Are they going to be paying you on-call availabilty hours and for after hour visits??

Specializes in School Nursing.
No, and since they didnt inform you ahead its not right to insist you take on-call. Yes they should have had a back -up plan. Are they going to be paying you on-call availabilty hours and for after hour visits??

I'm assuming we will get paid the per visit and on-call rate for those hours (though I am not even sure what those rates are since I have never worked on call or on a per visit basis). I am really just annoyed with the "this is your responsibility" tone of which I was approached with this. If I were working in the hospital, I would not be expected to work 48+ hours straight, and if a shift was not covered, it would be the COMPANY'S responsibility, not mine, to make sure patient's are cared for.

I think if the approach had been, "hey, we are in a HUGE bind, so-and so is off this day and we are having trouble getting it covered- can you please help out"- I wouldn't have been so put off. In fact, how could I say no to that? (I couldn't!). I don't like being bullied, which is how I feel right now.

Specializes in lots of specialties.

This is pretty standard for what I have seen. When I worked as a case manager day shift, we covered the weekends. Our dedicated on call nurse worked mom-Fri. If she was off and when she quit we had to cover the night shift and were paid per visit of we had to go out

Specializes in Hospice.

Where I work, we don't have an on-call nurse. Our case managers rotate call, and we are aware of that upon hire. We also have a rotation for holidays.

On weekends, we have a helpline nurse and a scheduled visit nurse from 8:30 am - 4pm ish.

When we are on call, we get paid an hourly on call amount and OT for all visits, including travel time.

If someone calls off (rarely happens), we usually split up the time.

It really helps that all of us "play well together" so our call isn't too bad... Unless of course it's a full moon!

Specializes in School Nursing.
Where I work, we don't have an on-call nurse. Our case managers rotate call, and we are aware of that upon hire. We also have a rotation for holidays.

On weekends, we have a helpline nurse and a scheduled visit nurse from 8:30 am - 4pm ish.

When we are on call, we get paid an hourly on call amount and OT for all visits, including travel time.

If someone calls off (rarely happens), we usually split up the time.

It really helps that all of us "play well together" so our call isn't too bad... Unless of course it's a full moon!

What is the census where you work? What size geographic area do y'all cover?

We are "supposed" to have a dedicated on call staff...we have a LPN who is primary on call Mon- Thurs and a RN Fri- Sun. There is always a 2nd on call CM to help.

With cases like this weekend for us, the RN on call decided to call off at 5:30pm on Friday, leaving the CM who was to be secondary to become primary on call with no help, and she was not made aware of this until 10am this Saturday.

No one offered to help.

The supervisor on call refused to attend a death that took the CM over two hours to get to.

Shady behavior indeed.

It sounds like your hospice is in a bad spot when the on-call nurse is out, and they have no backup plan, so they institute the mandatory overtime. They certainly should have told you about this when you were hired, but at this point your only choice is to do the work or refuse. If you refuse, you could be fired or irritate your coworkers for not doing your share. You really have no recourse.

Perhaps this will only happen once or twice a year. You can let your supervisor know that you are very unhappy to hear about this obligation after you have excepted the job, and that your obligations to family, church, or others preclude you from working this mandatory on call. Or, that you can do it only in limited circumstances and would like to see the company search for another long-term solution.

I have found that in small hospices with low census, there often is no back up plan for when the on-call nurse is out, are sometimes there is no on-call nurse at all. So the arrangement you specify is not uncommon, but it is unfortunate that you were not told of this requirement when you were hired.

Specializes in Hospice and palliative care.
Push comes to shove and there no one volunteers the supervisor ends up having to take the on call.

Our agency's on-call policy is very similar to Grumpy's with the exception that Grumpy has a nicer supervisor--if no one volunteers our supervisor puts our names into a bowl and starts pickin'...

Specializes in Hospice.
What is the census where you work? What size geographic area do y'all cover?

Usually our census runs in the mid 50's, this can really vary. 9 nurses (only 1 FT, the remainder PT).

4 counties; probably 40 miles from the north tip to the south tip of our area, roughly the same east to west. Usually no more than an hour travel time to reach a patient's home (for on call).

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