Rant About On Call

I usually work 13-27 hours during the week (by choice) and I do call friday 5p-monday 8a. I have been doing this for about 3 years. I did full time case management for 4years. When I first started doing on call we had about 175 pts and I was the 3rd. full time on call nurse. It was not too bad. I might get called out once on friday, see 4-5- pts sat and sun. I actually worked 20-32 hours, but I got plenty of sleep. Only on occasion we had a bad weekend. many on call nurses came and went and at times I was the only full time on call. the case managers did back up and we usually had a total of 5-6 nurses on call. fast forward. our census is 300+, we had 4 on call nursess, one just quit and they may not replace her. they cut the total nurses to 4, sometimes 3 on sunday. On friday, I usually see up to 3 pts and out until 3-4am. only to have a full days worth of pt, and then back out all night. I'm working at times 17 hours out of 24, and two weeks ago, out of 24h, I worked 22 with 1 1/2 hour nap. The management didn't feel we were seeing enough pt's, so along with the crisis care visits, the prn visits, the actual On call visits, they decided to add the 1st RN visits, AND if anyone said "fall" even when they actually didn't fall, the cg sat them down on the floor, or the slid off the chair and there are no injuries. If a COPD pt call about anything we have to go. If a nursing home calls, we have to go. If anyone calls twice for any reason, we have to go. What happens is while we are out on these NON-EMERGENT" calls, someone calls in that really needs us and they have to wait. We have tried to talk to management and they just dont care. They don't understand that it's not the amount of calls we go on, it's time in which we have to go. I can see 7-8pt during the day and be fine, but when you have to go during the night, it reeks havoc on you, no matter if you get a few hours sleep during the day, you just cannot catch up. Last weekend I drove 367miles. 11hours worth of driving in a 24 hour time span. Truck drivers cannot drive that much. Aren't there some sort of safety laws in place? The day I worked 22 hours, the triage nurse was trying to explain to the administrator on call that if I am working all day, that I cannot be expected to be out all night, her response was "she has too" the triage nurse said "no, she doesn't, if she says she us unsafe, I cannot send her" do you think that made a difference, hell no, I was out all night also. We are all about to quit, i have 2 small kids that need a mother. Anyway, sorry so long, but I just had to get it out.

i work for profit organization
we have approx 125 cencus for 8 rn's
my case load is 20( i have a busy area)
i case manage and travel( not usually more than 150 miles on for the week)
i make 32 an hr for 40 hrs( dont usually get paid for overtime)
we have no on call nurse for the weeknights(4p - 8am) our area is huge--- on call can travel over 150 miles a night
or less, but the area cover 6 counties
( on call week nurses don't last) the day nurses cover on call
we are burnt out and anxious about the weekend nurse quiting( on call weekend can travel 350 miles a weekend easily)
we also have not back up for either position
the company and the nurses we work with are great! but we don't seem to find anyone to stay( its either the salary or the travel)
any suggestions

I recall those days and am glad I very rarely take call. The one that killed me was a week-end call I did, 40 hours during the week and had call from 5p Fri til Mon at 8:30 am the back to work Mon at 8:30 am. I was out 40 hours that week-end for a total of 120 hours before a day off. I had to call my PCC out that wek-end to help and she worked 16 hours and another nurse worked 6 hours. We now have on call nurses or I would have to leave and retire early, it is nuts to work like that. I have also had nights when I almost fell asleep driving home-scary. When they tried to take our call nurses away because they are considered non-productive, we all turned in our resignations. Guess what? We have our call nurses and they are salaried. Sometimes we have to make a bold statement to make administration realize how unsafe some situations are. As long as we continue to do, they will continue to allow us to do as I have learned in my 42 years as a nurse. Anyway, find someone in authority to listen and get together with your peers and meet with them together to get them to understand the safety issues. Risk management may need to be involved since it is a safety issue for the organization. Good luck and keep us posted.

Our census is hovering at 80 and we have an every other weekend RN and our casemanagers do back up call. We are almost fully staffed so that the CM will only have to rotate back up call every 7th weekend and one night every two weeks. However when the CM works the weekend, they take one day off the week before and one after the call. If they are out a lot at night, we adjust the schedule.

Been there, done that with working 12 days straight and being too tired. Don't want it for our agency. Our nurses are too important. We want our nurses to balance work and a personal life, but they can't do that if they're too tired and always feel like they're working.