Advice needed on On-Call Hospice Nurse

nutella, MSN, RN · Nov 30, 2016

On call hospice position usually requires significant experience in symptom management, secure clinical decision making, and solid skills. I hope that you are an experienced hospice nurse because home hospice is a true specialty. Especially in the community setting, you are on your own - you can call the hospice MD at any time but it is you who gets called by families or patients in the middle of the night and you may have to guide them on the phone or also make visits.

You may be asked to do admissions in your on call shift if they are tight with staff, which is time intense.

What "on call" means in terms of working differs. If the agency serves nursing homes only or mostly, chances are you will be called less or not that often as there is staff that is familiar and has standing orders. If it is assisted living or home care, you will get called - how much depends on the population you are mostly serving and how well the case managers are on the ball during the day. You may get called out several times a night, you may go out and can't leave for hours because the patient needs a CADD pump for pain and needs to be bolused. People will call you for "small" things and expect you to come out - the territory can be large for on call.

If you get called a couple of times a night you will be tired next day.

Questions to ask:

- what is the average call volume per night? what is the expectation in terms of driving distance? company cell phone or pager?

- is the manager available in case you need to talk to that person ( it does happen that there are situations you will have to talk to the manager).

- is the pharmacy available at night ?

- will they expect you do do routine visits in your on call shift when they are 'busy' (which will be most of the time for many agencies as staffing is not that good)? Will they expect you do do admissions?

- How do they handle vacation time? who would cover if you need vacations?

- how is the pay? flat rate with additional money for visits ? mileage?

When I worked for an agency, the weekend was staffed during the days and night with "on call" but the day "on call" always had admissions and routine visit plus evaluations.

With school I would not take a position like that.

MissFNP · Nov 30, 2016

Oh my! You have certainly opened my eyes to the Hospice world out there. I was so excited that they called me and offered the position that I didn't have time to process what exactly was included. They made it appear that I would be getting more triage phone calls.

Thank you so much for your insight!!

MissFNP · Nov 30, 2016

This position is also salaried!

HeySis, BSN, RN · Nov 30, 2016

This position is also salaried!

It would have to be one heck of a salary!

The list of questions that Nutella gave you to ask is excellent.

I would only add one thing. Ask if you are expected to take on an administrative role on call, like if an aide calls in sick or doesn't show, will you be the one hunting down another aide to do the visits. I found that and calls about, I can't find the house, or my tablet isn't sync'ing my visit, to be the biggest pain. I once had an aide that called at midnight and woke me up to ask me what was the phone number of the cell he was calling from... ugh!

nutella, MSN, RN · Nov 30, 2016

Oh my! You have certainly opened my eyes to the Hospice world out there. I was so excited that they called me and offered the position that I didn't have time to process what exactly was included. They made it appear that I would be getting more triage phone calls.
Thank you so much for your insight!!

Yeah - the problem is that most agencies are not up front about what else is happening and just hope that once hired you will "suck it up" and get used to it. Most on call jobs are salaried with more money if you actually drive out to make a visit. The base pay can be on the low end and if you have a high call volume and do not sleep much you have the shorter straw.

Trauma Columnist · Nov 30, 2016

Moved to Hospice Nursing