Am I insane?

HeySis, BSN, RN · Nov 21, 2016

It is illegal for them to having you working with no pay, but lots of places try to get away with it.

You should ask for an on-call rate, which is usually very minimal, some where around 10 -12.5% of your hourly wage. Then every time you receive a call you should document the call and the hours and you should make your RN hourly wage will on the phone or dealing with the issue.

As of January 2015 all home health and hospice employees were no longer be able to paid per visit, it went to a straight hourly rate for all time (including drive time, though they can legally pay you less for drive time, like minimum wage) and you get over time when you hit the amount of hours your state has defined (after 40 hours in most states, but I know California for one has more specific rues about how many days in a row and how many hours per day)

These are the labor laws, and they were governed into law to protect you. Make sure you know what they are for your state.

Most DON will not know all labor laws (though they should be pretty familiar with most), HR is the resource that is mandated to know all of this stuff. If it's small agency you may not have an HR department, so you need to be knowledgable and google labor laws for your state.

I actually hate on call for home health, its the worst, mostly dealing with aides that did not show or people trying to change appointment times or people really ticked off. So along with discussing wages I would make sure you have an on call aide scheduled so if someone doesn't show up you can just call the on call. And I would ask for it to be policy that any disgruntled call that can not be easily resolved, be sent to your admin... even after hours.

anangelsmommy, ADN, BSN, RN · Nov 21, 2016

Thank you HeySis! I do not have to deal the staffing, they have on-call staffers for that. I only have to deal with issues such such as an aid has an issue with a patient, a patient falls for instance, has chest pain, gets locked out of the house by a pt with dementia, or an abusive/agitated patient such as I had for the last two days! As for having any disgruntled call going to admin - I am considered admin but I am new at this. I did call my supervisor several times and then called the director finally because it had escalated to such a point that I felt she had to know the situation. I recommended that we have a patient meeting to discuss and then call family and hospice with all administration.

I documented everything, I am all about document document document! Especially since hospice was not supportive at all and would not go back out to see the patient when that is the protocol!

Thank you for the info, I will look up our state laws. And luckily with cell phone and all documentation on computer, I have times for everything. Thanks again.

Libby1987 · Nov 21, 2016

I've posted to this issue before but our part time clinical staff like to take call because it's "easy" money. $50/day and then paid to make visits of which are rare. And the admin on call doesn't take clinical calls, those are differentiated by the answering service and calls are routed to the correct staff.

Our staff are encouraged to encourage their patients to call for issues sooner than later so that they can speak with someone familiar with their case. And our staff are strongly encouraged to educate and have good communication with their patients to lessen issues with not knowing what to do or when staff are coming. It's an ongoing work in progress.

Personally all of my patients, when I case managed, had my cell phone number and I encouraged them to call me first but only during waking hours. They had carte blanc permission to call me for any time from 6 am to 10 pm 7 days/week. And they were well also prepared to make it to the next nursing visit and knew when I was coming next. I also made sure they knew the other disciplines' schedules.

Guess whose patients rarely called, my cell or the office line? I've had dozens of people say that's nuts but the proof is in the pudding, not one inappropriate call in 10 yrs. And when they did call me after hours, it was usually prefaced with a humble apology for "bothering" me and a quick question or issue was answered in a minute without the oncall nurse, who worked all day, trying to get the whole back story before being able to give a response. I can't ask my staff to do that, it's even in our handbook not to give home numbers (though my work cell partially reimbursed given by company is also my personal phone), I've been so successful with it that I became the model of how to really manage a caseload instead of the caseload managing me. I'm going to say that one more time at the risk of being obnoxious.. I managed my caseload versus my caseload managing me. A big part of that was excellent communication and patient education. I could give many examples of how it worked for me if anyone is ever interested but I'm already off track here.

Back to your admin call, I think you need to renogotiate your salary to cover your on call time. And your office needs a revamp to reduce so many upset clients. All those calls indicate gaps in patient care and communication. Simply paying you more would only be a bandaid to underlying problems. If you had a staff of case managers who operated like I did, the majority of those calls wouldn't be necessary.

ETA I thought I remembered that you are salaried but just re read and you're a combo of PPV and hourly? In that case you should either be paid a flat call rate or clock the time spent on the phone and documenting. Oh both depending on your agency's budget.

Here.I.Stand, BSN, RN · Nov 21, 2016

You'd be insane to agree to work for free. Don't work for free. Those are very good suggestions from HeySis.

In the hospital I occasionally am put on call -- it happens when we are too overstaffed to keep my scheduled shift, but would be understaffed if we get admissions. I am paid my on-call rate for staying by my phone, but if I were to be called in, at that point I am no longer home on call. I am working. So for the time I am working, I am paid my regular wage -- NOT the on-call wage. You likewise were not waiting by your phone all that time, you were actually working.

anangelsmommy, ADN, BSN, RN · Nov 21, 2016

I probably should add that even though I only work 3 days a week, I am on call for a full week. I logged multiple calls, and two nights with no sleep.

anangelsmommy, ADN, BSN, RN · Nov 21, 2016

Libby,

our administrative staff does not take clinical calls either. Our supervisors (BSN and above nurses) take these calls, to deal with issues in the field with caregivers taking care of clients. This particular issue was not a upset patient, she was agitated and aggressive toward the caretaker and risking her safety. Since this is a case we share with hospice, they are responsible for client assessment, PRN medications, educating the family and obtaining medical orders among other things. There has been no support from the family or hospice, clients behavior escalated and she became irrational and abusive. Multiple caregiver phone calls. Guess who didn't call, the patients family because they didn't care, they figured we had someone there that was taking the abuse and getting paid for it, and the patient didn't call because she is not able to.

So while I think what you are referring to works in a different industry (do you work in visiting nurse capacity?), this is more of the home health realm and I am not only visiting the patients and supervising their caregivers in the field but taking calls from these same caregivers when there is a situation that they cannot handle or have any questions. The families or patients do tend to call during the day if they are going to call, unless it is an emergency.

Libby1987 · Nov 22, 2016

Libby,
our administrative staff does not take clinical calls either. Our supervisors (BSN and above nurses) take these calls, to deal with issues in the field with caregivers taking care of clients. This particular issue was not a upset patient, she was agitated and aggressive toward the caretaker and risking her safety. Since this is a case we share with hospice, they are responsible for client assessment, PRN medications, educating the family and obtaining medical orders among other things. There has been no support from the family or hospice, clients behavior escalated and she became irrational and abusive. Multiple caregiver phone calls. Guess who didn't call, the patients family because they didn't care, they figured we had someone there that was taking the abuse and getting paid for it, and the patient didn't call because she is not able to.
So while I think what you are referring to works in a different industry (do you work in visiting nurse capacity?), this is more of the home health realm and I am not only visiting the patients and supervising their caregivers in the field but taking calls from these same caregivers when there is a situation that they cannot handle or have any questions. The families or patients do tend to call during the day if they are going to call, unless it is an emergency.[/quoteD ]
I was referring to Medicare certified intermittent visit skilled home health care.
What do you mean by, "supervising their caregivers"?
And what do you mean by home health realm?

anangelsmommy, ADN, BSN, RN · Nov 28, 2016

I meant supervising the caregivers, sorry, misspelled. So in this case it would be a CNA. We are a home health company but we are able to provide everything from a sitter, a caregiver, a companion, or hospice care. We do not do "visits" we will provide a minimum of 2 hours of care, there are some other services provided as well for private pay. The majority of our clients are private pay but we do have medicare patients. I don't do any billing or authorizations etc.

The hospice patient went on intensive hospice care for a few days to manage agression but everything was the same when returned to our care and MANY phone calls, and we had another CNA leave her shift because of being attacked and hospice nurse did nothing - not sure why. Multi-supervisor discussion, no resolution, client was transferred to a facility. I hope she finds peace.

I did a few things this weekend that I realized I could not do if I was on call. I don't know what to think about that. I did this activity course that involved rapelling and zip lining and being up off the ground about 100 ft at least - not exactly a place you can stop and take a call, and look up client information and make a note! lol! or would you want to! And it took several hours, so I couldn't call back for at least 3 hours! I do a lot of things on weekends that are really active.

This week I was told, "it was in your contract when you were hired, you signed it, you have to do it." but I never signed anything! And I would have definately questioned a contract that said I had to do on call 7 days a week when I only work 3. Because at that point I was still working a second job. And I am still thinking about going back with the other company at least one evening a week.

Libby1987 · Nov 28, 2016

Ah I see. We don't call that service home health in California. Home Health is skilled intermittent care and Home Care is shifts. May sound like semantics but Medicare refers to the benefit of intermittent skilled care as Home Health.

Staffing private duty, especially non skilled, is a non stop process.

Also with our licensing regulations in California, we can't mix the three, home health, hospice and private duty home care. We have to be housed separately etc, so I'm not sure how your job can be a mix. Are they separate jobs and you get two separate pay checks?