Approximate number of calls during on-call

curiousauntie · May 3, 2013

Our census is between 40-50, and at present I am one of 2 "On-Call" nurses. We each work 7 days, Mon evening/overnight to the following Monday morning, esentially covering for the hours the office is closed. This includes from Fri at 5 pm to Mom at 8:30. I work one week and my partner works the opposite week. Dang nice for the 7 days off every other week, kinda sucky for the 7 days on :0.

During the week I get anywhere from no calls to constant phone ringing from after 5 pm usually until about 10 or 11 pm. A lot of them are "My aide didn't show up", "I think I have a social worker coming tomorrow. What time is she coming" to medication questions, especially if the case manager visited that day and made changes. Or "I am almost out of such and such medicine". Most of them are easily dealt with over the phone, either by calling the pharmacy and ordering meds, contacting the aide (if it is before 6, after that I tell them I will let the office know in the morning) and reminding the patient that if the aide is more than 1/2 to 1 hour late to call the office then as I don't have a schedule in front of me and can't answer their question. Same goes for other "appointments" they may have with staff. I also frequently have "routine" visits to make, either because a case manager was off that day and a patient needs to be seen to keep the visit frequency in compliance or because they are declining and are needing extra visits. I also do admissions in the evening, usually 2-4 times a week.

The weekends are a whole different story. I start getting calls usually about 9 or 10, a lot of them are along the lines of the week night calls and can be dealt with on the phone. But I also have scheduled visits to do, as extra visits, or follow up visits from admissions done on Thursday or Friday. And I always have at least one admission on the weekend, sometimes up to 4 or 5! Those weekends are killer as the admission is very time consuming at the patients home, then 3-4 hours of paperwork at home to finish each one. Not to mention visit notes, On-Call notes for each phone call I get and a phone log to complete. Those weekends I end up spending my first "day off", Monday, doing hours of paperwork and then taking it to the office. (no, unfortunately, we are not computerized yet...)

If the phone rings after 10 or 11 pm, it is usually someone in distress or someone had died. I make visits then, although if someone is in distress I do give instructions over the phone with the hopes that I won't have to go out. About half the time this works and the patient is made comfortable again. My favorite recent one was from a nursing home, patient close to death, but not actively dying. Pt was cyanotic and pulse ox was 78%. I asked the facility nurse what the oxygen was set at. "Oh, I haven't put it on yet, I wanted to call you first." I told her to put the oxygen on at 2 liters, recheck the POx and titrate the liter flow up till she was no longer blue and the POx was above 90%. And if she couldn't do that in the next 15-20 minutes to call me back. I called her back in 30 min, patient was comfortable on 3 liters and POx was 95%.

I was a case manager for close to 6 years before changing to the "On-Call" position. A lot of the workload of the on-call nurse will depend on the quality of the case-manager. Not counting physical changes or other factors that can never be controlled, I rarely receive phone calls from patients from certain case-managers as they anticipate the patients needs for overnight or the weekend. This was something I always tried to do..."tuck in" calls on Thursday and Friday for the patients who I knew were having issues, reminding them to take the meds, or making sure the family member was prepared for possible changes. I always hated it when my patients would call the on-call nurse for something I should have seen coming and fixed before it happened.

I hope this answered your question...although if you will be doing on call, I assume that you don't have dedicated on-call nurses. The first 3 years I worked as a case manager, we only had one on-call nurse who worked one week and we case managers did the call on the opposite week. We split the call time, usually doing 1 or 2 weeknights and either splitting Saturday and Sunday with 2 case managers or with 4, each one doing 12-24 hours of one day. We worked well together and tried to be sure it was split evenly.

alyiana · May 4, 2013

Thanks auntie. Currently our census is 3 patients and myself and another nurse will be the only ones taking call so it shouldn't be too bad now. After I get trained on basics she will progress into marketing and I will be the main nurse with her helping with call. I will have the opportunity to progress into more of a management roll as we grow. So lesson make sure myself and all nurses take care of little stuff first.

tewdles, RN · May 4, 2013

As you are building your hospice make certain to educate your patients/families about normal "during business hours" calls vs emergent calls.

As a case manager take the time to "tuck in" your patients, especially on weekends and holidays.

Count meds at EVERY visit to prevent calls for no meds.

good luck.