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Changes to On Call Job Description

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pixiec11 pixiec11 (New) New

Hello,

I am a full time, salaried, on call nurse for hospice. We have one on call nurse and one back up nurse that we can use if we are on another call. I like the job, but am nervous about "changes" to my job description. My hospice census is typically in the 80's, 3 counties-(about an hour and a half in each direction).

CURRENTLY-

I work about 110 hours/2weeks on call and about 10 hours/2weeks for IDG meetings. (Also, (4) 8hr holidays/year, 1 staff meeting/month, and multiple in-services during daytime hours.) On call hours are 3 nights one week and 2 nights the next plus ever other weekend. Nights are 15.5 hrs and weekends are 48hrs.

I do not do admissions. We have a back up nurse that does evening/weekend admissions, and in patient visits.

Paid time off is 4 to 1 for week nights and 2 to 1 for weekends. Meaning if we want a 16hr week night off, we use 4 hrs pto and if we want 24hours off on the weekend it would be 12 hrs pto.

PROPOSED-

Apparently, the management team feels like we could be doing more, such as weekend/evening admissions. And, that the pto should be revised so that we do not get as much time off.

MY QUESTIONS-

1. How many on call nurses are expected to go to IDG's during daytime hours?

2. Do other on call nurses do admissions in addition to being on call?

3. How is your pto set up?

4. Is fundraising mandatory on your evaluations?

5. Do other nurses/management feel like on call nurses are working less than regular staff because they aren't running every minute of their 110 hrs on call?

MY FEELINGS-

On call nurses should not have to go to IDG's or into the office during daytime hrs, except for inservices or staff meetings. (I'm tired during the day and need that time to sleep)

Fundraising should not be on your evaluation.

On call nurse should not do admissions. (Who's going to take calls if I am doing an admission?)

PTO time should not be changed after working there for 2 years for only the on call nurses. (Seems like being hired under false pretenses to me?)

Although, I may not be "working" every hour that I am on call, I am still technically working. I can not make dinner plans, etc as I must be "available" at all times during those 110hrs. (Even if I only "work" 20 hrs/week, I was still required to be available at all times.)

Unfortunately, I don't think I can do any more that I already do. When I worked 3-12hr shifts on med/surg plus overtime, I was less tired than I am now. I feel they should not require us to go to IDG, as it is too much. They feel they should add more work to our schedule.:crying2: I have a feeling my time is short at this job, which is sad because I really love what I do and my coworkers are awesome.

Any advice? Am I just whiny and really have it good compared to others on call nurses? How should I state my unhappiness about changes to PTO and extra work being added?

Currently my 2 week schedule is- (doesn't leave much time for sleep or anything else for that matter)

Sun-430pm-8am

Mon- off

Tues- 430pm-8am

Wed- 9am-12pm- IDG, then on call 430pm-8am

Thurs- 9am-12pm- IDG, then off

Fri-430pm- (til Sunday 430pm)

Sat-work 24hrs

Sun-work til 430pm

Mon-off

Tues-off

Wed-9-12pm- IDG, then on call 430pm-8am

Thurs-430pm-8am

Fri-off

Sat-off

Thanks for any input,

P

OncallRN

Specializes in community health. Has 12 years experience.

I did oncall for over 2 yr and left not long ago because of changes.

one was that oncall started having admissions... too much IMO as evening of oncall were often very busy ( our census was about 200)

we didn't do IDT,

they have a right to change the job and you have a right to not work under those conditions. I believe if you leave under a change in job description you can claim unemployment

Thanks so much for your reply. I hope that's true about unemployment for NY. Hopefully, they reconsider these changes.

Lisa

AtlantaRN, RN

Specializes in Med Surg, Hospice, Home Health. Has 13 years experience.

I am weekend on call, I'm on from friday at 5pm til monday 8am, I do come to the monday morning meeting at 8 to give report, and i'm done by 9am. I don't go to IDT meetings. I do come to the office at 4:30 ON FRIDAY afternoon to pick up assignment for weekend (and find out if there are any issues). Currently our census is just under 50. We average around 60. I am salaried, and I get mileage. I have 160 hours pto a year and 24 hours saved from last year for sick time.

They have just reinstituted our on call nurse during the week monday-thursday, she is on from office closing at 5pm, until 8am the next morning, she is salaried too. They eliminated that position about 8 months ago, but reinstated the position as it was *ell for nurses that work monday-friday 8-5 and then take one call night a week, plus do backup call for me on the weekends (it's not bad if no one calls, but how often does that happen.

I hate that they changed your job description. If you didn't have to do IDG meetings, and if your call wasn't broken up to every other night, that may have helped. At least i know after 9am on monday, i don't have to be the nurse again until 4:30pm on friday afternoon.

Our nurses feel free to text or call me with any issues during the week as well so i'm not walking into an unknown situation over the weekend. Most of my calls are medication refills or issues.

I don't know if the staff feels like i don't have much to do. They know that on many weekends, i'll have to go out at 2am 50 miles from my home for a pain/dyspnea issue..........On easy weekends, I try to do extra, like go to our inpatient unit and pick up medications to bring to the office monday. I go to local hospitals to do PR and bring them pens and post it notes and kind of sniff around for referrals, I am sure to have lots of diapers, foley kits, thick-it in my car so when someone is having difficulty swallowing, or is low on supplies, it isn't put on to the nurse monday to take a can of thickener or briefs to a patient. They know they can call on me as a resource-i've been an rn for 14 years and was previously in the critical care setting.

AtlantaRN, RN

Specializes in Med Surg, Hospice, Home Health. Has 13 years experience.

Forgot to state, I do admissions on the weekends. Granted, if a patient is coming home after 9pm at night, once I set up equipment, I will ask if it is "convenient" to come and do the admission that late--some folks are fine with it, others want it left til the morning-in that case, i give them the after hours number to the service with the understanding that they can call me at anytime, then i'll do the admission in the morning.

All day shift nurses are expected to come to IDT meetings.

You aren't being "whiny". You are basically doing what my company has slated as a 2 person job--monday-thursday, then friday through monday morning. You are doing the job of 2 nurses. They are asking alot of you, and I assume, they are for profit, or they wouldn't have you working so much. Unless you are getting paid like you are two nurses ($120K+), you have every right to believe you are being taken advantage of. My husband would say "nothing is impossible for the person who doesn't have to do it." It's a profit thing, the more they get you to do on a salaried position, the less they have to pay an hourly or prn RN.

RN CHPN

Specializes in Hospice, acute care, home health.

Easy question. Answer: Quit your job and find another. You're being exploited.

Thanks everyone for your replies. This is a wonderful forum. I have learned so much from all of you.

I am wondering for those that do admissions on the weekends, how do you take call and do an admission? I would be embarrassed to have to interrupt my admission to take calls. And, I can't imagine having time most weekends to get the paperwork done for an admission. On a typical weekend, I would say 25-40 calls is the norm with a couple deaths and in home visits for issues.

BTW, our hospice is non profit. And, I made a mistake when I said 110hrs/2wks on call, it is actually 128hrs/2 weeks on call plus 10hrs of IDG/2wks , in addition to the in services, holidays, and staff meetings.

I agree that "nothing is impossible for the person that doesn't have to do it" quote. I wish that everyone had to do on call for 1 weekend and then decide what is fair and what is not.

If I could cut out daytime meetings and continue not doing admissions, I would feel like my job was perfect for ME. As it stands, my job plus meetings and admissions seems like an impossible task. Of course, if I was making $120k/year, I could rationalize it, lol. But at under $50k/year, not so much. Sad that I took a $15k/yr pay cut plus a cut in benefits to work at a job I truly enjoyed only to have everything change 2 years later. My dumb luck I guess. Maybe, it is better to work for money rather than fulfillment. I'm torn and praying things will get better.

P

Easy question. Answer: Quit your job and find another. You're being exploited.

Your problem is one reason why I stick with extended care. Much less room for the employer to make me unhappy with my job.

tewdles, RN

Specializes in PICU, NICU, L&D, Public Health, Hospice. Has 31 years experience.

Hospices which are poorly managed will misuse employees...period.

A friend of mine works for a hospice with an avg daily census of about 100. She is a FT case nurse. She is required to take evening and weekend call amounting to 100-150 hours of time/month in addition to her M-F 8-5 hours. She may be called to do an admission during her regular work day as there is no admission team. They provide acute inpatient hospice care at a couple of local hospitals and must visit those patients daily...so the case nurses rotate every third weekend to provide those visits as well as any and all oncall visits (the oncall staff the agency does provide takes phone calls ONLY, the case nurses do the visits.)

As you can imagine their practice is hellish.

Oh my... I imagine nurse turnover rate is really high there. I know our day nurses already work 45-50hrs/week just managing their caseload. I am sure if on call was thrown in there many would leave quickly.

tewdles, RN

Specializes in PICU, NICU, L&D, Public Health, Hospice. Has 31 years experience.

yes...the RN turnover there is amazingly high...yet no one seems to get the idea that perhaps management style should be examined as a potential cause...the management "team" is pretty much convinced that the staff are simply whiners who lazy and ineffective. I left that hospice about 15 months ago...they only have 2 RNs and 1 LPN remaining that were there when I left. They have replaced my position 3 times in that span. One of the 2 RNs is actively seeking other employment...the other is a long termer and is probably stuck feeling that she is unable to get employment elsewhere (the agency destroys professional self esteem with their constant criticism and "need" for you to do more, faster, better so as not to "abandon" the patients, blah, blah, blah).

The place really needs to be unionized.

That is an awful feeling. I have certainly been in a position like that before that just sucks your self esteem right out of you. Unfortunately, it was my first nursing job, so I didn't know any better. It took me 4 years to get the courage to leave. When I started med/surg, I realized what it is like to be appreciated and that there really can be fairness in a workplace. Then, I went to hospice and felt like the management would be good. I was right. My management team does a great job. They are fair and easy to talk to. But, I think managing nurses doing home care is a much more difficult job than in a hospital setting. Sometimes, it is difficult to see the job the nurses are doing or even sense their stress level because the management is working from the office and focusing on the bottom line. Of course, the bottom line is what keeps us all working, but job satisfaction is what keeps good, experienced nurses. I feel like everything will work out in the end, but I don't want to feel like I am being put on the defensive all the time. I just want to do my job well and leave it at that. I think they know I do my job well, but are looking for ways to make it more cost effective for the company and not realizing they are already getting quite a bargain out of their on call nurses. Of course, that's my opinion and I guess things will become more clear as time passes. For now, I am trying not to stress too much and just see where this goes.

Lisa

tewdles, RN

Specializes in PICU, NICU, L&D, Public Health, Hospice. Has 31 years experience.

IMHO, too many management teams in the CHC and Hospice area try to micro-manage the professional staff rather than engage them in improving processes.

I am a full time case manager with an average load of 10 - 12 pts. We are a small nonprofit hospice connected with a hospital. We also have an inpatient unit. Currently we have 3 full time case managers and a full time admission nurse. Our supervisor also does admissions during the week as needed. I am expected to do on call one night a week from 4:30 pm to 8 am the next day. I also do weekend call every 4th weekend from 4:30 Friday night until 8 am on Monday. I do get the rest of Monday off after my on call weekend. We do admissions when on call both in the evenings and on weekends. Luckily we don't do very many on call but it is part of our job description. I've been doing this for almost 3 years and I am starting to wear out. I love my job and the people I work with so I'm hoping I'll get a second wind. I would love to have a dedicated on call person for even half the time.

Debblynn

jeannepaul

Specializes in hospice. Has 12 years experience.

I work for a large for profit hospice as an on call nurse weekends. I am sick today or I would be already out. I used to love my job, but it has gotten so bad, I sometimes fear one of these weekends I will end up having an accident and kill myself along with someone else.

we are treated like as mom used to say "redheaded step children". if they could work us every hour of the weekend, they would. we have over 300 pt, 2 full time on call ( 4 openings but we cant seem to keep anyone) we have case managers on also. we also have a triage nurse and an admission nurse on sat. sounds good on paper, but in application it is an impossible job.

On fridays we have around 6-8 admissions, so saturdays we have to see each one, we also have crisis care pts to see which average 6-10 cases, then the case managers can put their pts on the schedule if they think they need a visit on the weekend. the triage nurse has to call and get permission to use a case manager, because they are getting overtime. friday evenings we also get carry over from the day that the cms couldnt get to.

On friday I already had an admission waiting on me at 5p, finished that one, then I was sent 46 miles for a visit. got home and sent back out 47 miles for a death. I got home at 5am. I am already starting to feel sick, but I think it is because I am tired. I get 4 hours sleep and get up to get out again. I tell the triage nurse i am sick but I dont want to put the other on call nurse in a bind so I will try to keep going as long as I can. I still have 2 pts to see and I get a call for an admission. I have already worked 10hours and have 2 pts left, so I have to either call in sick or do this admission. I tell her Im going to finish these pts and call in. I end up working 14hours and still have to "call in" for 3hours for sat. had I not called in i would have been out all night again.

I dont have a problem working, but how many hours can a person work without a break. at 15-16 hours straight without a lunch or dinner break, with few pee stops, a body just cant continue. I end up driving 250+miles a day. I have been on call for almost 5 years and it is always the same thing. Its not the amount of visits, its not the overall time worked, but it is working many hours straight without a break. why cant management understand this concept.

also on call is for emergent visits, but a chronic cough in the middle of the night is not emergent. we are sent out on calls and by the time we get there the pt is sleeping. Or the familys are told just to call for anything and we will come running and if we dont get there fast enough we hear about it.

management acts like we are lazy, and continues to say "well when I used to do on call....." The two of us that are left are looking for another job, but i would like to continue to work the weekends, but is there a hospice out there that treats the on call staff like they are human?

they need to understand that this is a job people usually do not want. they also need to not freak out if there is a slow weekend and we only work 12hours a day. they just need to understand it is the price of doing business and everytime the on call staff is low, the cms have to do more and they start quitting, it is a never ending cylce.

Im just tired of all of it and just want to do the job I loved. thanks for listening, Itook some meds and now I must sleep!

tewdles, RN

Specializes in PICU, NICU, L&D, Public Health, Hospice. Has 31 years experience.

Not all hospices operate this inefficiently, jeannepaul, thank goodness.

My current hospice contracts out the telephone triage. We employ our own oncall visit team for after hours, weekends, and holidays. We have an admission team/department which completes about 98% of the SOCs (a guesstimate). The case managers provide additional evening coverage through a rotating schedule as well as covering one Saturday approx Q3mos. We occasionally have to complete an admission on our late evening or on the weekend, but it is not frequent.

As a cm, I make every attempt during my routine visits, to insure that my patients and families have their questions answered, the meds and equipment that they might need, and a written plan they can follow to achieve symptom control I am always mildly troubled when one of my patients contacts triage for something which I feel could have been taken care of during regular business hours. I feel that is part of my job, to sidetrack that sort of behavior, and I take it seriously.

Hi! I am new to this website but I am just looking for some advice. I am considering taking a 7 on/7 off position for a local hospice. You get paid for 123 hours a week, mileage and overtime if hours worked are over 40. I have small children and thought this would be a good job. I would like to hear from people who have worked this position as well as hospice in general as it would be new for me too. Is this schedule doable? Wondering what an average night is like. They have someone who does admissions. And we have schedule appointments on our weekend of call. Thank you for any and all input.

Geordi486

Specializes in Home Health and Hospice.

As I type this I am on call for a home health and hospice. I use to be salaried, then was switched to hourly and am now pay per visit. It all averages out the same. We supposedly work 8-5 with on call once during the week and twice every other weekend worked, once on the other weekends. We work every 3rd weekend. We work 5 days a week. While on call as the RN I am the on call, triage nurse, I have a patient care coordinator for any questions and I have to call for any pt related problems, not cancellations ect. We do admissions during the day, weekends and occ with on call. If I have to send someone out I have an LPN to do most of the running. Most nights I get plenty of calls but do not need to send out the LPN. I have been told not to send them out more then 3 times, if that, some visits I have to make. On an average day I have 6 contact hours. That would equate to 3 admissions or 2 admissions and 2 visits or 1 admit and 4 visits or 6 visits. We have hospice IDT on Thursdays and then the next week is home health IDT. First Wed of the month is education. I am in charge of 30-40 pts at a time. I have an LPN that works under me on my team and they try really hard to keep pts with their team. I am always working late to keep up with the paperwork, have to leave the building by 7pm. We keep being told that we are getting computers but I still do all my admits (home health and hospice), resumption of cares and recerts on paper. And we take call at .75 cents an hour 5pm-8pm nothing extra for actually fielding the calls. If I have to make a visit I get a pay per visit fee.