Changes to On Call Job Description

Specialties Hospice

Published

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

Specializes in PICU, NICU, L&D, Public Health, Hospice.

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

Specializes in hospice.

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!

1 Votes
Specializes in PICU, NICU, L&D, Public Health, Hospice.

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.

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.

Specializes in Med Surg, Hospice, Home Health.

When I have an admission, I call my backup nurse, or the nurse administrator/clinical manager to take the calls while I am doing an admission....Then I call the service and tell them to roll the phone to the na or cm.....It is impossible to do a good admission with the phone ringing off the hook (and what does it say to the new patient..."you have my undivided attention?"). Then I call my boss, and the service when done with admission.

the m-f case managers work hard at "fluffing and tucking" in their patients before I start the on call shift.....

linda

I tell the family that I am the weekend call nurse, I'm on from friday 5p-8a monday morning, not to let an issue wait---I'd rather they call me and let me tell them how to handle than have them up all night worrying and waiting until 9am...I tell them that I have a backup nurse. I encourage them to let the office know when they get down to 2-3 days of a medication, if their case manager hasn't handled already.

Specializes in Hospice.

Well, maybe this will give a different persepctive. I work for a non-profit hospice with a census between 40-50 right now, although we are growing. We have 2 full time on call positions, although one is not filled right now. Normally we have one nurse who does Mon-Thurs 5p-8a and sat 8a-5p. Then our other nurse does Fri 5pm-Mon 8 am. That leaves daytime case managers only doing 1 weekend day a month. Our on-calls are responsible for admits. This only really works if you have really good case managers- our on-calls are never doing things like delivering medications. As for whether I think our on-call nurses do enough- heck yes they do! They are my salvation, the reason I get to see my family and have some free time on weekends. I am not sure our on-calls get as much pto though.

Wow. I read every thread and have come to the conclusion that I am working for one of the bad ones. The comments about how we are degraded/demoralized really hit home. This is truly sad. I've been at it for ten years and kept hoping it would get better, but it gets worse every week. I'm happy, though, that some of you have rewarding positions. As of this minute, I am going to find one!

1 Votes
Specializes in Pulmonary, Cardiac.
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.

I am a new grad with previous hospice experience at an inpatient unit. I just started at a new company as a full time case manager. I am working 9-10 hour days and will be expected to take call one weekend a month from fri at 5pm until monday at 8am, and also about 2 days per week from 5pm until 8am. Plus we dont have a admissions nurse so we have to do admissions too. I am cringing and wondering what I got myself into. I am exhausted after 10 hour days, even 5 8 hour days would be exhausting in the heat here in nevada.

I love hospice so much, :redbeathe but I am thinking I might have bit off too much here, the on-call might be more than I can handle. I am bummed because the money is good, but I am so darn exhausted after work all I can do is shower and veg. My quality of life has dropped off.:mad:

If I can hold out for 6 months or so, I am hoping to find a company with a different structure. Darn new grad status!

Specializes in LTC, Psych, Hospice.
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.

75 cents per hour? OMG! I'm an LPN and I take call every other week (weekend included) I get $3.00 per hour for call plus mileage, travel time, and per visit rate for any visits made. Most weeks are pretty quiet because we all take care of our pt needs during the week (meds, supplies, teaching, etc). I may get one or two calls during the week and occasionally a visit has to be made. There's no way I'd be willing to take call for 75 cents.

After reading these posts..I'm thinking maybe our call nurses are not being fairly compenstated..here's the deal..7 days on, 7 off - call being M, Tu, Wed, Thur 5p-8a then Fri 5p-Mon 8a. If there is a holiday then call team is on call that 24 hrs. Admissions any time - sometimes several after 5 p.m. Usually 3 nurses on call. census about 200 covering 22 counties - patient must live no more than 50 miles from office but this is pushed sometimes. No extra pay for going out/admissions/deaths, mileage is reimbursed. Hourly rate $17.00/hr.

Is this a fair rate? Am thinking for the time they put in maybe not.

Thoughts?

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