Confused and scared...I need advice...

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Hi, I am currently an on call RN for a large nation wide for profit company. I have experienced burnout and have taken one LOA earlier this year. At that time I was a case manager for the same hospice company.

After returning to work from 3 weeks off to de-stress, the on call position opened up and I applied for it. I was interviewed internally and offered the job...very happy with the new hours....(i work 5 12hr shifts on call at night from 8p-830a Sunday night through Thursday night...62.5 hrs a week for a 40hr salary...which is ok)Then about 90 days into the new position I was called into the office by my don and administrator who pulled out a list of calls that weren't handled to thier expectations.

Respectfully, I obliged with their new expectations including me going out on EVERY call, yes, every call. Their rantionale was that we need to be present and improve the after hours service based on surveys etc....Did I mention nursing judgement doesn't come into play here at all...in fact a huge part of the reason for my increasing amount of stress as a case manager was due to the fact that every single visit note and IDT recert was constantly being scoured for imperfection. Everyday it was something new and I cracked...I told my supervisor "I seriously don't know what you want from me anymore?" That being said I still have no say in how I determine to operate as the nightshift on call nurse.

I am expected to attend deaths in SNF's wether family is present to not. After they have already been pronounced, and regardless of the distance from my home. I have been asked not to rely on the "support staff" that a re also on call with me. I was told "they are already stretched too thin, only call them if you are tied up". I must visit SNF'S every time they call, even if they have already handled the situation...The full time case managers pick up on call on weekends and they rotate....but they are not held to these stringent rules....why? Because its overtime for them, but I am salary.

Ok...so then last week, my supervisor sits me down and says "we have come up with a plan to eliminate the case managers from being on call"....great! (they need to be able to focus on thier duties instead of covering a 150 pt census on weekends, I was there...) My "new" schedule was handed to me....what they did was take 125 hrs of on call responsibility...divide by two FT RN's and they have created a rotating schedule where...picture this...I would start work thurs 5p-830a...fri same shift, off sat and sun, back to work Monday 5p-830a, tues, and wed too...off thurs and fri, then on call sat starting at 830 am all the way through to Monday at 830 am....then returning to the rotation on Thursday. Let me remind you all I am off every weekend and holiday. I currently work 12hr shifts. This means I need to work every other weekend now...unfortunately PA is an at will state so what they are doing is completely legal.

So....once again I start feeling increased stress of the uncertainty of where I will end up...I can't work those hours for so many reasons. (involved in a contract also...they paid for my BSN....stuck as well as screwed) I had a panick attack in the middle of my shift and seriously considered driving to er instead of the pt...called off the next night because I was still having a major panic attack....never this bad though...I was crying terribly for the better part of 12 hrs. (hx of anxiety and panic disorder)

So...I sought counseling and he pointed out some very scary things that I really never thought of. I have been doing as they say...whenever I questioned it have been shunned and treated terribly and rudely in front of co-workers...He says it smells like fraud...billing for medically unnecessary nursing visits to SNF's...now I'm so confused, in hindsight soooooo many things make sense now! And let me tell you I'm terrified. I want to do the right thing, but I'm not 100% sure that we are out of compliance.

I did ask my supervisor..."why is it that I have to attend all these calls and deaths in the SNF's but the case managers on weekends don't?" she replied "you don't need to worry about what is expected of everyone else, you worry about your job expectations! And next time you have a question like this you come to me!" so I reply " I am asking you now"...she says scoffingly "yea after you went and talked to everyone else!" I was speechless at that point because our reports are recorded and retrieved by general voicemail...I hear how they handle thier calls.

I'm not trying to get out of working or sit at home and triage for a FT RN salary...but what it going on here? And now that in hindsight soo many things from my past in case management make sense...all the recert and IDT notes that I was asked to change...."get creative" with...? I guess I could go on and on...thank you for reading and any advice/opinions welcome and extremely needed at this time. God Bless

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Perhaps you could have them give you written instructions regarding every aspect of what is expected of you, a complete job description so you have it all in writing, rather than verbal instructions. Get a printout of the policies and procedures for your place of employment.

"They told me to" is not going to hold up if it comes to any legal matters. Get everything in writing. Protect yourself. It sounds like they are pushing you beyond any reasonable limits.

I wish you the best.

Wise Woman

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Thank you! I have a meeting soon to discuss if the counterpart and myself can come to an agreement with the schedule, something that works for both of us...which is nice however I'm seriously afraid of my management. I was thinking about emailing my supervisor to ask her to have the on call policy and the job description handy for reference during the meeting. (the job description states "and duties as required" which covers them in a way). i am afraid of retaliation. But I do need to protect myself...thanks.

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Specializes in Hospice, LTC, Rehab, Home Health.

Is it possible for you to find another position with another company (not necessarily hospice, maybe home health) and pay off your contract to this company? It might be difficult but it sounds like you may need to focus more on your physical and mental health right now. Prayers and best wishes for you regardless of what you choose to do.

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Thanks for the prayers! Greatly appreciated! I am considering my options...it's just that the amount of the scholarship is close to $20,000. I saw a lawyer about that before I suspected fraud and he said that it would go to collections...I'm very overwhelmed at the thought of the financial consequences otherwise I would have left a long time ago...it's a 4yr contract that I am 2 1/2 yrs into and it specifically states they don't pro-rate...lawyer says good news is they most likely won't sue. But also doesn't see any other option but to allow it to go to. Collections and settle from there...ugh....this is too many dynamics for me to keep track of. I really need sme guidance...does anyone know where I can turn? Besides a lawyer at this point they aren't even returning my calls...

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Specializes in Acute + Dementia Modules.

At $40 an hour your income is approx $76,800 Gross annually. Seriously!? Quit the job after securing another position with another company that pay's the equivalent to what your making now with better terms and hours. Let the scholarship go into collections. Simplify your life and downsize. Pay off the collections in one year while living on an income approx of $30k and use the remaining $20K to either bank roll or pay other existing debts off.

If the suspicions regarding fraud are true, you do not want any part of this!

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go back and ask the lawyer now that you suspect fraud. And there should be a "hotline" for suspected medicare fraud, perhaps you could actually "make money" on this?

Thanks for the prayers! Greatly appreciated! I am considering my options...it's just that the amount of the scholarship is close to $20,000. I saw a lawyer about that before I suspected fraud and he said that it would go to collections...I'm very overwhelmed at the thought of the financial consequences otherwise I would have left a long time ago...it's a 4yr contract that I am 2 1/2 yrs into and it specifically states they don't pro-rate...lawyer says good news is they most likely won't sue. But also doesn't see any other option but to allow it to go to. Collections and settle from there...ugh....this is too many dynamics for me to keep track of. I really need sme guidance...does anyone know where I can turn? Besides a lawyer at this point they aren't even returning my calls...
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I don't make anywhere near $40 an hr....

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Thanks for the advice...I make less than $30/hr...comes out to about $3000/mo...already living check to check....like many....

At $40 an hour your income is approx $76,800 Gross annually. Seriously!? Quit the job after securing another position with another company that pay's the equivalent to what your making now with better terms and hours. Let the scholarship go into collections. Simplify your life and downsize. Pay off the collections in one year while living on an income approx of $30k and use the remaining $20K to either bank roll or pay other existing debts off. If the suspicions regarding fraud are true, you do not want any part of this!
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Specializes in Hospice, Case Mgt., RN Consultant, ICU.

So you have a BSN and 2 and 1/2 years hospice experience. Can you tell us more about your background? I am assuming you were an RN when you went to work for this company either a AA degree or a three year diploma grad. How much other experience in nursing do you have? What was the agreement for this employer to pay for your BSN? What are hospice nurses in your area paid. Less than $36000 sounds awfully low! Your gut is telling you something is terribly wrong and your supervisor does not support you. I wish you the best.

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Specializes in hospice.

I hate to say it, but you are getting screwed!!!! I am an on call nurse and there is no in H@ll I would to that schedule. Not to mention at 150 pt's you should have at least 2 on call nurses at all times, possibly 3.

It is usual protocol to go to deaths even in nursing homes, we have to stay until the funeral home picks up the body even if the family is there or not. but going out for every call, no way.. Our policy if they call twice for the same thing, we need to go out. We have to go out for falls, (but if its the middle of the night, no injury and they are back in bed, I usually go out in the morning. regs are it must be within 24hours)

It is my understanding that Medicare pays one flat rate per month regarless of how many visits you make, what meds they get or equipment, someone correct me if I am wrong. the only time they would get more money is if they are on crisis care or GIP, then it is a higher rate.

I work Friday 5p until Monday 8a. We have a little over 100 pt's and I have a case manager backup. I have to do admissions, deaths and visits. Somedays even with both of us, I still end up working anywhere from 14-16h straight, no breaks except what I eat in my car on the way to next visit.

What happenes if you get fired? If that would break the contract, I would do what I felt like and if I didn't think they needed a visit, so be it.

It sounds like a very toxic work environment. Possibly hostile, and if it is hostile, maybe you have something there to work with. You need to document, document, document and if possible, have somelse attend any meetings they have with you. I have known people to lie about that they say, or get a tape recorder and and record it every time you talk to them. CYA.

Sorry this is such a mess, our work is stressful enough, without that kind of BS.

Good luck.

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OK, there is definitely a problem where you are, you have a bad feeling about what is going on at your place of work, they treatinh you like trash, and all of this is stressing you out and you are going to get sick, depressed, leave nursing or make mistakes, is this all worth it to you? Go to someone that can give you some financial advice of how you could pay this money back. This job is not worth what you are going through. If they really are committing fraud or you even think there is fraud you need to report it to Medicare or you can be considered just as guilty for not reporting and you do not want to lose your license, acrue fines and possible jail time. Seriously, start looking for a new job and get out of there and file your report with the Medicare Fraud Hotline, it turns out it is fraud, you may recieve a reward for reporting it and I have heard that it can be a pretty sum. You can do this anomonis (ok, can't spell), but you need to protect yourself, no one else will do it for you. Best of luck, I hope you come to a decision soon. Life is way too short to be this miserable.

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