For on-call how do you ....

[Kitty Hawk]

Not sure there's an answer for this as all of my co-workers voice the same complaint. But how do you stay "on" for on-call without letting it consume your nerves? I love my job, the first time I can say that in nursing and I'll be here a year in June. I love my co-workers they are awesome. The only thing I don't like about my job is the on-call.

Right now I have the weekend which for us is Sat 8am to Mon 8am. There's a 12 hour nurse with me til 9p. We have an IPU that takes calls until 7am starting at 7pm and if there's an emergency I would need to go out. Because we are slow tonight, the 12 hour nurse has the phones, but quite often I would be triaging calls from 4p to 7p from answering service.

I had to go out earlier today with a foley not draining and it was no big deal. The pt was wearing briefs AND long pj bottoms so it was all twisted and an easy fix. But I guess I hate that unknown and not knowing what crisis it could be and other nurses voice the same.

We are blessed as we only have on call weekends approx every 6 weeks. However if you don't have a weekend that month you are generally scheduled for more overnights (for us that's 430pm to 8am) however we do have an evening nurse that works from 9p to 7am and for the most part we never go out after 9p as she catches it all for us. We do frequently have admissions though after work if we are on call or tuck ins, which can go until 10pm, so it's exhausting.

I just can't relax when I'm "on" I'm always on high alert, can't sleep etc... because you just never know I would rather have an assigned shift than this. I've gotten better for it not darkening my mood totally but I do find that I will sometimes be thinking about it the week before, dreading it's upcoming which is nuts because then I'm losing piece of mind on 2 weekends! Writing it out makes it sound nuts!

So how do you relax and just let what happens happen? I usually am v good about trusting God and his plan and any time I've been called out, it really does have his plan and purpose imprinted on the experience but I still don't like "not knowing" haha.

[Kitty Hawk, ADN, RN]

Oh and ktwlpn, I do go in on my follow up visits when explaining hospice (and if I'm the one doing the admission) do educate the family that even though we are 24/7 we will try to walk you through symptom management over the phone. I don't like how some CE's will say we will come 24/7 when they call, because when asked that I always correct the family and again teach them I am empowering them to handle the care. That we will come if it's an emergency, but first we try to help over the phone.

I even did a direct transfer from hospital to IPU by getting nurse's report which was appreciated instead of running out there. Hospitals sometimes feel we need to actually see them but if they're appropriate by MC guidelines that seems a waste.

Sometimes I wish our answering service could tell the ones that want to know "when is the nurse coming?" that we will get back to them in the morning or even to call us back as that's not even close to something that needs answered after hours. But that's not customer service so....

[DLS_PMHNP, MSN, RN, NP]

I don't like how some CE's will say we will come 24/7 when they call, because when asked that I always correct the family and again teach them I am empowering them to handle the care. That we will come if it's an emergency, but first we try to help over the phone.

That is a great way of putting it!

[lifelearningrn, BSN, RN]

I don't agree,I think on call staff doing admissions is a waste of time.In my experince the case manager never seems to catch up....and The on call as neededstaff never seem to know all the p and p.f

.When the regular staff take call daylights and on weekends they are given other time off so they can recharge.

You prefer to take call over having a team take call after hours? I think you're definitely in a minority there (or an administrator that doesn't give a crap how your day staff feels).

[toomuchbaloney]

I prefer working with dedicated on call staff for after-hours and weekend call.

That staffing pattern, however, is very difficult for a small agency to maintain on a couple of important levels.

I am a firm believer that if you are a case manager who works primarily M-F 0800-1700, you should be given other hours off to compensate for the addition of the on call time. No one should have to work more than 7 days consecutively in such a demanding position. When I have had employers try to require that I refuse and reschedule my hours to bring me back into my 80/pp contractual or employment agreement.

When I am oncall I simply plan my life as if I will be out of the house and working all of those hours. I have come pretty darn close on many occasions and have had to call in additional help to assist with simultaneous issues across a large service area of more than 200 patients.

Certainly families can call the mortuary at time of death, but doesn't the patient have to be pronounced before they can remove the body from the home?

[ktwlpn, LPN]

You prefer to take call over having a team take call after hours? I think you're definitely in a minority there (or an administrator that doesn't give a crap how your day staff feels).

I see the effect the lack of continuity has on the patient.The caliber of the on call admission staff I have worked with for the past two years don't seem to give a hoot,they are unfamiliar with the home 's p and p and even that of their own agency.There documentation must blow because the regular case manager comes in and basically starts over so what is the point?.

[lifelearningrn, BSN, RN]

I see the effect the lack of continuity has on the patient.The caliber of the on call admission staff I have worked with for the past two years don't seem to give a hoot,they are unfamiliar with the home 's p and p and even that of their own agency.There documentation must blow because the regular case manager comes in and basically starts over so what is the point?.

Perhaps better training of the on call staff?

[ktwlpn, LPN]

Perhaps better training of the on call staff?

Has not happened yet.And I am not an administrator who does not care about how the staff feels.But isn't this about the patient and their feelings?

[Kitty Hawk, ADN, RN]

I

Certainly families can call the mortuary at time of death, but doesn't the patient have to be pronounced before they can remove the body from the home?

This would be a concern in our area as well. Our LPN's can pronounce too.

After I posted all that, my weekend went insane. Of course I'm fielding calls one after another and even calling my back up, the calls were still coming in faster

Simultaneously I had one family dealing with pt vomiting feces. He had an ileostomy and hadn't emptied the bag in two days, at the same time a FACILITY couldn't deal with a pt that refused to put her o2 on sats in the 50's and becoming paranoid.

My priority was still with the first pt so until I had that squared which I did a direct IPU transfer based on sx. Then I could deal with the other. At first the facility was mad because I didn't drop everything and run and advised them to try the ativan first. Then when I called back, they stated everything was fine. The pt's family member called and demanded someone "that knows what they're doing" come look at pt ASAP because she is paranoid again. I went and he was irate it took me over an hour to get there. I get there only to find the pt perfectly calm, pox at 92% (they got her to put her o2 on, imagine that) and refusing any other interventions.

There was more mayhem to be had that night such as an air mattress that wasn't inflating. a CTB that family didn't call us, but called 91 and wanted the equipment picked up NOW, and another direct transfer to an IPU for pain control. It was after all, a full moon.

Not to be short changed on all the fun. My husband tagged along to the one over an hour away. Neither of us had eaten as every time I went to grab a bite, the phone rang. So we got ice cream at 10pm and were giddy like a couple of naughty kids out past bedtime and contemplating whether to go to bed at all. Turned out no more calls, but there's no guarantee of that, and that's what gets me. The not being able to relax.

After completely being stressed out yesterday and managing to do my actual work. I am back to normal today. On the plus side, I won't have another weekend til July so that helps, but I will have 4 "16 hour" nights in June so....(plus one more this month)

And ontop of all this the IPU's are short staffed and they want us to stay after work with the incentive of $$$. Seriously? I love my family far more than $$$ and my sanity too. Maybe if they didn't exhaust us with all the constant on call/admissions, we'd have incentive on our own to help out with the over time. As it is now? Nope, they can hire more staff. I agree this is getting downright dangerous to give your all not just with skills we provide but the equally exhausting emotional support we provide.

Thanks all for your insight and help.

[amir-amir]

I'm looking to get IV certified in the Columbus area, I'm awaiting verification of license(LPN/LVN) from CA, where I'm pheblotomy certified but not IV. I thought the Red Cross did it, but I dont see the class on thier schedule. Is there anyplace semi-local (I'd go to Cleveland or Cinci for a weekend if necessary) where I can get this? I just got hired at a new job and they'd like me to be certified ASAP. Text me at 740-835-5273

thanks in advance

Kit

Sent from my iPhone using allnurses

[lifelearningrn, BSN, RN]

Has not happened yet.And I am not an administrator who does not care about how the staff feels.But isn't this about the patient and their feelings?

In the end, the patient is the one that loses out if the nurse caring for them is over-tired, over-worked and burnt out. This leads to poor care and high turn over-- and how is that beneficial to the patient?? Again, it is unreasonable, and even dangerous, to expect those responsible all day long to also be ready to drop and run all night as well. NOBODY should have to be available 24 hours a day. This job is too emotionally charged/draining as it is.

[ktwlpn, LPN]

In the end, the patient is the one that loses out if the nurse caring for them is over-tired, over-worked and burnt out. This leads to poor care and high turn over-- and how is that beneficial to the patient?? Again, it is unreasonable, and even dangerous, to expect those responsible all day long to also be ready to drop and run all night as well. NOBODY should have to be available 24 hours a day. This job is too emotionally charged/draining as it is.

That is exactly why both the local agencies I work with here in this LTC do not make on call hours overtime.The staffare scheduled off prior to and after their call weekend.They are not expected to work a full day after being on call for 48 hours......