Changes to On Call Job Description

  1. 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).


    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.


    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.

    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?


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

    Thanks for any input,
  2. Visit pixiec11 profile page

    About pixiec11

    Joined: Jan '08; Posts: 13; Likes: 4


  3. by   OncallRN
    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
  4. by   pixiec11
    Thanks so much for your reply. I hope that's true about unemployment for NY. Hopefully, they reconsider these changes.

  5. by   AtlantaRN
    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.
  6. by   AtlantaRN
    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.
  7. by   RN CHPN
    Easy question. Answer: Quit your job and find another. You're being exploited.
  8. by   pixiec11
    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.

  9. by   caliotter3
    Quote from RN CHPN
    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.
  10. by   tewdles
    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 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.
  11. by   pixiec11
    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.
  12. by   tewdles
    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.
  13. by   pixiec11
    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.
  14. by   tewdles
    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.