How many days off are appropriate?

caliotter3 · Jun 21, 2014

Workaholic that I am, tend to only take off when I'm dead sick, or something comes up that is out of my control. But that is me and not necessarily the norm. A lot of aggravation for the family could be avoided if the agency would keep some "backup" type nurses available to fill in when those necessary days off come up. There really are some nurses that prefer to move from fill in assignment to fill in assignment on several cases that they have oriented to, or worked, in the past. Cultivating schedules for these individuals can be quite a boon to all involved. Unfortunately, not many people can make a sensible living from scheduling themselves this way.

SDALPN · Jun 21, 2014

One of the benefits if this job is choosing your hours/days worked. You are not the primary caregiver. The parents sign forms with an agency that say they are responsible as the pcg and will care for the patient in the absence of a nurse. Its not your problem if the agency can't cover your shift...that's their problem. The agency or the family needs a plan in place. Plus I would assume (since you show work ethic) that you would give plenty of notice for vacation. That notice gives the family and agency plenty of time to find coverage and again is not your problem as long as you give reasonable notice. Enjoy the benefit of choosing your schedule, not many jobs offer that.

RNathome2010 · Jun 21, 2014

I guess my question is, if you commit yourself to work 9-5 M-F didn't you already chose your schedule? That's not per diem, it's s commitment.

Right now, one nurse is on track to take the equivalent of 6 weeks off this year, mostly in random days 2-3 times a month.

The issue isn't whether the patient will be safe in her absence. It's whether the mom can work her part time job , keep doc appts, etc. with a schedule that is only reliable 80% of the time.

Finding coverage for multiple random shifts every month seems like a lot to ask especially when there are 3 other nurses in the house who also need to take time. And since there are no back up nurses tho the agency has looked for a long time (complex case).

I'm not saying don't take time. Just that if you had 3 weeks of vacation at another job, you'd still only have 1.25 days/month. And common curtesy would be to check with your place of work to make sure that your desired days work. There's good reason for this, you're part of a team.

caliotter3 · Jun 21, 2014

If one nurse is on track to have six weeks off this year, it is because the agency allows her to do this. And, in reality, as SDALPN pointed out, flexibility in scheduling is part of the perks of doing home health care. You can't blame her for taking advantage of this. All home health agencies use scheduling flexibility as a sales point when recruiting employees.

SDALPN · Jun 21, 2014

The only commitment you have is the shifts you agreed to work in advance. I request my days off before the next schedule is made. My agency does 6 week scheduling. You don't need to worry if the parent doesn't have 100% coverage. When someone has a child, they make a choice to have that child and to take on that responsibility. There is no guarantee the child will be born healthy. There is no promise that they will qualify to have a nurse. Their child is their responsibility. Scheduling is the responsibility of the agency. Your responsibility is working the shifts you have agreed to work. You cross boundaries when you are concerned with issues that aren't your problem. What happens when a parent has a healthy child in daycare that gets a fever and has to go home until afebrile for 24 hours? Or the babysitter that gets sick or goes on vacation. Most parents have a back up plan for that and it should be no different for a parent with a special needs child. You work for the agency, not the parent.

trachmom · Jun 21, 2014

I just wrote a long response, and lost it.

I'm a mom of a complex child and SDALPN I have to say you really don't seem to get it.

I have no back up for my complex child. That's why insurance is willing to pay for nursing -- b/c my alternative is institutionalizing him. If my healthy kids lose their child care, I have back up fairly easily (relative to medically complex children.) If my healthy kids lost their childcare 2-5x/month, I'd switch baby sitters or day care -- it's hard enough setting child care in teh first place. Rearranging not only chld care, but appointments, work commitments, etc, is very stressful, very distracting, and very time consuming. No one would tolerate that... unless they were desperate....

Which is what families with complex kids often are. The number of nurses to care for kids like my son is low, as I've learned in these 4 years. . The number of competent nurses who also have a good work ethic is very, very low. When you get someone who fills even some of the requirements, it is very tempting to make due and hold on to them.

Combine this wtih the fact that agencies usually don't give a crap enough to advocate for families... and voila, that is why "flexibility" like you're describing is tolerated.

If it is understood that you are just filling in random days in any particular scheduling period, then scheduling different days every time makes sense.

But if it is understood that you are THE Mon-Fri nurse, or the Weekend nurse, etc. than you're taking a position that someone else could fill. Finding back up for random days you want to take off -- above and beyond a day or two a month -- is very difficult. Our agency has never found one for us, and I don't know many families that have actually found one.

Do you really commit to a family that you're going to be their regular nurse for days or nights, and then just take whatever days you want to, without even a thought as to what that will do to the family? I don't mean guilt, I don't mean you don't have a life. I mean you do whay anyone at any job would be required to do -- check in, give a ****, asking if teh week you want time off works, negotiate. They are holding these shifts for you from time period to time period.

I have a nurse right now who commited to Saturdays, except "maybe one a month", and has yet to come thru for this in 9 months. She was surprised, even offended, when I told her I needed to find a different Saturday nurse -- those were *her* shifts.

This is not about entitlement. And saying things like there are no guarantees really misses the point. There is no guarantee you won't need a c-section at birth either -- does that mean that its ok if you dont' have access to one? Doctors and insurance companies have agreed to providing medically competent care so that parents can sleep, work and have a small (very small) amoutn of respite is medically necessary. You're job is to fill a medically necessary roll. That you can dismiss this as easily as you do -- just not your problem -- is troubling.

SDALPN · Jun 21, 2014

I just wrote a long response, and lost it.
I'm a mom of a complex child and SDALPN I have to say you really don't seem to get it.
I have no back up for my complex child. That's why insurance is willing to pay for nursing -- b/c my alternative is institutionalizing him. If my healthy kids lose their child care, I have back up fairly easily (relative to medically complex children.) If my healthy kids lost their childcare 2-5x/month, I'd switch baby sitters or day care -- it's hard enough setting child care in teh first place. Rearranging not only chld care, but appointments, work commitments, etc, is very stressful, very distracting, and very time consuming. No one would tolerate that... unless they were desperate....
Which is what families with complex kids often are. The number of nurses to care for kids like my son is low, as I've learned in these 4 years. . The number of competent nurses who also have a good work ethic is very, very low. When you get someone who fills even some of the requirements, it is very tempting to make due and hold on to them.
Combine this wtih the fact that agencies usually don't give a crap enough to advocate for families... and voila, that is why "flexibility" like you're describing is tolerated.
If it is understood that you are just filling in random days in any particular scheduling period, then scheduling different days every time makes sense.
But if it is understood that you are THE Mon-Fri nurse, or the Weekend nurse, etc. than you're taking a position that someone else could fill. Finding back up for random days you want to take off -- above and beyond a day or two a month -- is very difficult. Our agency has never found one for us, and I don't know many families that have actually found one.
Do you really commit to a family that you're going to be their regular nurse for days or nights, and then just take whatever days you want to, without even a thought as to what that will do to the family? I don't mean guilt, I don't mean you don't have a life. I mean you do whay anyone at any job would be required to do -- check in, give a ****, asking if teh week you want time off works, negotiate. They are holding these shifts for you from time period to time period.
I have a nurse right now who commited to Saturdays, except "maybe one a month", and has yet to come thru for this in 9 months. She was surprised, even offended, when I told her I needed to find a different Saturday nurse -- those were *her* shifts.
This is not about entitlement. And saying things like there are no guarantees really misses the point. There is no guarantee you won't need a c-section at birth either -- does that mean that its ok if you dont' have access to one? Doctors and insurance companies have agreed to providing medically competent care so that parents can sleep, work and have a small (very small) amoutn of respite is medically necessary. You're job is to fill a medically necessary roll. That you can dismiss this as easily as you do -- just not your problem -- is troubling.

I do get it...been doing this for 10 years...I really get it. I work for the agency, not a parent. If a parent has a problem with staffing they can take it up with the agency. I'm not a slave to any parent. I chose this job for many reasons including flexibility. I work because I chose to, not because a parents expects me to jump when they say jump. I happen to take a vacation or two a year and a few weekend trips. I work a very stay schedule and overtime most weeks. But if I need off for a break or Dr appt, I will take it. If I can't take care of myself, I won't be taking care if anyone else. If the agency can't staff a case, that's not my problem. Typically the hard to staff cases are the parents that are never happy anyway. Any parent that has a problem with a nurse working for an agency and choosing their own schedule needs to hire privately if they want a different situation. With an agency, that's how it works and you accept that when you use the agency. You are ultimately responsible for your child, not us. Our responsibility ends when we are off the clock. There will be days a patient can't be covered...that's life. Its hard for agencies to find nurses that only want to work call outs and open shifts. On top if that, most open shifts are cases nobody wants to work anyway. Most nurses need full time hours and can't sit at home waiting on a call. That means the nurses already working for the agency may be working another case and can't be in two places at once. I don't get benefits, I don't get anything other than hourly pay. So my benefit is flexible scheduling and that works well with my life. Someone elses child is not my full time responsibility. I didn't make the choice for that child to be brought into this world, the parent did. I don't work for the parents. I work for an agency and for the childs best interest. I almost never call out and I cover call outs when I can. If a parent doesn't want to worry about call outs and missing work, they can put their child in a facility and then they won't have the problem of missing work. Don't forget facilities get short staffed and then the child in the facility won't get the care you can give or the one on one care that is better for the child.

Nibbles1 · Jun 21, 2014

I was called in 136 times in one year because of nurses not showing up. I learned that it is NOT my responsibility to cover every shift or making sure that they have coverage. It's the agencies job. I have been to the worst cases that no ones else will cover. There's a reason for that. I will take off when I want to. I don't do it often. Maybe two days off per year. But I will. I don't get health insurance or vacation days or anything else. So I agree with a few of the posters on here. Not my responsibility to save the world. The family can always ask for a different nurse if she keeps calling in.

allnurses Guide · Jun 21, 2014

RNathome, I handle it the way you do. If I have stable shifts with a family I give as much notice as I can. The advantage of agency work is that if you need extended time off or need to work around a school schedule or whatever, you can change your schedule with a lot more freedom than a standard facility with lots of spots to fill for each shift. You can take a summer off, etc. I don't think you can expect not to be replaced on your prior cases though.

I had to learn to not feel guilty for not filling in at the last minute for nurses who don't give enough notice for their personal time off!

eeffoc_emmig · Jun 21, 2014

My agency schedules month to month. I ALWAYS work the nights I commit to and usually a few more due to other nurses calling off. I take off as much as I want...but I also tell my scheduler the month before. If those nights gets covered, great...if not, oh well.

eeffoc_emmig · Jun 21, 2014

The only commitment you have is the shifts you agreed to work in advance. I request my days off before the next schedule is made. My agency does 6 week scheduling. You don't need to worry if the parent doesn't have 100% coverage. When someone has a child, they make a choice to have that child and to take on that responsibility. There is no guarantee the child will be born healthy. There is no promise that they will qualify to have a nurse. Their child is their responsibility. Scheduling is the responsibility of the agency. Your responsibility is working the shifts you have agreed to work. You cross boundaries when you are concerned with issues that aren't your problem. What happens when a parent has a healthy child in daycare that gets a fever and has to go home until afebrile for 24 hours? Or the babysitter that gets sick or goes on vacation. Most parents have a back up plan for that and it should be no different for a parent with a special needs child. You work for the agency, not the parent.

This. Exactly.

I can't tell you how many times my days off have been interrupted due to the agency calling me because a parent is calling them whining about no coverage. No, I certainly will not cover yet another 3 in a row because the parents/agency can't keep nurses on a particular case. I want to spend time with my family on my days off.

You created a child and the bottom line is that you are responsible for the care of that child.