How many days off are appropriate?

maryen · Jun 22, 2014

I learned the hard way to always schedule my time off with the agency. I never inform the family. I used to but the families would make me feel so guilty and want to know my reasons for why I was taking a day off. I like to keep my private life private. I would also like to add that many times families have gone away on last minute vacations and long weekends and do not give the agency any advance notice.

SDALPN · Jun 22, 2014

I learned the hard way to always schedule my time off with the agency. I never inform the family. I used to but the families would make me feel so guilty and want to know my reasons for why I was taking a day off. I like to keep my private life private. I would also like to add that many times families have gone away on last minute vacations and long weekends and do not give the agency any advance notice.

Good point. Nothing like showing up to a home and nobody answering. Plan a whole day to work, arrange child care, spend gas and time that won't be reimbursed just to turn around and go home. We sure can't just decide to not call in. The parents don't own us and don't sign our checks.

smartnurse1982 · Jun 22, 2014

The main agency i work for has what they call"full time PDN positions" with health benefits and PTO.

To be eligible for full time you have to commit to 40 hrs a week.

If your pt is hospitalized you have to work shifts with other clients,and you can't refuse or you get downgraded to "per diem".

You are also guaranteed your 40 hrs.

If your local office cannot find any work for you,then other offices will offer you work.

This is a very large agency with many,many clients and offices.

My 2nd agency works differently then everyone else's,but in a bad way.

I have to call out 8 hrs in advance(for sickness) for that agency or else it is regarded as a call out.

3 call outs and you get fired.

Too many vacations and you are fired.

This for an agency that does not offer no benefits,sick,vacation,no 401k,and low hourly rates.

Then the braniacs wonder why nobody wants to work for them.

For example,last week i called my agency to to see if the child came out of the hospital.

They said they were not sure; it was already 2:00 pm and her shift starts at 10:00pm.

Since they did not call me back at 4pm i took some work with another agency for that night.

My agency called me back at 6pm to tell me she was coming out of the hospital.

I told them i took a shift with another agency.

They regarded that as "calling out".

Here is the kicker...hospital called the agency at 8:00pm and told them she will not be coming home afterall.

I called the agency and asked them will that stay on my record as a call out even though she did not come home.

Nope,it was still regarded as a call out.

smartnurse1982 · Jun 22, 2014

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.

When my main agency wants me to cover for a call out i ask them to raise my rate for that shift.

Usually it works out.

caliotter3 · Jun 22, 2014

Good point. Nothing like showing up to a home and nobody answering. Plan a whole day to work, arrange child care, spend gas and time that won't be reimbursed just to turn around and go home. We sure can't just decide to not call in. The parents don't own us and don't sign our checks.

Yes. Twice now in less than a month and the agency refuses to pay the full amount for reporting time pay. So, I'm forced to file a complaint with the Labor Board and get to wait for the next time this family and the agency screws me over.

trachmom · Jun 22, 2014

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.

Your attitude is the problem to parents like me (or at least what I can infer - I may be off base.) My point is not that any nurse or agency is responsible for my child. It's that once you've committed to a schedule, you should feel responsible for keeping that schedule -- whether we're talking about taking care of a complex child, mowing someone's lawn, or filing someone's taxes. People count on those they hire.

I'm not suggesting that nurses should cover other nurses, or that nurses can't take vacation, or sick days, or make doctor appts, or shoudl drive in a foot of snow. I'm only agreeing with the OP that once you've committed to covering a shift with regularity, you should show up most of the time; and that vacations and time off should be reasonable, not unlimited, unless you're willing to be taken off the case altogether.

You say on the one hand it's the agency's job to fill spots. And you're right. And they do that when the say Nurse A will work Monday through Friday. You also say that it is very rare -- and understandably so -- that the elusive unicorn of a nurse who is not only fully trained but also free to cover random days off doesn't really exist.

So, how can agencies simultaneously keep their commitment to the families who are paying them (and do not forget THAT is where YOUR money comes from -- families, not the agency, they just do us the favor of taking a cut of our insurance benefits before passing on your cut to you -- we pay you both) when nurses who commite to, say, all weekdays, then take far more than the typical 4 weeks off a year of sick + vaca?

What you're really saying is you don't care. At least own that. Stop implying that families are holding your responsible for their child's wellbeing. That is a straw man. We're holding (or wishing we could!) nurses responsible for holding up their end of the commitment. And stop implying that families want you to have no life, or never take a day off. On the contrary, the families I know very much expect and encourage nurses to take scheduled vacation time.

The issues are: 1) call outs 2) excessive time off and 3) time off with no regard to what else is happening in the family or to the schedule.

Again, these things are tolerated because agencies are usually only very minimally invested in families, and because families are desperate. Not because it's ok.

Workers in offices or hospitals or any other area of life have private lives too, hobbies, vacations, sick days, and they do not expect unlimited time off. You take advantage because you can. End of story.

SDALPN · Jun 22, 2014

Did you notice which nurses got the likes/thanks and that you got none? Maybe you should be saying that to everyone...just a thought.

Like I said earlier, I cover my shifts and only call out when I'm sick or some emergency that keeps me from going in. I called out after a major car wreck on the way in to work. I also left work one day when I couldn't tolerate the pain anymore and went to the Dr to be sent by ambulance to the ER foran ovarian cyst that ruptured at work. I take the shifts I've agreed to seriously. But if I'm not available due to plans or just the need for a day off, I'm not covering a nurse that called out...that's why you are the parent. I will take time off when I choose because that is an agreement between the agency and myself. Being that I work for them and not the parent, I'm sure they would talk to me if there were a problem...guess what, I've never been talked to. If a parent has a problem with taking care of their child and blames it on a nurse, there are many other families that will appreciate me and my consistency. Parents sign an agreement with the agency saying that they understand 100% of shifts can't be covered, but that the agency will try their best. Again, if its such a problem for you, you can always hire privately and then you can make whatever agreement with the nurse that you hire. Until then, you have no control over any nurse choosing their schedule.

trachmom · Jun 22, 2014

Did you notice which nurses got the likes/thanks and that you got none? Maybe you should be saying that to everyone...just a thought.
Like I said earlier, I cover my shifts and only call out when I'm sick or some emergency that keeps me from going in. I called out after a major car wreck on the way in to work. I also left work one day when I couldn't tolerate the pain anymore and went to the Dr to be sent by ambulance to the ER foran ovarian cyst that ruptured at work. I take the shifts I've agreed to seriously. But if I'm not available due to plans or just the need for a day off, I'm not covering a nurse that called out...that's why you are the parent. I will take time off when I choose because that is an agreement between the agency and myself. Being that I work for them and not the parent, I'm sure they would talk to me if there were a problem...guess what, I've never been talked to. If a parent has a problem with taking care of their child and blames it on a nurse, there are many other families that will appreciate me and my consistency. Parents sign an agreement with the agency saying that they understand 100% of shifts can't be covered, but that the agency will try their best. Again, if its such a problem for you, you can always hire privately and then you can make whatever agreement with the nurse that you hire. Until then, you have no control over any nurse choosing their schedule.

I don't think we're discussing the same thing... I would never expect a nurse to cover for another nurse, or to come in after an accident or while sick. I would never expect a nurse to not take days off or go on vacation, or to clear their vacation dates with me.

When you say you show up for the shifts you've agreed to... that's all I wish for. And honestly? I have gotten that from most nurses.

But. I also consider a commitment to cover regular shifts each month means just that: A commitment. Just like any other job.

I'm not ok with missing multiple shifts each month out of your regular shifts, not at all. Do you do this? Does anyone responding here do this, b/c I'm getting the impress you don't. And I've only had 2 nurses who do.

And there have been a few times when I've pushed back on days off -- because a day is a random beach day and the night nurse is already going to be out the night before and after... because I have an important appointment... because it's my son's camp week... This is all I mean with I say having some regard for what's going on with the family, with your place of work. This is no different than any other place of work -- ususally you can take any day you want. Very occasionally, it's your turn to bend to accomodate the place you've committed to.

And I give as much extra flexibility as I can -- leaving early, coming late, random stuff the agency would discourage, but things change sometimes last minute and we are super flexible whereever possible to accomodate this.

Need long term time off? I get it. I've had nurses take 4-6 weeks off for medical conditions or hospice/funeral/grief, and we hold their spot without a thought.

But to basically hold your spots from month to month on the calendar by being the nurse on a regular shift, and then scheduling exceptions every month knowing that a) the family is probably going to keep you b/c you're trained and it's slim pikcings, and b) the agency doesn't care about anything besides something that's going to be a liablity to them... You don't think that at least professionally speaking that this is pushing it?

You also mention control. I think you hit the nail on the head. We families depend on nursing care for any amount of control of our time. When we have zero say as to whether a nurse can jsut call out last minute or multiple shifts... yes, we do indeed lack any control. And that feeling is not good. Maybe that's not important in terms of policy.

But in case it matters: Not knowing for sure what your family's schedule is month to month, or even week to week, is a depressing loss of control. And it happens all the time in home care nursing, with impunity.

JustBeachyNurse, LPN · Jun 22, 2014

In my opinion, it is my responsibility to cover my shifts that I am scheduled for, if I can cover call outs then great but I am under no obligation to cover call outs for coworkers. I do not discuss my schedule requests for adjustments or time off with the family, according to the contract I signed with my agency (I am under a benefits contract with specific requirements. This is no business of the families but a confidential agreement between me and the agency) that ALL scheduling requests for hour/shift adjustments and/or time off are due at least a month in advance and to dh requested of the agency. The agency communicates the schedule to the agency.

I take a week off in the summer for an annual obligation to my own child. In 3 years I have called out once for each agency I work for....with valid reason, I had a fever over 101F as I work with medically complex/fragile children (one just d/c post extended inpatient stay) it was not safe for me to work until fever free without meds for 24hrs. I called in to the agency ASAP and both shifts were covered by other qualified nurses.

Because I have a specific request for next month, I agreed to a schedule change that impacted my family life and reduced my hours with my primary patient to cover another patient/family in need. My primary family was not happy about the schedule change even though the rest of my hours were covered by another qualified nurse. But that nurse wasn't me. I said I had another obligation, the family did not need to know it was for another patient nor was it any of their business.

I do have requests for shorter shifts. (I usually work doubles or extended shifts) or days off to meet responsibilities or obligations for my own family. I place my requests with my agency way in advance as soon as I am aware of the need. My big issue is other nurses that find out why I need off and tell the family. It's not their business to share office specifics.

As a human being, I feel bad if a shift is not covered but is not my obligation to personally staff a case 8-16hrs/day 7 days a week. If I can help out I do but sometimes the answer is no. And I do jot feel obligated to explain to the family that I could not cover Janes shift yesterday even though you requested me personally as I would like to see my own child after school and not just tuck him into bed after he is asleep. It doesn't matter, the simple answer is I worked my shift and was not available to cover Jane's 5th call out of the year for her personal issues.

I will call out if my condition is a risk to my ability to safely your child whether due to illness or injury. I will call with as much notice as possible.

I will not go out partying the night before a 6 or 7 am shift and call out as "too tired". If it snows 18" and I cannot safely get to your home (and your street is blocked plus your job cancelled you) I'm sorry but I'm not risking my safety to walk the 10+ miles in 1.5 feet of snow in -10F weather. I would expect you would feel the same way.

I do make arrangements for less extreme situations such as arranging for child care if my son's school closes for ice and 1/2" of snow plus leave extra early to arrive safely and on time as that is my job.

I follow the time off and vacation guidelines put forth by my employer (the agency). I'm sorry if you don't like my qualified replacement for the one week a year I take off, but I fulfilled my obligation to my employer and the patient who is a client of my employer.

SDALPN · Jun 23, 2014

Its not pushing it in the slightest. Its the nature if the job and the reason many if us choose to do this job. I will take whatever day I need off, of course with advance notice. As with most people, I'll take care of my needs before anyone else. If I choose to take a few days off a month, its my business.

Has anyone ever explained how this job was started? Maybe the history would help you understand. Either way, no matter how bad you want things one way, it won't be that way. So the options are accept it, or be miserable over something you can't control. Back to the history....when people used to come home from the hospital to receive home care, they weren't as bad off as they are now. Thanks to todays technology, more people are "saved" and can be cared for at home. The agency would hire hospital nurses who wanted extra hours/shifts to give respite and help families out. As time went on, technology in the home increased. The acuity level of these patients increased. More and more nurses were able to get the hours they needed and wanted in just this job that allowed so much flexibility. This hasn't changed. The flexibility is still there and one of our only benefits. Some nurses are single parents that need flexibility for their own child, some are young and single and want to live life, some in school...you get the idea. And the parent/family has always ultimately been responsible for caring for their family member. You always have the option of finding a friend/family member to be back up just like any other family with kids or a sick family member. You're asking for something that can't be provided by an agency. You can't get pizza at a steakhouse...same idea. You can't get mad at McDonalds for not giving you a gourmet meal. Simple.

RNathome2010 · Jun 23, 2014

Wow. This is why I asked.

First, I'm not crossing a line as one poster said by questioning this behavior. My hope was to understand what counts as per diem.

Yes, the agency is allwoing it... they allow anything. We know this, and we're lying if we say otherwise. We're lucking if agencies have our backs, they definitely do not have the families' backs in most cases.

I understand that many nurses enter home care because of this interpretation of flexibility. But that does not make it professional. In no other job would you be able to get away with just taking the equivalent of weeks and weeks off of work, while an employer holds your position for you. We know that if we take a summer off, or a medical leave, that we could lose our position. Why then is it ok to take that same number of days off spread throughout the year? Answer: Because we know that probably the family will put up with it.

I agree with trachmom, the reason nurses and agencies get away with this is because the customer, the families, are that needy. Something to think about.

I also have to say that most of the nurses I've worked with do NOT think they can just take days off every month, when they're working stable shifts. We take pride in our job, we recognize that we've been asked to perform a very important job, for people who are suffering (patients AND their families). There seems to be a great split between PDN nurses (and agencies) as to what is counts as professional.

And I'm not sure where all of this venting about being forced to cover shifts for other nurses is coming in, or being forced to work and take not time off. I didn't argue for that, and either has any family I've worked for. Just looking for basic, minimum professionalism.

Nibbles1 · Jun 23, 2014

I covered 8 shifts in one month for a nurse who kept calling in. She had a drinking problem. She got mad when another nurse and I split up some extra hours between the two of us. I see it as if you can't cover your own shift why should you get extra hours?