New On Call procedure. Need ideas, suggestions

Specialties LTC Directors

Published

We've had several call ins as of recent and unfortunately every time someone calls in myself and the DON have to cover. Recently I had to work 7 days in a row. Most included my own duties in office but the other 2 days were spent on the floor because a nurse called in.

Luckily the DON splits shifts with me so I usually only end up working 4 hours. Today is my day off and I'd love to go to the lake but I continue to worry that if I do I may get a call to come in.

This feeling is horrible never knowing when you will be expected to be at work and because I'm the ADON I feel it is my responsibility to come in when we are short. Currently we do not have any type of on call procedure for when someone calls in so usually the scheduler will try to get the shift covered but if unable to then myself and the DON usually cover. I do not mind to do this at times but my concern is that we should not have to work 7 days in a row like we had to recently. It's not good mentally or physically and you can't plan outings or anything with family and friends.

We are considering starting an on call procedure with our nurses to where if someone calls in then the nurse working stays over for 4 hours and then someone comes in 4 hours early. For example, if the nurse on 1st shift calls in then the 3rd shift nurse is expected to stay over for 4 hours and the 2nd shift nurse would need to come in 4 hours early. We do 8 hour shifts here so we feel like it would work out well. We also plan to pay staff an extra amount if they have to stay over.

What does everyone think of this? Is it fair? and how much do you think a person should make extra if they had to stay over? The residents care is our main priority and doing this helps us to know that we won't be short. The don and myself will also take call as well as our mds nurses. If anyone has suggestions or if you currently do this in your facility let me know how you do it. Any input would be helpful. We haven't started this yet only discussed it, it's all new to us too so we're trying to work out the kinks.

PRN staff can't be an option surely if they don't know the area??!!

With situations like this, it's not only the extra time demanded but the uncertainty involved. How do you plan for child care or transportation or school on such short notice? Of course, you can't. And that's the kind of thing that infuriates people who are otherwise loyal and somewhat willing to be flexible.

I suggest hiring a pool nurse or two or having everyone cover a pre-arranged on-call period (so long as it's not too often) that they can plan for ahead of time. If they know that on such-and-such a date that they'll be covering a shift, they'll be able to arrange for their personal needs when they're not under the gun. This is the difference between mild grumbling (taking call) and red-hot rage (get dumped on at the last minute).

If there are some who want extra hours, they could certainly list themselves as more available than others. This can come in handy when there are times of lower census and folks are looking to make up lost time.

I hope that you would also be taking a look at people who are repeat offenders or who seem to cause more than their share of last minute disruption.

Whatever you do, please, don't go with your proposal of mandating one nurse to stay late and another to come in early. Staff members often have others depending on them and may not have workable last minute options available to them or their family members. Surprise mandating is the kind of thing that makes people look for other jobs, even if they're reasonably happy otherwise.

Specializes in trying to figure it out.

oh geeez when i worked LTC our ADON would pretty much bully us into coming in to cover call offs. if we said no, we knew we'd have a crappy assignment for the next week. She assigned nurses each and every day to what hall(halls) they would work. Needless to say it didn't take too long for me to burn out and leave. :bowingpur

Specializes in retired LTC.

I worked at one small, 'Mom & Pop' type LTC facility that had a very good reputation. As we didn't use agency, it had a really workable solution to overtime. They would automatically pay DOUBLE-TIME if any nurse covered an unexpected shift (one that occcurred with less than 24 hours notice). Automatic DOUBLE-TIME - no questions asked, no authorizations needed, no payroll screwups, no begging, no threats, etc. Just automatic DOUBLE-TIME. It was their way of saying thank you to the staff for helping out in a short-notice pinch.

We would just volunteer to cover the shift. We all felt that it would be just as easy to do the same job for double time as it would be for straight time, and we all liked the little occasional extra $$$. It was never abused. There were certain nurses who especially liked to do the OT, even to be called on their days off, if nec. Some gals even had overnight bags packed in their car trunks with extra clothes, toiletries and some non-persihable snacks. I worked a couple of long ten-day stretches a few times. Yeah, I was tired, but the OT was nice and I felt appreciated and respected to help out. This was explained to me when I interviewed. No surprises.

It worked with that administration. When a new LNHA came in, he abolished it - felt we 'had a racket going on' among the staff. Needless to say, morale went down; staffing became problematic, our state surveys toilet-tanked, private census decreased, etc. Interesting what happens when staff appreciation becomes non-existent!

Specializes in med-tele/ER.

I wouldn't go for an extra 4 hours on my shift and I would quit if I had to stay extra everytime someone called out sick.

I've VOLUNTEERED a number of times to stay over 4 hours when there was a call in. Being mandated to stay? No way in Hades would I go for it.

Oh I have to stay over today for 4 hours, put my personal life on hold. No problem be glad to. Next day guess what I'm calling in for the whole shift, expect I'd be job hunting. Some nurses enjoy extra time especially when we choose to work it or are asked, but don't tell me I have to due to a call out. You are management find someone , or you stay the 4 hours. This would not work/fly with me.

Sorry posted wrong.

What is 'per diem'!!?????

Specializes in ICU.
What is 'per diem'!!?????
Lol- it means working "as needed."
What is 'per diem'!!?????

As needed..some call it PRN staff.

Normally they get paid a bit more. No benefits but they commit to so many days per schedule or month or are on call for so many days or shifts.

Specializes in acute care and geriatric.

Inkydorei, et al, with all due respect, what profession did you sign up for?, Guess what- we are not working in a clothing store, a museum or NASA, in our business the show must go on, 24/7 NO MATTER WHAT, we dont close our doors because one of our nurses is sick, we have a professional responsibility to stay and take care of our patients when the oncoming nurse is late or cant come. We have a moral responsibility to honor our work schedule, to come on time or early and to help when there is a call-out. I know you "signed on for 40 hours a week" so did we all, but it doesnt always work out that way. Who told you that it is management's problem if there is a call out - its EVERYONE'S problem and you have to work together to shoulder the burden. Management is responsible for so much, staffing is a small percentage of it. Strong nursing management is in your favor and it is to your benefit to support your nursing management if you want to work in that facility.

I am so glad I work with nsg staff that totally understand this and there is such a sense of camaraderie when there is a call out. In fact I hear the nurses caring about the nurse who called out ("Oh,her daughter is sick again, OMG she had a car accident? With her new car? poor thing, let me also call her and see if she needs help"or," Wow, her dtrs boyfriend just proposed?, so exciting, sure I'll help cover her shift tonight so they can celebrate") .

Just my 2 cents..

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