New On Call procedure. Need ideas, suggestions

[gerRN23]

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.

[PrimaFacie]

1. You need to hold a staff meeting to find out why there is such a high volume of call outs. If you don't get to the root of the problem, no amount of fixes will help.

2. Consider letting the nursing staff do their own scheduling. As long as they stay within HR policy for how many hours they have to work, let them get creative with the schedule. Maybe some of them have conflicts that other nurses are willing to fill in for, but they don't want to bring the issues to supervisors because they don't want to appear needy or an admin problem.

I remember once when hired to work at a nsg home, an ADON scheduled me to work four 4-hour shifts, instead of the 2 days I said I was available to work. The 6p to 10p hours were the med-pass times and when they needed the most help. That schedule was great for the facility but terrible for me, and I shouldn't need to explain why that burned up any goodwill she would have had with me.

Always remember that people work to live, they don't live to work.....even nurses who are often more dedicated than most.

[inkydorei, LVN]

As a floor nurse in LTC, I would have to say that this wouldn't work with myself or the nurses I know. What you are proposing is basically unscheduled mandatory overtime. I don't care what sort of bonus my superviser offers me, I don't want to be told I *have* to work OT. I signed up for 40hrs a week. If I wanted the obligations of management, I would have applied for a management position.

just my 2 cents :)

[Pinkmegan]

4 of us share the on-call. The 2 senior nurses & 2 of the staff nurses. We are rostered for on call on the days that we work so this does not impinge on our days off. On-call, basically, is for someone to call for advice. On the odd occasion that someone does not turn up for a night shift, or that they have phoned & the message has not been passed on, we are expected to do the shift, whatever we have worked during the day!

A while ago, I was getting ready for bed, had put one leg in, when the 'phone rang! The night shift nurse had rung in sick but the message had not been passed on! I had no choice but to get out of bed & do the shift!

This back-fired on the rest of the staff as the next day was my 60th birthday & they had arranged surprises for me! After a few hours sleep I went back to accept the gifts, eat the cake &, generally, accept all the good wishes!!

[DC Collins, ASN]

It's very good of you to ask for opinions first before implementation.

1) Ask your nurses for suggestions before implementing anything.

2) Forced overtime is anathema to many, many nurses.

3) Hiring another nurse is cheaper than all the overtime and bonuses.

4) Hire a Per Diem willing to be called in.

Best wishes,

DC :)

[sapphire18]

I don't work LTC, but where I work, all full-time RNs have to sign up for three "on call" shifts in a 6-week period. So if someone calls out and they need you, you work the shift for overtime pay. Not my favorite thing but at least I wouldn't be worried every time i was working that I would have to go in 4 hours early or stay 4 hours late. That's no way to live.

[scrubwearer]

My facility used to do the stay over four hour and the other nurse came in early. Everyone had scheduled days that they could be "mandate" and have to stay over or come in early so they could plan for it. They also did a pay bonus for having to be mandated. It worked well and our CNA's still do it. The nurses switched to 12 hour shifts now so we don't have the mandate anymore but a lot of times people would volunteer to stay for whoever was mandated so we never had any issues.

[Mandychelle79, ASN, RN]

Before instituting any time of mandatory overtime policy, you may want to check your state laws.

[buytheshoes11, MSN, RN]

We have per diem and part time nurses who are willing to come in when there are call-offs. Our DON never, ever helps out on the floor (it's nice to hear that you and your DON do!). There are times when a nurse from the previous shift will stay and help out for awhile, or the nurse from the next shift will come in early. Despite this, there have been days where we have only had three nurses for four carts. Do you have a registry company where you live? This is also an option.

[Mom of Diskids]

At my LTC facility, ALL administrative nurses take call; MDS, Treatment nurse, Unit Managers, ADON, DON....... one person is on call each weeknight, and then two of them are on call each weekend (1 LPN and 1 RN)

[NotFlo]

Oh hell no. That's my reaction, and I can almost promise that will be the reaction you will get if you implement this without speaking to your nurses first.

At my facility we are all (from the ADON, MDS nurses, unit managers to floor nurses RN and LPN) on call one day per schedule (about a month). I hate it. It's the worst thing about my job.

However, it's still better than being worried every time I come in that I'm going to be forced to stay late. Or waiting at home for a call that I *must* come in early.

Floor nurses don't get paid the big bucks for that type of aggrevation.

[RNGriffin]

I don't think the 4 hour forceful stay is convenient for the nurse on duty, nor the nurse who is coming on duty. You don't want to be in the facility 7 days in a row. I am sure the other nurses aren't going to be pleased with being forced to work overtime. You also may want to check the labor laws on this issue. Your staff morale will go down, and turnover will increase. Thus, this is going to cause the execs to become involved in the issue, as hiring new staff is never inexpensive( especially nursing staff).

The DON & yourself should look into contracting with an agency or possibly hiring a PRN nurse( possibly 2 if budget permits.) in the end, you will save your department money & time.

If the PRN staff is not an option, arranging for a call in list is the best solution. You can arrange for each nurse who has had 2 days off during the week to be on call each week in rotation. Do not exclude yourself and the DON. You don't want to create a separation of hostility in the environment.

Management calls for creative thinking, not convenient to myself thinking. By the way, during the summer months you should expect higher call out rates. It's summer, after all.