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.

[NutmeggeRN, BSN]

In the LTC facility I work at Per Diem, the issue is not the RN/LPN calling in. It is the LNA...Part of the problem is that we are staffed on census, not acuity and when they are down one person already because the census is low, and someone calls in, it is brutal. All these folks are heavy duty. You need a sit to stand and/or a lift. Most have some level of dementia and many are incontinent. Yet the expectation is to put on a smiley face and just get everything, do not skimp on showers or baths, make sure all that can are encouraged to walk, everyone is always dressed, their hair always looks perfect and the LNAS walk peacefully around the facility with a smile on their face the whole time. This place is a private BIG BUCKS$$$$ facility and the residents expect to be waited on hand and foot, as they SHOULD for what they are paying but with only 4 LNAs on it is really hard. YEt when one of their peers calls in, they are trashed to no end....and then those who get ****** get self righteous and say well, if Iam gonna work short, so is somebody else! and the cycle goes on.

Staffing on acuity is not considered, agency is out of the question and they are told "we are doing things a different way today" and that is the message to be given to the residents......he RNs and LPNS are as helpful as they can be with their own issues.

[achot chavi]

Strategies I have seen work:

1) On every unit have a nurse who really wants work full time but tell her you can only give 75% hours for now and will build up but you will consider her for every call out so that hopefully she will end up with 100% hours..... I am not endorsing this, just passing on an idea that I see works successfully

2) If there is too many call outs on one unit, call a meeting explain that because of the call-out problem you will have to hire another nurse who will have to be given an equal slice of the pie so that there will be less for everyone, you wish you didnt have to do this, but your responsibilities lie with consistent patient care and if the present staff cant cover their units shift responsibilities, you have to bring in more staffing. Unfortunately seniority wont mean better shifts, everyone will be given fair shares of hours - even the new staff. (it goes without saying that staff that dont welcome new staff will be dealt with on an individual basis).

3) Overtime is usually according to whatever is the norm in the state/region (according to location), Find out what other facilities or hospitals in your area are paying for overtime.

4) Often we allow the nurse who is forced to work an extra shift to take off a future shift and ask the call-out nurse to take it. This doesnt always work but is an option.

5) We have sometimes called back the call-out nurse and said, we called everyone and no one is available, you will have to come in anyway (unless she is sick herself) and find someone else to (watch your dtr, stay with Mom at the hospital, or whatever) However we can give you tomorrow off and "Betsy" can cover if that helps.... OR if the call out is because of an unexpected funeral or event, we will find a way to give her two hours to attend and return, and find someone who is close by and can cover for the two hours, of course we do full shift handover with each coming and going of nurse, we dont like it but in an emergency situation we allow it, and it goes without saying that no one gives meds that someone else prepared.

6) Every so often I will ask a nurse from one unit to cover another unit just so she be familiar with the unit, in case of call-out she can cover the unit and it wont be foreign to her. Also if there is a unit nurse on vacation, the nurse from another unit who is now familiar with two units can help cover during her unit nurses vacation.

This is not a new problem, it is great that we share ideas on this, Anyone with other ideas, Please share!

[achot chavi]

When staff work short, they must be made to feel appreciated, and compensated for the extra miles they have to go that day, Compensation need not be monetary, although some nice extra to the unit like a pizza or ice cream for the staff would go a long way. Letter of appreciation, or some other prize.

You have to know your staff and what makes them tick, what approach to take to make them feel like going the extra mile is to their advantage and at the end of the day they get something for it.

Activities that make the staff bond and care for each other will also help. Celebrating birthdays together or the like so that when one calls in, they dont see it as a burden but as helping him out and he will help you out when you have to call out...

Keeping the positive atmosphere is the best thing you can do for your patients, your staff and the facility. Anyone grumbling should be asked to take a short 5 minute break, do some deep breathing and relax and come back to work, as complaining wont help and besides together the work will get done. Administration should see that it is hard and takes longer (I would ask for overtime if the staff just cant manage to get it all done on time) and shouldnt get the idea that the unit can manage short....or they might get ideas.

[aprildennis87]

This sounds like a good plan as long as the rest off the nurses are ok with this. A staff meeting may be a good idea too. At my facility if u are a full time nurse, you are required to be on call. On week days, the RNs take turns being on call. On the weekends, an LPN and RN are on call...the LPN taking care of staffing needs and the RN on standby in case a med needs to be mixed, there is an emergency, or if RN coverage is needed for the day. However, we are not paid extra for this and are usually sent home later in the week if we are in overtime. I like the plan that your facility has devised. I also think that nurses should be compensated for coming in on their day off or working over. However, most facilities are looking for ways to save money...I know mine is!