Nurses "on-call" related to low census; Am I rightfully angry?

[inthesky]

I work on a small 15 bed behavioral heath unit at a local hospital. Even though the economy took a dump, our census has not really been affected. More and more people come in depressed with nervous breakdowns due to financial pressures, job and home losses, and marriages crumbling in those stressors. What has changed is our staffing policy when the census does have a dip. When the census dips to 11, a nurse has to leave or be put on the dreaded 'on-call'. For example, let's say that I get a phone call at 1230 to put me on-call for my 1500-2330 shift. I have to be ready to come into work whenever I am called. This means that I cannot do anything with my day, not knowing. The stress of not working is more than if I were at work. Usually that patient #12 does come in because well.. it is rather ridiculous to be able to predict the census for the entire afternoon and night at 1230. When I do make my way in (I live 30 minutes away), the single charge nurse looks ready to cry with the stress of admitting patients, dealing with the doc, and giving patients their meds. Even our on-call docs don't have to come in! I make new grad pay and get a measly $4 an hour for on-call. One day, I was really pulled around. I was called at 1300 and told I was on call before a 1500 shift. I was called at 1445 to come in . I was lazing around in my PJs reading a good book. It took me a rushed 45 minutes to get there and I was very angry in my car. My day turned around when I arrived to the lovely day nurse waiting for me and people happy to see me. It was just dumb, but being at work was a relief from the on-call stress :icon_roll. It is much worse for the day charge nurses when their AM med nurse is called in. How one charge nurse is supposed to pass meds and PRNs (psych patients get a lot of PRNs) for 10 patients, transcribe all new orders, deal with the docs, put out unit 'fires', be harassed at the desk for things like patient belongings and laundry issues, and admit patient #11 is beyond me. This is one of the reasons which I have not fought to renew my charge nurse status after previous issues at work which have faded for the most part. A 20 year experienced extremely capable nurse told me that she locked herself in the med room and almost cried. It made me feel so bad.

This on-call policy strikes me as wrong and unfair. I'm sure that employees (who keep their jobs) in every job field around the world are being abused in one way or another and I'm lucky to have a decent job. However, that doesn't make this right. Anyone else have to be put 'on-call'?

[mjjlRN]

I understand the anxiety you have, and it is really hard coming into work "late" and playing catch up all day.

I have worked placed where we were required to be "on-call", and as long as you are being paid on-call pay, I wouldn't be complaining too loudly. Currently where I work, they give "HR"'s which are Hospital Rquests Off for low census. We work 12 hour shifts, though, and they will only give out an HR in 4 hour increments. (ANd we do NOT get paid anything for this HR) For example, if I am scheduled 7a-7p, they will call around 0530 and give me an HR, but I have to be "by the phone until 0730 unless someone doesn't show up. Then, I have an HR until 1100. I am responsible to call the unit by 0930 to see if they need me for 1100, and if not, must stay available until 1130. then, I have an HR until 1500, but must call by 1330 to see if they need me. If not, I have to be available until 1530 before I can actually do anything. So, really, I can't do anything with my day on the chance that I get called in, and I am NOT getting any call pay because it is an "HR" even though I really only have a few hours of not being on call through the day. It is a huge bummer, and for that reason, I usually ask to be floated to another unit instead of taking an HR if they call in the morning.

[BrnEyedGirl, BSN, MSN, RN, APRN]

Wow one nurse for 11 pts? I've never worked on a behavior health unit, but anywhere else I've worked we had to have a minimum of 2 RN's even if there is only one pt,...just in case there is a code. The hospital were I work does a similar "on call" for low census only our on call time is only $2.50/hr then we get 1.5 X pay for actually being called in.

Until just a few years ago, the rule was staffing was decided at 1600 for my 1900-0700 shift. I would get a call at 1630 and told I wasn't needed at 1900 and to check back at 2300 to see if they needed me. At 2300 I was told to call back at 0300. We got nothing for that time,...really sucked and they did finally stop that. When I'm on call I just stay ready to go into work.

[Neveranurseagain, RN]

I'm not defending the on call policy but what would help is a change of attitude toward being on call. Consider yourself lucky that you get to lounge around in pj's (one of my favorite things!) and try not to let your anger and anxiety build. Have specific things to accomplish the days you are on call that can be done at that time. The not knowing if the phone is going to ring can put you on edge. I used to be the only paramedic in a 50 mile radius and was on call 24/7. Took me along time to change my tude and get used to being on call.

[VORB]

I get $0.00 for being on call. They usually just downstaff us period, but will occassionally ask us to be on call. But then they usually say we won't be called in past 4 hours into the shift. That's good, because I wouldn't be available beyond that.

[Smackdown]

A measly 4 dollars an hour for on call? Wow, we only get 1 dollar an hour, count your blessings. Being put "on call" is part of many nurse jobs both in the hospital setting and out.

[VORB]

We get $0.00 for on call. If we're down-staffed, we have the option of taking Paid-Day-Off money -- which cuts into our vacation days of course. I always decline the money and save up my vacation time. But it's sad that we have to make that choice between vacation time and getting paid.

[Music in My Heart]

Have you as a group tried to negotiate better on-call terms?

Using on-call staff is a necessary evil as hospitals try to cope with unknown demand and struggle to balance revenue and expenses.

[cardiacmadeline, RN]

I work on a stepdown unit. We don't use "on call". If we are overstaffed, we either float or are voluntarily called off. We can choose to use our vacation time or not get paid for it. You are called one hour before your shift starts to see if you want the shift off. If you say yes, you have the day off, they can't call you back in.

[BGgirl]

We are ALWAYS putting nurses on call now. I'm a charge nurse and even after a call in and taking our float to another floor I had to put one nurse off and 3 on call. It's not fun but they have an hour to come into work and then get time and a half. PLus if you're just on call you get $2/hr. Nothing more you can do when census is so low. They either have to take on call or get forced off.

[Wise Woman RN]

We are occasionally on call for low census, but only until 11am... we have planned admits, so they will know if a patient is going to be admitted that day... but no on-call pay... and we can use paid time off (vacation day) if we need to be paid for the day... It seems to me that a skeleton staff is what the place wants, with the ratios according to numbers and not acuity. Can't let the nurses have a good day, or to really be able to be a "good nurse."

Sometimes it just makes me sad...

[AnnaN5]

Our unit uses on call quite frequently. We are a large 55 bed unit and the staffing is made as if we are full. When we are not full then nurses have to be either low needed, put on call, or floated to a different floor. Our hospital has a resource pool so we are not often floated to other floors. If we are a few patients away from needing another nurse they will usually put 1 or 2 nurses on call, which means you can be called at anytime during our 12 hour shift. If you are low needed, that means they don't need you and you are not on call, if you want to be paid then you have to use PTO hours. If you are on call, I believe we get $2/hr while sitting at home and if you are called in you get time and a half for every hour worked.