On Call dilemma

Specialties Home Health

Published

How does other agencies do your oncall? We cover a 6 county area & have someone triage all the after hour calls, so the field nurses do not have to take time to answer each call. We have LPN's who are scheduled with PM visits, but the RN's may have an IV follow up visit in the PM, then an admit to do and answer the Prn calls (leaking caths, wound vac problems, IV problem) that requires a home visit. It can make for a long night at times..... :crying2:

I was wondering how other offices do their oncall and how often you are oncall? Does your agency tweak your schedule to account for the upcoming oncall? All the nurses complain about the oncall, but sometimes it helps to see how others have it. Any suggestions would be greatly appreciated...

Thanks!

At our agency, it depends on how many nurses we have of course, but right now I am on call every 6th weekend, from 8 am Saturday to 8 am Monday. We have a RN who is hired to be on call during the week, she does PM cases, and any admits that can't wait until the next day. Our supervisor's rotate to triage all calls, so our beeper doesn't go off every three minutes! Besides being on call, we take any cases or admits that have not been covered. I am lucky that the nurses want to volunteer to do some of the cases on the weekend, because we get time and a half on the weekend, even if you are part time. If we are called out, we get a minimum of two hour's pay, even if we are there at the house for 30 minutes. We get paid mileage, and the driving time, and I am paid hourly for record time (paperwork!). With an admission, I am doing paperwork longer than I am at a patient's house! On holiday's we get double time. The on call rate is $2.50 an hour on top of your pay you get when you do visits, or go to a call. Currently, our Agency is working with the nurses to come up with a plan to make on-call less frequent, although after working every other weekend in the hospital, I think it is great!(don't tell my boss that!) After reading the posts, I am very grateful for the people I work for, they are very flexible.

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Our agency has extended hours that we see patients. We are open 7-5pm. From 5-8pm a nurse covers this. She works 9:30- 8 pm, 4 days a week. In return for working this shift she doesn't work rotating weekends. The triage nurses cover 8 pm-7am, M-Fr and 24 hr on weekend, with rotation every 5-6 wks. They pay $1.75/hr to carry the pager and you get paid a minimum 2 hours pay at 1 1/2 if you are called oput plus you get paid for travel time, paper work and mileage re-imbursement.Our nurses work weekends ( 10 hours to cover 7am-7pm) the Triage nurses take TC's only. If we are really busy other nurses volunteer to do their own pts and the Triage will help in a pinch.We have recently joined a union SEUI and are working on better wages and incentives in homecare. We cover a 40 mile radius from dubuque to Illinois and starting into Wisconsin soon. The only reasons a nurse a nurse needs to make a HV after hours in our agency is for IV's,TPN problems. We have the care givers cut the foley catheters and remove them. We see them in the am(unless they are having pain from retention) A G-tube can wait as they're usually giving themselves bolus feedings.If they're having resp problems, we send them to the ER if needed. Our on-call Docs are good about ordering meds based on our asessments over the phone...we know most of our clientele very well. We carry the 485's of all IV,foley,IDDM,Coumadin therapy pts,DNR pts and psych pts. That way we have all updated info. Our secretaries update the 485's weekly and the nurses add addendums for any patient changes.I've been in homecare for 18 yrs and still love what I do. I always say you either love HC or you hate it.You stay or you leave. We all have our niche!

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Specializes in Case Management, Home Health, UM.
that's why I am no longer in home health. I would work all day, get an evening admit and have to have the paper work turned in the next day. The queens in management wouldn't go near a patient or risk their life driving out in boondocks at night. Many times those evening admits could wait until the next day, but our director wanted everything right now like a spoiled two year old.

TELL me about it! I did 14 after-hour visits in one week once...and HALF of them were for admissions, that they couldn't (or wouldn't) schedule during the regular work day. I informed my manager that this was an abuse of the on-call nurse, and refused to ever do it again.

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HI...I have been trying out home health also, and I know what you mean about the paperwork. My area is around where I live, and I will be on call for the third time this m-th night. They say if you get a call that can wait until the next day, to do that. So far I have had only a few calls, and one was a call off. If I were you I would look at another company. Your travel sounds nasty, and Im not real happy with the pay either. I was a agency nurse doing private duty working with vents/iv's and g tubes. Was making more, BUT, was also on steady nights. Its good to be in bed at night:) . Good Luck, hope this works out for us :)

As some of you know I have been working home health for a little while now, I am not comfortable with all of the forms and rules that seems to go nowhere. I am trying to give HH a open mind and a fair chance, but the on call thing has me a little uneasy. The original area I was to be working was close to my home, not too busy and no real danger except from wild animals. I know being out in the boonies for some is a scary experience, but I know most of the people for 100 miles so I felt ok. Now I have been filling in at the main office and they cover a larger area, more inner city, more in the drug areas, and in some places I just do not know how to get to. I have been having second thoughts since they announced last week we will be required to attend a weekly meeting for 90 minutes, get all of our paper work in next day, and take call more. I do not feel that I am making the money I should be making for the job we do. I was given a letter from the director who more or less said the insurance was going up 15% because the nurses utilize it more than other staff. I don't like the wear and tear it is putting on my auto, and I just don't feel like I am working with a top notch group of people who have all of the skills they need to run a agency. Any pointers? Please!
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Guinney- your pay for taking call is wonderful. The agency I used to work at paid $20 for a weekend and $10 during the week from 5pm to office opening at 8. We covered many different area codes and my cell doesn't work at the house. I often paid more in long distance calls that the $20 I was paid. The more I talk to you nurses in the area of hh, the more I can see that there is no standard. If you are unhappy at your job, shop around. After 3.5 years I had enough and quit. What I ended up with was a wonderful surprise. I have not taken call in the 4.5 months that I have been there. I have been able to double my patient load, and we don't leave things hanging knowing it will be on the on call nurse who won't have any idea of what is going on. For those that are unhappy at their pay, call schedules, mileage rate- bring these things up to your director and see what happens. We brought these things up and I turned in my resig the next day and another co-worker did the same. I don't know if part of it is lack of organization and common sense with the management- but some agencies stand far above the rest. I think this means that the patients receive better care because the employees are happy. At my old jog I remember a Sat. doing 4 admissions, 3prns, and one scheduled and driving 200 miles. You cannot tell me this could not have been handled better. It pays to look around and see what other places are doing. The nurses and the patients make the company exist. If neither are satisfied, it won't take long for the company's bottom line to suffer.

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Where I previously worked you would do on call 1-2x a month. Hours were from 5p-8a and had to be taken on you regular workdays. Oftentimes it was like pulling a double shift as admits,and visits that were not covered during the day were given to the on call nurse along with any prn snv's. We covered 3 counties,so potentially could be alot of driving. The office would start paging you as early as 1pm and have you start taking extra visits at that time,eventhough call didn't officially begin until 5p!sometimes you might have an LVN on call with you ,but only until 9p and there were many visits such as admits that they couldn't do,after9p you were on your own--that contributed to my leaving. I won't do call anymore. :o

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First let me say I just left HH for all of the reasons already mentioned here.

The agency I worked at was a small privately owned agency. There are currently 4 field staff RN's, 1 RN administrator who hasn't done a visit in 5 years and probably couldn't if her life depended on it, 1 RN assist admin who does help with visits and admissions if the nurses are overwhelmed, and 1 RN in the office who also helps with admissions and chart audits etc.. We took call for a week at the time Mon at 8am to the next Mon at 8am. Some weeks were tough and some were very quiet. I worked with a great group of nurses and we helped each other all the time. We covered 3 large counties and could be as far as an hour or more away from the patient calling. Our policy was not to make visits after dark unless it was a scheduled IV or BID wound care.......then we always double teamed those patients. Leaking foley isn't an emergency, show the care giver how to remove the foley when you initially visit and tell them to change the patient frequently during the night......they should be fine until morning. I always ask myself if there's anything I can do for this patient other than call the doctor when I get there, if the answer is no, I send them to the local emergency room. They could be wasting valuable time waiting for me to get there.

There was no triage nurse for our calls, if someone calls the answering service the service pages the nurse on call. We always tried to find someone to teach for the BID wound care and even the PM IV's, I've taught neighbors and preachers to keep us from having to go out in the evening.

My family is so excited that they have my undivided attention in the evening now and my cell phone hardly ever rings. I will no longer take paperwork with me on vacation so I can have it all done by the time I get back. What a relief.

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At our agency, it depends on how many nurses we have of course, but right now I am on call every 6th weekend, from 8 am Saturday to 8 am Monday. We have a RN who is hired to be on call during the week, she does PM cases, and any admits that can't wait until the next day. Our supervisor's rotate to triage all calls, so our beeper doesn't go off every three minutes! Besides being on call, we take any cases or admits that have not been covered. I am lucky that the nurses want to volunteer to do some of the cases on the weekend, because we get time and a half on the weekend, even if you are part time. If we are called out, we get a minimum of two hour's pay, even if we are there at the house for 30 minutes. We get paid mileage, and the driving time, and I am paid hourly for record time (paperwork!). With an admission, I am doing paperwork longer than I am at a patient's house! On holiday's we get double time. The on call rate is $2.50 an hour on top of your pay you get when you do visits, or go to a call. Currently, our Agency is working with the nurses to come up with a plan to make on-call less frequent, although after working every other weekend in the hospital, I think it is great!(don't tell my boss that!) After reading the posts, I am very grateful for the people I work for, they are very flexible.

I am interested in knowing how much the person is paid that your company hired during the week and what her duties are, if any, other than on call. I have worked in home care for many years and have had informal discussions on hiring an on call nurse for Monday through Friday but would like more detail to do a detailed proposal. Thanks.

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Specializes in Labor and Delivery, Orthopedic.
I am interested in knowing how much the person is paid that your company hired during the week and what her duties are, if any, other than on call. I have worked in home care for many years and have had informal discussions on hiring an on call nurse for Monday through Friday but would like more detail to do a detailed proposal. Thanks.

Well, obviously I'm not the PP but I just got hired into a similiar position so I can tell you what I do. I am on call Sun-Thurs. From 9pm to 8am each night. It is a salaried position. Annually it is only 17K/year but considering that I triage calls from home, can sleep as long as I have the phone right by me to answer calls I think it is fair. If it is necessary for me to make a home visit then I get 70.00 per visit. I am brand new in this job - only 2 weeks in but I am liking it. I have husband/kids and only want to work part time so it is really ideal. I am not entirely sure how they divvy up on-call when I'm not doing it. I believe they have a "PM Back-up" nurse who will triage calls and do late admits between 5-9pm, and then they rotate between nurses for Fri/Sat when I'm not on. I do not have to do any admits and I know that they will hold true to their word on that one. They haven't even trained me on Oasis so there is no way I'd be able to do one. Hope this helps!

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The on call nurse, who takes on call during the week from 4 pm to 8 am Monday to Saturday, gets a regular salary. Depending on the Position Grade of course. Within my own Position grade, that would mean between $54,171- $69610 a year

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The only on call that I've experienced in home health has been when one of the office staff (those responsible do this on a rotating basis, or there are one or two people hired for this function) start making phone calls to field staff like myself to try to get someone to cover shifts for people who call off for some reason or for shifts that were not staffed for some other reason. I would not relish the task of being the one who starts calling trying to get people to come to work, especially for night shift. When I worked in LTC, the night shift charge nurses had to call staff for fill in for call ins. It was horrible trying to do this at the same time that you were supposed to be doing a med pass and other duties. Most of the time no one would answer their phone.

I would not want a traditional on call duty in home health. When I would be on call, I would not be able to accomplish a thing, always expecting that phone to ring.

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Specializes in LTC, HomeCare, a little med/surg.

In our office only the full-time nurses take call. We have 5 full time RNs and 4 full time LPNs, we have several prn of each but they don't take call. We do call one night at a time during the week and it rotates. On the nights that an LPN is on call, an RN is backup for pm admits, PHE's, etc. Our RNs take call on the weekend from Friday at 5p-Monday at 8a. It comes out to every 5th weekend at this time. The LPNs take backup on the weekend, every 4th at this time. We also have a weekend RN that works every weekend. She and the LPN take scheduled visits before the RN that is on call. The nurses that are scheduled on call for the upcoming weekend get a day off during the week. This is probably a little confusing but hope it helps. I know each company has its own method but this is the only way I have ever done it.

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