On-Call Duties in Acute HD

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Specializes in Med/Surg, Tele, Dialysis, Hospice.

Just wondering, because this is how it worked when I was a hospice nurse; do any of you work for a HD company that has day shift nurses and then on-call nurses who only work in an on-call capacity after hours?

The company that I currently work for (one of the Big Two), expects the acute nurses to work all day, sometimes a very long day, and then still be on call that night. This is the normal practice, not just a once in a while thing when we are short staffed (which is pretty much all the time because no one wants to stick around due to having to be available all 24 hours on some days). I'm getting the impression that this is the norm for the Big Two, and probably for most of the smaller companies, but why do these companies feel that a human being should be able to work 18, 20, even 24 hours straight? This isn't even safe, is it?

I realize that I am probably going to get responses about the cost of having separate on-call staff to cover nights, but if hospice companies do it (and it's pretty much standard in hospice) when their night calls are rarely as long as in HD where even a two hour emergency treatment equals at least four hours out, then why can't HD companies care enough about their acute nurses to do the same? Hospice benefit reimbursement from the government is paltry, so if they can afford it, why can't two very profitable corporate entities do the same for the sake of giving their nurses some semblance of a normal life and a better chance of practicing safely because they aren't fatigued out of their minds?

Signed,

Burned out acutes nurse looking desperately to transition to chronics

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Specializes in ICU.

This was standard when I worked in acute dialysis, unfortunately. I don't know what else to say.

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Specializes in ICU, previously Dialysis.

This was not the standard in two of the companies I have worked for...one being one of the big two and a smaller physician-owned company.

With the one of the big two, days worked we were expected to take two patients, either HD or TPE. CRRT and PD didn't count in the two bc for obvious reasons. Third was at nurses' discretion. Anything after 12hrs was OT which if you took a third, would be 5-6hrs of OT.

Call days, we were on call starting either 1400 or 1500 depending on area covered til 0600, and off the day after scheduled call. Very rarely was absolutely necessary to be scheduled to work after call and if that happened, we were not expected to go back in til 1300-1400.

Smaller company, call was 0600-0600 and work maybe the next day but we only covered three hospitals that were not as busy.

I hear the above posts all too often and I think I just got lucky with the teams I've been on.

Sent from my iPhone using allnurses.com

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This was not the standard in two of the companies I have worked for...one being one of the big two and a smaller physician-owned company. With the one of the big two days worked we were expected to take two patients, either HD or TPE. CRRT and PD didn't count in the two bc for obvious reasons. Third was at nurses' discretion. Anything after 12hrs was OT which if you took a third, would be 5-6hrs of OT. Call days, we were on call starting either 1400 or 1500 depending on area covered til 0600, and off the day after scheduled call. Very rarely was absolutely necessary to be scheduled to work after call and if that happened, we were not expected to go back in til 1300-1400. Smaller company, call was 0600-0600 and work maybe the next day but we only covered three hospitals that were not as busy. I hear the above posts all too often and I think I just got lucky with the teams I've been on. Sent from my iPhone using allnurses.com[/quote']

My experience is very much like this. We also have the option of working a call day or only being on call that day.

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Specializes in Med/Surg, Tele, Dialysis, Hospice.

Interesting. I have days where I work 12 hours and am on call from the time I get off until 6 AM the next day AND am scheduled to work the next day. We generally notify our manager if we were out late and we aren't expected to be there early in the morning the next day if we were, but still...

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Interesting. I have days where I work 12 hours and am on call from the time I get off until 6 AM the next day AND am scheduled to work the next day. We generally notify our manager if we were out late and we aren't expected to be there early in the morning the next day if we were but still...[/quote']

That sounds terrible. Are you at least being paid very well??

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Specializes in Med/Surg, Tele, Dialysis, Hospice.

Not bad, about what I was making as a floor nurse in the hospital hourly, but no OT until after 40 hours.

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Hmmm I'm getting 3 dollars an hour more than typical floor nurses around here plus time and a half after 12 hours and if you do call on a day you work then that's time and a half too. Time for some negotiating if I were you!

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On call is awful. We work on our on call days, then on call from 6pm-6am. On call pay is awful...$35! Sometimes we are on call, then the next day scheduled to work. On call easily 2 days a week. I've seen people on call up to 3 days in one week.

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Specializes in Nephrology, Dialysis, Plasmapheresis.
Not bad about what I was making as a floor nurse in the hospital hourly, but no OT until after 40 hours.[/quote']

In Texas, I was on call 4-5 nights a week and I worked 4-6 12 hour days weekly. It was not my choice! Was a travel assignment. But you have to consider that the hospitals I was on call for, were small and not much activity. I was on call 4 nights a week in SC after working a full day. I would work a full day in Florida and keep going through the night if on call. In colorado, you work the days you are on call. You could easily have an 18-24 hour day. I have worked some 20 hour days, most of those in Texas. Are you likely to be working through the night or is it a rarity? If it is rare, then I don't think it's too bad of a deal. It is my experiences that working a full 12 and being on call that night is the norm! It sucks!!!

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Specializes in RN, BSN, CHDN.

My experience was very similar and i worked for a small independent company

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I'm interviewing for a job with Fresenius, and I'm pretty sure call is part of the job. How does that work? When I was a new floor nurse 10 years ago at a small country hospital, on call meant you made a whopping $2 an hour to stay home and hope the phone didn't ring. Yes, only $2. My last job, you didn't get paid a cent for being on call, but you could count on being called right around 7 AM, which means you should have just gone on in to work. They tried to save $$ by cancelling staff, then the ER filled up with admits, and it was a mad house with them trying to get half the hospital's nurses to come in.

I don't mind call, but I think you should get paid something, since you basically waste a day you could have been doing other things. And if you have kids, you have to have "standby" child care which is almost impossible. Luckily, I don't have kids, but just the logistics of "sitting on ready" are a bit of a pain.

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