On-Call HELL..

[ap_NRN]

Apologies for the long post, but I am very frustrated and would like to hear from my home health and hospice peeps on this one.

I currently work for the second largest home health and hospice agency in my area and have been there about a year. I was originally hired to do on call 3-day weekends for hospice, as outlined in my job description. Since then multiple changes have occurred in the workplace, from structure to job description, to expectations, and nearly every nurse has quit in both agencies.

The turnover is extremely high throughout the year and this agency hires a lot of travelers. Long story short, my experience at this company has been rocky from the start, including inexperienced supervisors (we have been through three since last year), promising that my license points for speeding in the last 3 years would not affect my ability to apply for the job (they decided to give me a write up my first week, stating they had forgotten about the point policy when they hired me and this would appease management so I could keep my job), very poor training and orientation of case managers, and lack of support on the job. This resulting in poor coordination during the week and 18+ hour days on weekends for me (like ordering multiple meds and delivering to homes, visits for needs/supplies that were not addressed by case manager during the week).

Fast forward to 6 months, and I was informed a weekend back up nurse would no longer be available. We have had a steady but busy census around 30-40. When I brought up the possibility of staying up all weekend due to workload/lack of backup and driving tired/dangerously, I was told this was unlikely to happen and things would be fine. Wouldn't you know, this very scenario began to occur at regular intervals about one weekend every month.

At the 8 month mark of employment, I was informed the on call nurse for HH had quit and I would be taking over call, admits, and visits on weekends for home health in ADDITION to hospice. Home health census is larger, around 300. I was told I would have a backup nurse for HH if things got chaotic. I was told this was a temporary situation as they were interviewing applicants. This was four months ago.

This entire year has been awful but the last 4 months have been a special kind of hell. I am salaried for 40 hours (both work and on-call time included) and now regularly work (boots on the ground, excluding call time) 40-50 hours every weekend for both agencies, with no backup for hospice (which can be much busier). It's a 50/50 shot that the backup nurse for HH will answer the phone, so no backup there either. This basically means I am not getting paid for being on call. I could work during the week for 40 hours in the hospital, not be on call, and make the same amount of money. At this time a typical weekend is around 40 patient calls, 5-7 visits/day, 2-3 admits per weekend, and no sleep from friday night to sunday early morning.

Recently I had a weekend with a death and an admit (requiring extensive assistance for discharge from inpatient to home) that were occurring at the same time, resulting in poor care and pissing off both families. I had also been up for 30 hours straight without sleep. Attempts to contact my supervisors for assistance went unanswered (this is typical).

I am at the end of my rope here. I planned to use this job as an entry into hospital case management in the future. I feel like my position is being abused, but have nothing to compare my experience to. Does anyone here consider this experience on par with this specialty? Is this normal? Or do I need to just tough it out?

I'm considering a position in hospital CM or utilization review, but I'm not sure if I have the experience (3 years LPN, 2.5 years med-surg RN). A friend of mine was hired into hospital CM with 1 year experience, but I think she just knows the right people.

Any comments/advice from hospice and home health nurses greatly appreciated.

[Libby1987]

The theories of the path of least resistance and you teach people how to treat you come to mind.

I can't speak to how common, you work for a giant corp and their volume alone can skew the percentages but you already know that it's entirely unreasonable. Unfortunately it's been allowed to happen for an extended period of time and that makes it much more difficult to change.

You now have enough experience now to find a different company and what to clarify from the beginning. You may also have enough to exposure to home health to be considered for hospital case management.

[oceanblue52]

Props to you for juggling that...I would have been out of that environment months ago. You are salaried and working full time during the week AND on weekends? Being on call during weekends for home health duties is hard enough without throwing hospice in, and it sounds like you are not getting extra pay? No time and a half? If you feel as though you must, stick it out another 4 months to get the year experience...but if I were you I'd start looking around for another job. Sounds like a decent amount of experience to try something new and as Libby1987 pointed out, knowledge of home health regulations is a very marketable skill.

[ap_NRN]

Thanks all. Appreciate the feedback:)