Published Jul 31, 2012
How are after hour and weekend responsibilities structured in the hospice agency you work in?
I am an on call nurse, hense the hour I am writing this. I start Friday at 5p and go until Monday morn at 8a. I also have a case manager backup and either a social worker or chaplain on call also, along with on call hha's. the calls come into our triage service and if they cannot answer question or a visit is needed, they call me.
I used to do everything and only use my backup if I was with a pt and a visit was needed, but I found myself working way too many hours straight without a break, so now I will divide visits up on Saturday morning so I am available to do the admits and whatever else comes in. I try to get a break in the evening to ensure I am ok for the night. I will use the sw/chaplain to do hospice 101, and consents to free me up for visits also.
I have also worked for a large hospice and we had 4 full time on call nurses and we rotated getting calls or went to the patients closest to us.
The only thing I REFUSE to do is both triage and visits. There is no way you can take calls and make visits at the same time. You will not get any sleep, it is dangerous on the road, plus what family wants you to be answering calls while you are with them. I will quit before I ever do it again. It almost killed me.
jeannepaul what is the census of the hospice you work for? I just interviewed for a job that sounds a lot like what you are doing. I was told they would pay an hourly/salaried rate for the time and a per visit "bonus". The current census is 47. With that, can I expect to be pretty busy?
we have about 90 pts right now. A per visit bonus sounds nice. I don't get anything except my regular salary unless I work during the week helping out then it is 60.00 per visit. they also pay 100 for admits but that is not worth my time to do, it takes way too much time to do them start to finish properly.
New to the board so this is my first post. I am a full time on call nurse for a small non profit county hospice. Patient load 30 to 40. I am on call 98hrs a week (get paid for 40hrs/week salary - I have yet to work actual 40hrs;) - 24hrs on Sunday and 16 hrs a day Mon thru Thurs. Another nurse takes Fri and Sat with same back up. I have a social worker on call, case managers and nurse management share back up duties. I am responsible for triage and visits if necessary and after hour admits. The case managers I work with are awesome and try their best to take care of issues before call starts. I have learned to utilize the team, understand that you can't do it all and delegate accordingly. If the feces is getting ready to hit the fan make sure your back up is aware they may be needed.
I'm a case manager who does on-call infrequently to cover when no on-call staff is available. I get 5 dollars an hour to be on call. 45 dollars for a visit and 145 dollars to do an admission.
enchantmentdis, BSN, RN
We are a huge hospice, over 400 patients, so we have a dedicted on-call and pool staff who handle the "call" full time.
Counting my BLESSINGS I am the every other week call nurse. 5p to 8a M-F and 24 sat and sun. Get paid for 80 if I go out once or a thousand times. I get OT if I do anything my week off. Census of 40 at present with some really good case managers. Only out once this week with 2 phone calls for tuck ins.
I realize this is an older post, but is there anyone who works without any backup at all? This is my current situation and I am very concerned.
LookUp2Sky, ASN, RN
Hi HillieRN - I totally understand your concern! I was the first, full-time, on call nurse hired with a not-for-profit agency, with a census in the 50's. No rules, no boundaries, no back up, etc. After over 1 1/2 yrs, I am still there desperately, diplomatically trying to make them aware of the "potential" harm in not providing a back-up. Mostly, it will be the patients who might suffer. We serve a huge geographic territory, with one-hour minimum between some patients. In hospice, family members are not happy with that type of response time, and no matter how diplomatically you try to explain that you will be there as fast as possible (because of no back up)...they perceive it that someone else is more important than their loved one:(.
I work 7 on and 7 "off." It is straight salary for 5pm Friday straight through until Monday morning, at 8am...back on Monday night at 5pm until 8am Tuesday, etc., until Friday morning, then supposedly "off 7." However, they want me at team, weekly, mandatory inservices, etc on my "off" time, with no additional pay. It consists of 123 hours of on-call, 63 straight hours for weekend. So, even though paid for 80, I am available (or reserved) for 43 hours over the 80 hours I get paid for.
I am not a quitter, and continue to diligently/gently take suggestions to them, which have to go through corporate, but am not sure any adjustments will be made:( I do admissions, deaths, triage, lab work, respite visits and on-call visits...all for one small salary. I guess I'm thankful to have a job, but most thankful to have "riches of heart" in working with hospice patients.
Long story/response later-lol. Yes, it's quality of care/patients that suffer when there is no back-up. Feasibly, it is not possible for one person to do the work after hours, that it takes a whole team to do during the day/week. "There is no "I" in team."
I have been doing the 7 on 7 off for the past year. Prior to that I was a full time case manager for 6 years. The on call "team" is me and the nurse who does the other 7 days, and although I know I can always call the case managers (at a reasonable time, of course) for questions, there is no back up for me if I need to be in 2 places at the same time, but over the past year that has not yet happened. I also don't have Triage, the office phone goes to a service who calls me. We have an average census of 40-50, 3 full time case managers and 1 part time case manager. They are AWESOME...for the most part, I don't get the calls about needing meds, symptoms that have been occurring over a long period of time that have not been addressed, etc. Some weekends are full of 2-4 admissions, scheduled visits for wound care, follow up visits from admissions done Fri or Sat and urgent visits due to calls I have received. And since our office covers a very busy tourist/seashore area, the traffic figures into almost any weekend visit.
During the week, (5p-8:30a) I do admissions, visits and emergency visits. But the office has learned that NO ONE wants me there at 9pm to do a 2 hour admission visit, or to call at 8p to say "your nurse asked me to make a routine visit", so I am usually kept at 1 visit or at the most 2, if one is in a facility OR 1 admission. Night-time, wake me up, calls are usually truly emergencies and when that danged cell phone rings at 3am, I am reaching for my scrubs at the same time as I am reaching for my phone...I just know I am going to have to go out. But those calls are few and far between.
I just had the best weekend...1 emergency call on Saturday that needed a visit (pt. fell), one evaluation that was not eligible and one admission. No other phone calls...I actually called the office number to be sure the service picked up as I didn't have one call from them from 1pm Saturday through Monday morning when my call ended. I pray for these kinds of weekends, as I do Mon evening to Monday morning, and by Saturday night I am usually bushed and ready for those precious 7 days off!
How safe is it for me to have no scheduled back up? So far, so good. If I was slammed, I would call my administrator and let him make the decision about who to call or what to do. And even if I needed help and none was available, it all boils down to seeing the most emergent patient first and keeping in frequent phone contact with the other(s). I have found over the past 7 years that if you are honest with people about the urgency of another situation, they usually understand as they know if their loved one was the one with the crushing chest pain, I would be going to see them before going to disimpact the other patient!
SuesquatchRN, BSN, RN
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