On Call Nurses - advice needed

Specialties Hospice


I accepted a weekend on call position a few months ago.

 The position was to be Sat/Sun only and the offer letter stated "weekend on call" but no specific hours. I confirmed with HR and the Administrator it was Sat/Sun only (48 hrs total).

My first day I was told by the Administrator the position hours were "adjusted by corporate leadership" and weekend only was to be Fri 5pm-Mon 8 a.m. so if I wanted to work only weekends that would be the schedule. I was surprised but agreed. There is no triage and no back up on the weekends other than the Administrator for questions. Mileage was to be from my home to patients houses and back since it's on call, that also has changed and mileage is now as though I am a case manager - no mileage to first patients house but mileage kicks in if the patient lives more than 15 miles (which they all do).

I still do not have a nursing bag or badge and have to call the Administrator if I need to make a visit to schedule it in HCHB as IT has yet to set up my access correctly (and yes, I've made multiple attempts to get it corrected and continue to be told "they are working on it")

Today I was asked to "tack on" another night "or two" of call during the week though it would be paid at a lesser rate since the weekend position is salaried. Though it was presented as a request I get the feeling it will soon be required. There are 2 FT Case Managers, the Administrator, who is an RN and a FT Clinical Manager (also an RN) and a FT LPN. The census is 14. The CM do not do Admissions unless the Clinical Manager or Administrator is busy as the company prefers for the Admin or Clinical Manager to do the visits. Since I started a few months ago there have been 3 admissions so Admissions are not an everyday/every week occurrence. 

 I understand CM work M-F and have IDG every 2 weeks but IDG is via phone and the CM they are literally working less than 5 hours a the days they do work and are not seeing patients at all several days a week. When I am on call I am triage and going out for visits the entire weekend (5p Fri to 8a Mon). Call volume is higher on weekends for various reasons.

I feel taking on an additional 2 nights of call a week and at a lower rate is asking too much. I don't mind picking up extra call time to time to help out but I feel with the census as low as it is, the CM not working a true 40 hr week asking me to pick up 1-2 additional nights and at a lesser rate, is taking advantage - am I wrong?


Not a question of right or wrong. They're asking you to expand your hours. Do the math and see if it's fair and/or meets your needs for your situation or is at least tolerable.  Tell them what you'll agree to and respond to the answer with yes, no or a counter offer. Don't let it get personal. They have a need, you provide a service. 

2 Votes
Specializes in Hospice.

Agree with above poster.

Also recommend (if you haven't done so already) to get your scheduled hours and compensation in writing. 

Not sure what your caseload/ visit load is or your geographic area is.

I work a 48 hour weekend position (Saturday 0800-Monday 0800). Flat rate paid for these hours regardless of visits. Includes admissions. 1.0 FTE/ Full time position. As it is an "on call" position, I get paid mileage for all miles driven related to work. If I pick-up extra call or visits outside of my scheduled weekend shift, that is additional compensation. Visits during the week are no mileage paid to the first visit unless over a certain number of miles and no mileage home from the last visit unless over a certain number of miles. On call during the week is the all mileage covered. 

Most of the time, I enjoy my position as an on call hospice nurse. I did case management for several years and honestly this is a great fit for my skill set (EMS background). I also love having most of the week off. I never schedule anything on Monday before the evening. Lately, I've picked up one day a week to help with admissions, but this is something I chose to do. 

1 Votes

I went back and asked for an updated compenstation and schedule in writing as well as mileage clarification, the nursing bag, badge and car stock that I should have in addition to the forms for revocations/deaths/admissions as suggested.

I have not recieved anything in writing per se, I did received, finally last night after 3 weeks, an email from HR stating that any call in addition to the weekend schedule of 5pm Fri to 8 am Mon (what I was hired for) is paid at a "beeper" rate of $10/hr. If a visit is made them I am compenstated the per visit rate for the visit - mileage included after the first 15 miles. Mileage back is not compenstated unless I go from the patients house to the office but I can request mileage adjustment and depending on the distance some of the mileage may be compenstated.

The forms I requested were emailed to me for me to print and copy. The nursing bags are on back order, the car stock is based on patient needs so I was referred back to the local office. The badge order was lost so that is to be redone.

I don't want to risk identifying a patient but this agency seems to struggle a LOT with communication, supplies, scheduling and more. In the past few months I've been there more patients have declined, transferred or revoked services than have been admitted. 2 RN's, an aide, a marketer and the Exec Director have all been hired and then left. That alone should've been a red flag for me as they all have extensive hospice experience. It's been disheartening but also a lesson for sure.

$10 for on-call beeper pay is excellent in my experience!  I've been offered $2 -$5, and it felt like a slap in the face.  As for the Friday night bait-and-switch, not sure what to think, but I hope you negotiated for higher salary when that happened.  It is important in hospice, though, not to burn any bridges, as we are a tight community.  If you do apply with other companies, make sure to have your resume proof-read and professionally excellent, as re-applying with the same company that might not hire you during an interview will have openings again, and will look back at your previous resumes for congruence if you choose to re-apply.  (Sorry for the sentence structure)

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