On Call Schedule.....that is workable

volsfan · Sep 18, 2010

Our company has 2 FT and 1 PT on call staff who work primary call. The RN Case Managers rotate backup call; and will take primary call if the on call staff are sick or on vacation.

Mon-Fri: 1 primary (depends on day of who it is) with a backup RN Case Mgr

Sat/Sun: 1 primary on call works (8 am - 8 pm); the other works the (8 pm - 8 am); the part time on call staff member works 12 noon-8 pm and then the RN Case Manager is backup.

About 6 months ago we moved to having the RN Case Mgr doing 1 whole week call at a time, giving us call every 8 weeks. As a case manager I didn't like this at first, but now enjoy knowing I am on call only 6 weeks out of the year. However, there will be times that the Case Manager will be out many nights during a given week; so if this happens I would make sure they get enough sleep and check to see if they need help with their case load. This is usually rare, but it does happen.

I know not all hospices can have the staff we do. I came from a smaller one and we were on call every other weekend working 24 hour shifts. Our average LOS was low, like 25 days and every weekend we averaged 2-3 inpatients who would die. So, basically we busted our tails. It just didn't work; case mgrs got sick and burnt out. Our staff turnover rate was extremely high there. And I guarantee pt care suffered due to the staff being tired all the time.

If you don't have designated on call staff I recommend sitting down with your case managers and collaborating on a schedule. If they are part of the process they will accept the decisions better and may make your job easier by coming up with something all on their own.

ErinS, BSN, RN · Sep 18, 2010

We have a census of around 50.

We have 3 full time case managers that work M-F 8a-5p.

1 on-call admit nurse M-F 11a-6p

There are 2 full time on-call nurses. 1 works M-Th 5p-8a and Sat 8a-5p.

The other works Fri 5p through Mon 8a.

We also have 1 part time on call nurse- we are unsure where she will fit in, but she works 7on and 7off.

Case managers take turns working the on-cal Sun 8a-5p.

This system has worked well for us for several years and provides some level of continuity.

Leda1st · Sep 19, 2010

We don't have designated on-call staff, and in my opinion, it is a disaster. Our caseloads are already too high, and all of us work at least 50+ hours per week already (salary). We desperately need to hire on call staff, but management has to be convinced.

I would be interested to know, when people give answers regarding what works, if they could/would include the following info:

(1) What is the pay for "holding the phone" (for primary AND for backup)

(2) What is the on-call pay? Is it per visit, per hour, and what is the dollar amount? Thanks!

volsfan · Sep 20, 2010

Our company has 2 FT and 1 PT on call staff who work primary call. The RN Case Managers rotate backup call; and will take primary call if the on call staff are sick or on vacation.
Mon-Fri: 1 primary (depends on day of who it is) with a backup RN Case Mgr
Sat/Sun: 1 primary on call works (8 am - 8 pm); the other works the (8 pm - 8 am); the part time on call staff member works 12 noon-8 pm and then the RN Case Manager is backup.
About 6 months ago we moved to having the RN Case Mgr doing 1 whole week call at a time, giving us call every 8 weeks. As a case manager I didn't like this at first, but now enjoy knowing I am on call only 6 weeks out of the year. However, there will be times that the Case Manager will be out many nights during a given week; so if this happens I would make sure they get enough sleep and check to see if they need help with their case load. This is usually rare, but it does happen.
I know not all hospices can have the staff we do. I came from a smaller one and we were on call every other weekend working 24 hour shifts. Our average LOS was low, like 25 days and every weekend we averaged 2-3 inpatients who would die. So, basically we busted our tails. It just didn't work; case mgrs got sick and burnt out. Our staff turnover rate was extremely high there. And I guarantee pt care suffered due to the staff being tired all the time.
If you don't have designated on call staff I recommend sitting down with your case managers and collaborating on a schedule. If they are part of the process they will accept the decisions better and may make your job easier by coming up with something all on their own.

All our staff is salary; including on call staff. The starting salary is $24.00/hr. Our case loads are b/t 12-15, but can get as high as 17-18.

When the RN Case Manager is on call (backup/primary) they get paid a minimal daily rate, it's under $10.00, nothing to get excited about. If we have to go out to make a visit then we get anywhere from $25.00-$150 depending on the time; usually the visit is $25,00 to $50.00, rarely more. However, the time does not include travel; which can be a problem. It is really not worth it to be on call IMO, but like I said we only do it for 6 weeks out of the year; which is much better than the place I came from and doable. Every hospice RN Case Manager in our area has to work call; no matter who they work for. Nobody likes being on call, but it is a fact of life.

Leda1st, since you guys are salary and don't have on call staff it's really not fair. When I worked so much on call at my last place we were hourly so at least we were compensated well.

AtlantaRN, RN · Oct 23, 2010

Day shift m-f 8a-5p are hourly. On call is salaried. I do weekend on call 5pfriday to 8a monday. One of the day shift nurses is backup call for me 8a-5p sat and sunday-they get $2/h to be backup, plus time and 1/2 for doing visits or pronouncing if i'm slammed. If i've had a crazy night, i'll text backup and let them know i have to have a couple of hrs to close my eyes, they are great to help me in a pinch (even if i don't get to really sleep well, if i can just have 4 hrs to lie down i'm good with another starbucks). the day shift nurses take one night a week monday through thursday to do 5p-8a call-they have hired a nurse to do this, but she hasn't started yet....she will be a welcomed addition because the day shift nurses are stretched to the max and 4 out of the 5 nurses have small elementary school children, so it's hard on them.

Hospice Nurse LPN, BSN, RN · Oct 23, 2010

I work for a very small company (avg. census 20-25) and I take call every other week for one week (mon-sun). DON is backup. On an average week I'll get 2 or 3 calls....no visit just questions...then the next time I'm on call I'll get slammed and have an extra visit or a death every night. I work only Wednesday and Saturday during the day (full-time student) and the other nurse I share call with works in the office 3 days/week. The pay isn't anything to write home about, but for the amount of calls it's o.k. ($3/hour). We get $25 for visits, $50 for a death, plus travel time at our weekday hourly rate, plus mileage to the pt and back home.

patsysparksrnchpn · Nov 15, 2010

I have worked as on call nurse for three hospices with a variety of schedules. Right now I work for VistaCare Hospice and my director let me choose the schedule I wanted so I opted for 7 on and 7 off. I work Monday through Sunday and I love having 7 days off as does my counterpart. When one of us has to be off, the case managers pitch in and each take call for a night or on the weekend for a part of the day. They are allowed to discuss and set the schedule that works for them.

river19 · Nov 23, 2010

Where I used to work we started having ATC staff on regular salary instead of the case managers doing it.

So far I hear it has worked fabulously. You could easily work all night as well as work all day if it was your day to be on call before the change. That is a larger not for profit with a census in the 110s.

Our little hospice here in the wilds of Oregon, we take turns one week on-call three off. Our census is about 6-8 usually.

This works ok for here.