On-call staffing solutions for a growing hospice

[nyx1121]

I work for a hospital based NFP hospice with an average community census of 150 and an inpatient census of approx 8 to 16. Our case managers carry a caseload of 12-18 patients and are responsible for their own admissions. We have a huge coverage area approximately 200 miles. Recently we hired 2 on-call nurses to cover evenings with CM back-up M-Sun, 7days on, 7 days off with 16 hour shifts.One of those nurses just quit. We also have 1 nurse who covers daytime weekend call with 1 CM backup days with the afterhours nurse working alone 8p-8a. I have 12 case managers on staff, with 3 PRN RNs who work on average 3 to 4 days per week.

Our on-call is brutal. After hour calls range between 10-15 calls per night, with approx 7 visits and atleast one after hours admission.

The alternate week that we do not have a designated after hours nurse we are forced to pull from our case management team. They are currently seeing as many as 6 to 8 visits per day. They are overwhelmed, exhausted and very frustrated. Understandably so!

I am looking for a feasible solution to easing stress and improving morale. We plan to meet with the nurses next week to discuss their ideas on how to best relieve the additional call that they will be responsible for with the loss of our after hours nurse.

I am curious what other hospices are doing and how they retaining staff and reducing burnout. We have a phenomenal staff who work tirelessly.

I am frustrated for our nurses, social workers, aids, and chaplains as they all carry enormous loads and do a remarkable job.

I will be very open to hear what has worked for folks out there or what has failed.

Thank you:)

[curiousauntie]

As a case manager who has had 2 on-call (7 on, 7 off) nurses for the past 2 years (one nurse each week) and for the 3 years before that only one nurse on call (same 7 on, 7 off) so I had to do 2 or 3 over night on calls and 1 weekend (24 hours) day every other week, I have one thing to say...PLEASE HIRE ANOTHER ON-CALL NURSE ASAP. I love hospice and love where I work, and even though I liked the overtime money, I got so burnt out so fast with the extra time that I almost quit and left hospice. And our census is no where near where yours is, probably an average census of 50-60 for my office.

To expect your dedicated nurses (who you seem to respect and like) to work 8 plus hours a day doing their "job" of case management and then give you another 16 hours of constant phone calls and visits, then expect them to continue to preform their case management duties for the rest of the week is unreasonable at best. With such a large census and coverage area, you probably should look at having 2 nurses on call every night. Because with the description you gave, (number of calls and coverage area) that is just too much for one nurse to handle effectively. Once those case managers are "done" seeing patients, I am sure they have mounds of paper work to do. And if they are like me and my co-workers, we take the work home to finish so we can be ready for team meeting, hand in time sheets and notes on time. Which means we are short-changing our families and ourselves...remember, your case managers are doing an emotionally exhausting job all day long and NEED their time off to be TIME OFF. Not time dreading the phone call that is sure to come.

And just a thought from someone who was "Management" in my previous nursing jobs (and will NEVER be again) Please ask the on-call who is leaving to be very frank with you as to why she is leaving...not family problems, not I don't like nights, not I got this great opprotunity...I have a feeling you will find that the amount of calls and the amount of travel involved (how do you drive 50 miles in one direction for an admission then get a call and have to drive 100 miles back the other way for a death and after a while not have that negatively effect your stress levels?) may be a very large part of her decision. Especially as you said you had "recently hired" the 2 on call nurses.

(If any of this came across as hard or judgmental, I am sorry. I now have a great case management job with great bosses who would never expect us to take call unless the on call was suddenly sick, in fact our Director took call one day this weekend as she did not want to ask us to do it. This has not always been the way at this company, as my old bosses would have told us to suck it up and do it...with no sign of respect or acknowledgment that we might be overworked or tired and maybe need the next day off in place of running all over and answering the phone all night long.)

Oh, and please don't wait til next week to let the nurses know you are trying to solve the on call problem. They are probably already trying to figure out how they will do their job AND on call. A word from you that you are actively trying to find a solution and the meeting is just one step you are taking will help. And don't expect the nurses to have the answer. They are expecting you to have some answers by next week. A few good ideas from you and they may be able to brainstorm a great answer!

[pnhopeful]

We have a census of approx 225 with a designated triage nurse, 2 RNs on call for weeknights M-Th and 3 RNs on call for weekends Fri 5 pm -Mon 8 am. We also have a designated admissions nurse also. Case Managers rotate call for holidays that fall on weekdays. If call is brutal, sounds like you need more help!