Overwork in Acute Dialysis Travel

[Fomite, RN]

Acute dialysis travelers, how much overtime and call do you typically take on assignments? Does your contract say anything specifically about overtime and call to protect yourself from overwork?

I'm on one of my first acutes assignments, and I'm really getting killed. My contract is very general, stating "40 hours per week and compensation for low census call off". I arrive to find such a crazy unit. There had been 5 full time nurses, but all 5 resigned at the same time due to staff conflict, stress, and general overworking. The new unit is left to be staffed entirely of travelers and new dialysis nurses. Only problem is most of the acute travel nurses have about 6 months of dialysis experience, still having trouble with basic stuff like machine alarms and testing water. Manager deems the travelers unsafe to be taking call or be left by themselves, leaving myself and 1 other traveler to pick up all the slack. We're doing at least 75 hours per week and the manager makes it seem like there's no choice about it..

We're constantly precepting new dialysis nurses and acting as charge nurse without extra pay, taking 5-6 nights of call & backup call per week, and been put in charge of things like ordering and managing supplies since there's no one else left to do it. But 13 weeks is almost done, so how do I keep this from happening on the next assignment? Write a contract stating "takes 1 night of call per week and works maximum 45 hours per week"? Is it too late to set any limits for call and overtime on an assignment if the only limitations were for low census?

[NurseRies, BSN, RN]

That sounds so exhausting and you sound very unappreciated and undercompensated for your efforts! My first travel assignment in San Antonio was a wake up call for me. I was scheduled 5-6 days a week and was on call 4-5 of those nights. Although I didn't get called out a bunch because most of our facilities were long term acute care hospitals, I still received unnecessary phone calls in the middle of the night from floor nurses. We had no charge or no coordinator, so the hospitals had my cell number. They would call me in the middle of the night to tell me about a new admission and ask if I could "look up" which clinic they're from. Meanwhile I can barely open my eyes from a long 18 hour work day.

Since I was on call almost every day I worked, if treatments popped up, I couldn't say no. I would work 20 hours and be expected to be back at 6am to do it all over. It was sooooooo crazy! Needless to say, I think we both learned our lessons on that one.

Here are my tips:

-negotiate an overtime and call back rate that is not just time and a half of base rate. Think about this : hospitals are paying $60/hr for you, your base rate may be $25, plus all the incentives and housing, etc. So when you are working those 35 of overtime and call back, you may only be getting $40/hr, but the hospital is paying your agency $90/hr. What this comes down to is that your agency is making $50/hr pure profit off you for every hour worked. They have already covered your benefit costs through your regular 40 hours. I simply told my agency that I demand to be paid $55/hr for any overtime or call back pay or I will refuse all offers.

-It was in my contract that any hours worked over 40 hours per week were voluntary and not mandatory. You must get this in your contract.

-You can for sure ask to be on call only 1 day per week or ever not at all.

-To make it easy- these agencies NEED YOU and so do the hospitals. Do not agree to their terms, make them agree to YOUR terms. Do what is reasonable for you. There are assignments out there that are much more reasonable that will not allow you to work overtime because they are smarter and realize that it is costing them $90/hr, whether you see it or not, they're still paying for it.

If your agency tells you it can't be done or it's not allowed, find a new agency. I suggest Quik Travel Staffing for negotiating flexibility. Smaller company, less stringent rules. Also if your potential next assignment refuses to agree to your terms, that's probably not an assignment you want anyways. Be assertive and tell them exactly what you want, when you want to work, etc. You may be surprised that they will do whatever it takes to keep you on board.

Good luck with your next job!!!