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."