Salary or Hourly On-Call Overnights

[SunDazed, BSN, RN]

Have been wanting to make a big change and so applied for the overnight on-call 7 on/7 off spot that was open at the hospice. They came with an offer of $42/hour being paid 8 hours of any overnight shift (5p-9a). I get why one is not paid for every hour, but have also seen in want ads that many of these positions are actually salary. This offer comes in around $61K a year.

Since it is hourly, I was curious if the hours over 40 hours in a Sun-Sat week would be overtime. That would bump the annual up into the upper $60K's for the year. I was told they are not. I know hospice pays less than the hospital, but I would be dropping by more than half my hospital annual. I just want to make sure it is feasible financially. I don't want to be stressed about money. I can do with less, but not that much less. 

The hospice offered that I could work extra on the on the day shifts on the week off. So what is the point of that? Seems like they don't promote a good work-life balance for staff. 

Curious what others make and whether it is hourly or salary. There is an after hours triage vendor used, so I would not have to take every call. Still, I was expecting closer to $75K for the 7 on 7 off in expensive northern California.

[PollywogNP, ADN, BSN, MSN, LPN, NP]

5PM to 9AM is 16 hours, that you must be available but you would only get paid for 8 hours? Is that even legal? Are you going to have to do admissions after 5 pm or just if pt calls? Do you earn sick leave or PTO?

[SunDazed, BSN, RN]

1 hour ago, PollywogNP said:

5PM to 9AM is 16 hours, that you must be available but you would only get paid for 8 hours? Is that even legal? Are you going to have to do admissions after 5 pm or just if pt calls? Do you earn sick leave or PTO?

Yes, it is 16 hours. Yes, the earnings are based on 8 hours of work. I suspect that is why it is a salary position, versus an hourly in some places. I have been told there are occasional visits that did not get done during the day, but it is discouraged for case managers to rely on this. 

There is ETO, combined PTO and sick leave. Probably based on the 8 hour idea. There is a simple 401k and insurance benefit. I am not close enough to retirement yet to not continue to contribute to that. 

If they won't budge on the compensation, I may just have to see if they have any other positions that end up paying a bit better over the annum but require day shifts. 

[vampiregirl, BSN, RN]

If I were considering a position like this I wound want to know how many hours are typical to be working (including visits, documentation, driving, phone calls etc). Census and geographic area coverage can have a pretty significant impact on the "typical" time spent working. Also, how are meetings, inservice etc paid for this position?

[SunDazed, BSN, RN]

13 hours ago, vampiregirl said:

If I were considering a position like this I wound want to know how many hours are typical to be working (including visits, documentation, driving, phone calls etc). Census and geographic area coverage can have a pretty significant impact on the "typical" time spent working. Also, how are meetings, inservice etc paid for this position?

Meetings, inservice, etc. are paid hourly.  The nightly rate is based on a percentage of the hourly rate. 

I was able to convince them that working on my weeks off was the equivalent of me working a part time job on top of a full time job. They upped the offer quite a bit. It is now on par with wages ranges for this job in other areas with similar cost of living, etc. (at least from what I could find.)

Wish me cluck. 

[vampiregirl, BSN, RN]

Good Luck SunDazed!

Hospice is an amazing area of nursing. 

I actually enjoy the challenge of on call, there's a lot of diversity in the visits and a lot of critical thinking/ problem solving and education involved.

Not sure if it's everywhere but lately our area has seen an increase of patients shuffled to hospice with active drug use/ legal issues that have influenced them not being eligible for more aggressive treatment. We've really had to assess safety plans of care in several instances. On call staff can be out of the loop since they may not attend IDG, I would encourage you to find out how safety concerns/ specific interventions are identified in your plans of care. If there are visits that require 2 staff at all times, figuring out who can be your 2nd person ahead of time if needed. Changes in condition of these patients can either require increased safety interventions (add in grief) or in some cases decreased interventions with careful monitoring (reliable family caring for patient at end of life, visitors restricted by family). 

I always cherish the visits that start with a huge change in condition and end with a comfortable patient and a family that feels comfortable with the plan of care. Even as I initially grumble under my breath at long drives in the dead of night after leaving my warm bed, I usually find myself reminded why I chose hospice nursing and how special this area of care is.

I also love the cases where it seems like there is no possibility for a good outcome due to family dysfunction/ circumstances and somehow things fall together to meet the patient's needs (even if it's not exactly what we think meeting those needs should look like).

 

[SunDazed, BSN, RN]

15 hours ago, vampiregirl said:

Good Luck SunDazed!

Hospice is an amazing area of nursing. 

I actually enjoy the challenge of on call, there's a lot of diversity in the visits and a lot of critical thinking/ problem solving and education involved.

Not sure if it's everywhere but lately our area has seen an increase of patients shuffled to hospice with active drug use/ legal issues that have influenced them not being eligible for more aggressive treatment. We've really had to assess safety plans of care in several instances. On call staff can be out of the loop since they may not attend IDG, I would encourage you to find out how safety concerns/ specific interventions are identified in your plans of care. If there are visits that require 2 staff at all times, figuring out who can be your 2nd person ahead of time if needed. Changes in condition of these patients can either require increased safety interventions (add in grief) or in some cases decreased interventions with careful monitoring (reliable family caring for patient at end of life, visitors restricted by family). 

I always cherish the visits that start with a huge change in condition and end with a comfortable patient and a family that feels comfortable with the plan of care. Even as I initially grumble under my breath at long drives in the dead of night after leaving my warm bed, I usually find myself reminded why I chose hospice nursing and how special this area of care is.

I also love the cases where it seems like there is no possibility for a good outcome due to family dysfunction/ circumstances and somehow things fall together to meet the patient's needs (even if it's not exactly what we think meeting those needs should look like).

 

I have been a visit nurse for hospice in the past. I was often sent on those symptom crisis visits and I also enjoy the challenges and rewards. 

Thanks for the heads up on the substance issues you see trending. In general, substance use and abuse is a problem here. Lots of heart failure related to methamphetamine use in the hospital here, so I guess it follows that those folks need care at end of life too. I will follow up with the safety plans for sure.