Weekend Hospice Nurse

Hospice Nurse LPN, BSN, RN · Apr 27, 2010

I work for a small agency (average census 20 pts.). I take call every other week--including w/e--plus my scheduled visits and it is rare that I get called at all. I may make 3 OC visits a month. Once I did have two actively dying pts approx 75 miles apart. I called my DON for back up. I'd ask your DON because an overly tired nurse isn't good to anyone (plus it's dangerous to be driving with so little sleep!!)

tewdles, RN · Apr 27, 2010

I currently work as a hospice nurse. A portion of my schedule is during the week and then I work on-call every other weekend from 5pm Friday until 8am Monday. My question is : For those of you who work a weekend call schedule...how many hours are you expected to work and travel from pt to pt? Is there a limit set by your company that requires you to stop and sleep and call someone else?
Recently I left my home at 2pm on Friday and returned home by midnight. On Saturday morning recieved a call at 4;30 am and didn't get back home for 24hrs and then called out 3 hours later. The area that I work in is pretty wide open spaces, and it may be nearly 100miles to get to a pt. Just need your feed back!!
When you need help, who do you call, and do you quickly have someone available to assist (IE: 2-3 pts actively dying at the same time)?

I may be wrong, but I think there are labor laws which prohibit employers from requiring staff to work more than 16 hours continuously.

Regardless, it is not safe to drive a vehicle with that level of sleep deprivation...this has been documented by studies done on the driving behaviors and incidence of accidents etc. of truck drivers and similar occupations. Your agency should be responsive to a request for relief in situations such as you have described...call them, take care of yourself! Further, it could be argued that your ability to think clearly and meet the needs of your patients will be impaired by that lack of rest...this is why they have changed the work/call requirements of medical interns and residents.

Please advocate for yourself so that you can be a happy and healthy long term hospice professional.

AtlantaRN, RN · May 2, 2010

I am a weekend on call RN. I'm on friday 5p-monday 8am. Some weekends are awful, and some are great. I have one RN as backup and then my clinical manager. If i have 2-3 patients going at the same time, the other two nurses back me up 24/7. When I'm having a steady weekend (where things happen one at a time) I am alright for about 16 hours, then I'll call my backup and tell her I need a couple hours of down time....(granted, if I see the night is going this way, I'll text message her several hours prior so she can get some sleep before I officially say "i can't do this another minute.") I have found alot of families are not wanting the patient to die at home, so when they are imminent, i'll transfer them to our inpatient unit--that takes some of the pressure off of me to be at bedside when a patient passes. It does seem that when my weekends are super busy, it's usually for simple remedies--like mama is getting choked on water---so I bring some thickener.....

you should always have some form of backup. Even when we had a position monday through thursday 5p-8a, even that nurse had a backup nurse and the clinical manager... we can't do this alone, especially when my location has 60 patients from 40 miles south of atlanta to the middle of atlanta....some weekends there just isn't enough of us to go around!

linda

AtlantaRN, RN · May 2, 2010

The area that I work in is pretty wide open spaces, and it may be nearly 100miles to get to a pt.

Bless you!!! How do you manage such a large area? With my job, we have to be within 60 minutes of our patients, that is just not possible for such a large coverage area

linda

dkellyrn · May 8, 2010

A bit of a dicey problem that is more complicated because of the reimbursement issues involved in hospice. To keep the lights on, make payroll, provide DME, provide pharmaceuticals and supplies and (for the for profit hospices) paying the investors enough to make them agree to keep the doors open one more month, administrators are faced with a challenging balancing act.

One can work to "build a better mousetrap" or after-hours challenges only so much at a certain census that stretches everyone until large enough to get another FTE - then decide, use them as a case manager or on-call? Both? Share the love?

There are many models out there - some outsource incoming calls - a questionable practice. Some large organizations in some states have chosen not to attend deaths... that raises the question "Why Hospice"?

We all know the problems but there has yet to be a viable answer for the small "for profits" trying to do a good job. It is no wonder Hospice staff (all disciplines) show signs of PTSD!! Work-life balance is a challenge for even the most engaged staff.

Hospice, the best health care dollar in America, needs to find some of our solutions from our legislators!

In the meantime, you are killing yourself! Please be careful!

Hospicetex · May 8, 2010

This is a tough situation. On call we cover three areas. We have 100+ patients and there is always the lead RN and then back up LVN or RN. My PCC"s are available via phone/text at all times although one will jump in when it is bad and make visits and the other will not.

One weekend recently my day started at 1230 am, with it ending at 1030 each night including Friday night. By Monday I was teary, exhausted and ready to quit. I was averaging two hours of sleep, each visit was running a couple of hours with a good hour drive time each way...it just wasn't pretty.

What I discovered was, I need to roll phones at times so that I can sleep at least a few hours, call my PCC when I am at the point it is not safe for me to drive nor treat patients and my back up is out as much as I am. After all we are only human and we are not good to our patients if we are not functioning well ourselves.

I know some weekends there isn't enough of us to go around and we ask the rest of the staff to volunteer to finish admits or see pain follow ups so that the on call can be on call. It means less weekends off for us but I would rather help my coworker and friend with a admit or visit so that he or she is there for the patients that need a prn visit. But we also do death visits for eachother even not on call. Our area is very large and most of us live in other cities so if on call nurse lives 45 miles from patient on call nurse will call the co worker that lives in the area to see if they can make the visit. I don't mind helping out my co workers.

GigiRN1957 · May 9, 2010

I also work in hospice, last year we had 120 patients, this year, we are down to 55. However, our weekend on-call is for never more than 12 hours at a time. NEVER!!! And, we always have a back-up RN & social worker available if needed. During the week, our DON is backup and rarely does she get called out unless 2 deaths happen at the same time, or two urgent admissions etc.

It just isn't safe to agree to more than 12 hours, not with all the driving hospice nurses have to do. Stand up for yourselves and each other. Nurses need to stop allowing their employers to abuse them. However, I doubt this will ever end, it's been going on Florence Nightengale mopped floors after all patient care was done for the day. Good grief, have we not advanced anywhere when it comes to jobs that are still considered primarily female positions? I think not.