Work zone and pt numbers growing, oncall staff numbers are not

[OatmealRanch]

I was wanting to get a little bit of advice as I am planning on trying to approach my clinical director regarding the increase size of Service area an increase in patience without increasing the on call staff numbersWithout increasing our on call staff numbers.  I do not expect to get paid to sit at home, I enjoy my job and I don't mind working long hours. The problem that I have is that they weekend shift is 64 Hours long and it is not uncommon for me to be out driving in seeing patients for greater than 30 hours at a stretch,then maybe getting 3 hours of sleep and going right back on the road.  The amount to caffeine that it takes me to be able to safely upright my car brings my heart rate into the under thirties by the end of the weekend my thoughts are scattered and I am very forgetful because of sleep deprivation.  The nurses who work with me there's usually 1 or 2 both have worked all week long and then they work with me on the weekend and they too are running very long hours. Myself and the other on call nurse who works when I am not working both feel that is necessary to talk with our supervisor about the need for another full time on call staff nurse.  I have researched through Department of Transportation and the board of nurse examiners for my state and there is no laws or rules to help protect me. When I have brought up this topic verbally I have been told that it is my job and that I new the hours when I took the job. This is a true fact but when I took the job we didn't stretch as far as we do now some of my patients live more than 2 and a 1/2 hours away from each other. A lot of them live in very rural areas and it takes funeral homes many hours to get to you. There is a high turn over rate in both oncall and regular staff because of the oncall requirements for regular staff to work with the oncall staff frequently.  Any advice is appreciated 

[InletNurse40, ADN]

Reading this made me SO anxious. I worked a job with these exact requirements (corporate changed staffing hours/territory during the middle of my employment). This is absolutely not doable physically and mentally, not to mention the obvious decline in your ability to give great care. I resigned after being mocked in a meeting for daring to say it was unsustainable. 
Shorter version: You are in a toxic environment that will work you until you drop. Leave. 

[vampiregirl, BSN, RN]

This is one of the very reasons I chose to work for a small, non-profit hospice. This type of situation you are currently in is not safe for the nurses doing on call (physically or mentally). However, I've encountered some corporate cultures who may consider staff very replaceable. 

I think your approach should depend on the supervisor and the work culture. Safety/ risk management may resonate with some supervisors. In other work places, customer service may be more effective approach.

I would recommend having objective data to present to the supervisor. Have some very specific data to present. For example, something from a couple recent weekend that clearly shows how many consecutive hours you are working. It would be very helpful if both nurses had specific examples. If you are approaching from the customer service aspect, some way to illustrate time between time of call and arrival at the residence may be helpful. 

Another strategy I've found helpful to have prospective solutions. Be prepared to show how additional staff would be helpful. If case managers or visit nurses are overtime when on call, adding additional staff could potentially save the company money. Or offer alternative scheduling ideas - for example the on call person has a specific 8 hour time period during the night that uses another nurse as the primary on call person and the weekend nurse is back-up.

Best of luck to you!