On-call responsibilities can be a major burden as a nurse practitioner (the dread!). They mean bringing work home with you and the obligation to be on duty after hours, on weekends, and even holidays. Although managing patients by phone can be an inconvenience, the way in which this responsibility is delegated within a practice is the make-or-break factor in determining if taking call is reasonable. If your employer or soon-to-be boss is asking you to accept call responsibilities, ask these six questions first.
1. How will call be distributed among providers?
It’s natural to assume that call responsibilities will be distributed equally among providers in your practice. However, this assumption is often flawed. Each practice delegates call responsibilities differently. Some, for example, let providers of a certain age or level of seniority off the hook when it comes to addressing patient concerns after hours. Others take a case-by-case approach in determining call obligations. Certain providers in your practice may, for example, have negotiated a more favorable call clause into their contracts. Before you agree to take call as a nurse practitioner, make sure the schedule is clearly laid out and you know how often your name will be on it.
2. Whose patients will I be expected to cover?
Nurse practitioners often make the mistake of assuming they will only accept call for their own patients or those in their immediate practice. In reality, some practices join together in what is called “cross-coverage”. Practices within the same healthcare facility, or smaller practices from different facilities join together to spread out the on-call burden. For nurse practitioners, cross-coverage means higher call volumes when you’re on duty, as well as increased liability. Make sure that the benefit of fewer call days shakes out.
Taking call can mean much more than picking up your cell. In some practices, on-call providers may be expected to round on patients in the hospital as part of the arrangement. Clarify what call entails for your practice. Ask if you’ll need to assume some level of the patient’s care in the hospital or head into the clinic if this is the route you advise the patient to take.
Nurse practitioners should also ask about average call volume and the types of patient concerns they will be expected to address. This helps in determining if the arrangement seems reasonable.
4. How are holidays and vacations handled?
Taking patient calls on a Wednesday evening is one thing, on Thanksgiving Day it’s another. Before agreeing to accept call responsibilities, ask how holidays and vacations are handled in the group. Are holidays taken into consideration in making the call schedule and if so, how? You’ll also want to ask about vacation days and how call is structured when another provider in the practice is out of the office. Will you be expected to step up and fill the gap left by the individual on vacay?
5. Will I be reimbursed?
In some cases, nurse practitioners are paid directly for call responsibilities. In other cases, call responsibilities may be wrapped up in the NP’s employment package and expected as part of a salaried position. Will you receive any additional compensation for taking call? If so, how much? Discussing on-call pay and outlining this in your employment agreement can save you from a dispute over compensation for the responsibility later. Not to mention, it’s easier to negotiate pay for taking call at the beginning of your employment.
6. Who’s my backup?
As a nurse practitioner, you’ll likely have backup from a physician when you’re on call. In many cases this is a requirement of state law and/or your employer. Determine how support, if any, will be provided should a patient have a question or situation you are unsure of.
What do you wish you had asked about on-call responsibilities as a nurse practitioner?
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