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The Hidden Cost of Staffing Weekend Hospice Care

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Google “hospice weekend shifts” and you’ll see pages and pages of hospice care providers looking for extra help. The challenge hospice providers face is to find professional staff who can provide professional support, patient and family education, determine the necessity of intervention, offer knowledgeable advice on medication, and support those who are actively dying.

Many hospice organizations are struggling with finding a workable model for weekend staffing. Some hire dedicated on-call staff or use phone triage to field patient and family calls, manage problems as they arise, and schedule a visit if a problem can’t be resolved over the phone. Other hospices ask their on-call nurses to do both telephone triage and patient visits. Many hospices have their team assume responsibility for on-call care for nights and weekends on a rotating basis. Each of these models comes with a hidden cost: increased risk of nurse burnout and staff turnover, and increased risk of overpaying for weekend incentive programs in times of reduced need.

Working Weekends Can Lead to Stress

Staff nurses who are required to work on weekends can be at greater risk of burnout. This requirement can create stress when staff members miss out on family activities, or other special occasions, that are generally scheduled on weekends.

12-Hour Shifts Affect Quality of Care

Having to work three 12-hour shifts over a weekend not only creates stress for nurses, but also affects the quality of patient care. A 2012 Shift Length Study found that “nurses working shifts of 10 hours or longer were associated with worse reports of patient care quality and overall safety grade compared with nurses working 8 to 9 hours.”

Pressures to Reduce Cost of Weekend Shifts

Weekend Incentive Programs create a financial incentive for working weekends by allowing nurses to work three 12-hour shifts (36 hours), yet paying them for 40 hours. These programs can also include full-time benefits. The drawback of this care model is that staff gets paid independent of demand or patient census. If you have fewer patients to care for or few weekend calls, staffing becomes less cost effective. Increasing demands on the industry to reduce healthcare costs is having a major impact on this type of weekend pay structure. In January, British government ministers raised an objection to extra pay for health workers who work weekend shifts in order to save money. Pressures like these are leading hospice administrators to look at alternative models for weekend care.

Outsourcing as a Solution

Finding a cost-efficient model for affordable, efficient weekend care is critical for both hospice nurses and administrators. More and more hospice organizations are looking to outsourcing after-hours care to protect their staff and their budgets. Outsourcing weekend work allows hospice staff the chance to spend time with their families, rest and recover from the prior week, and to recharge for the demanding week ahead. This is important to retain top nursing talent and avoid unnecessary staffing turnover due to burnout.

Financial Advantages

The financial advantage of outsourcing is the ability to add or reduce shifts based on need. Weekend care models that pay for full-time employees with the added costs of benefits aren’t flexible. Some professional telephone triage models offer services that can be scaled up or down based on changing census numbers, or call volumes, eliminating the need to pay for an entire shift.  This allows hospice managers to operate more cost efficiently by only paying for telephone triage as needed, which can be a real cost saver.

Providing quality hospice care on weekends is a challenge for hospice nurses and administrators. Outsourcing weekend telephone triage can be a cost effective solution that prevents accruing hidden costs of inefficient full-time staffing or losing staff members to burnout.

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