when you don't feel safe on call

[ran2much]

Hi -  I have 13 years in as an onc PA.  In the last 3 years, I have worked in survivorship (putting folks back together post tx). Prior to that, worked like a dog in the outpatient clinic (but never on call). Took the job as I was burned out and wanted to minimize risk. Boring but not stressful.  I spend my days now providing coping skills for anxious/ depressed pts and send to counseling.  I give diet tips and refer to dietician. I give tips for deconditioning and refer to PT.  I send folks to acupuncture and yoga.  Now, the practice I am with says we all need to be on call (also for free but thats another thing entirely).  I havent seen a patient on chemo/ immunotherapy in 3 years - neither sick nor doing reasonably well all things considered. Calls come from ERs asking for advice, calls from patients, calls from hospital. All over the phone. This weekend, an acute leuk with von Willebrands in blast crisis and new PE.  Rapid response doc calls me to ask what he needs to know for anti coag? Frick! I dont know. Lemme call someone. Or, "we think we have an 81 yr old in blast crisis", ER and hospitalist MDs dont know how to work up or manage or transfer... then, of course, there are some I can manage - fever in chemo pt goes to ER. Others are ED wanting permission to discharge elderly sick chemo or immuno tx patients.  I am out of the loop on the drugs and AEs x 3 years.  3 MDs on call as back ups for me all "slept through" my calls between 1-7 am.  How can I  professionally say - I do not feel safe on call. I dont see patients on tx and am not in a offer advice to manage acutely ill pts, especially under tight time constraints, and having new pages coming in while working up previous onc emerency. None of our jobs are rocket science when you do them daily, but when you dont see pts on chemo or immunotx, its hard to figure out emergencies. You dont just naturally learn like you would if you were seeing this regularly in your role. Any advice for making a solid pt and being professional? Also, it just seems like an EMTALA breach of duty to care when the MDs backing me up on emergency wont wake up and take their call and it takes us a couple of hours for someone to wake up and say oh, sorry. missed this.  Here's what to do.  My license is flapping in the wind. Thanks in advance. 

[SedRate]

Ugh, that's a tough situation and doesn't sound like a great situation. I would talk to your manager about your concerns with what you're being asked to manage as first call (especially since you haven't managed these things in YEARS) and difficulty contacting your collaborating physician. Perhaps even phrase it like, "Hey, just making sure I have the correct phone number for everyone as when I tried calling the physician about a specific case it went to voicemail."

[sas5814]

That's a tough spot but, in a way, easy to manage. You need to talk to the med director or whatever physician is in charge and explain the situation. It has to be framed in a patient safety/liability light and with some urgency. Once a patient has been harmed its too late.

Don't slow walk it. It is an urgent issue and the FIRST thing the med dir needs to do is light a fire under your back up. That alone will give you some breathing room. Then you can work out the other things regarding types of patients you haven't seen in years.

[ventana]

Sorry you are facing this. 
 

i  am hearing it more and more that they are forcing people on call

 

i would meet with your supervisor and HR saying you are uncomfortable

 

initially just call the docs and have them handle it.   If they refuse to answer then again involve HR that they are not backing you up.  
 

remember the hospital system is forcing this to save money.