"Gwynn, I discovered that I was the only person on-call last night! I worked a full-eight hours yesterday, and I saw five patients. I cannot be the only one on call when I've already put in a full day! I was called out for two patients, and I had to pronounce a death. I only got three hours of sleep. I can't go on like this; it's killing me. I hate my job, and it certainly isn't good any for the patients. My hands are shaking, I feel nauseous, and I just can't do this any more. I'm sorry, but you can consider this my two-weeks notice. I've got another offer, I'm going to take it. I can work three days a week, day-shift, and make as much as I do working all week here, with no forced overtime."

Gwynn Halsey looked across her desk at Lisa Deering, a bright, hard-working RN with a genuine commitment to her patients. "I understand," said Gwynn Halsey. "We'll be sorry to see you go."

Lisa stood, gave Gwynn a wan half-smile, shook her hand, and closed the door behind her. That wasn't the only door Gwynn felt close. The hospital was already closing beds in units due to the lack of nurses. She wasn't likely to get much sympathy if she complained about her problems as director of home-care. She certainly wasn't going to get any nurses from them. Something had to change from within, and it had to be affordable.

She called Nancy Gilman, her administrative assistant in and explained what had happened with Lisa. To her surprise, Nancy began bubbling with enthusiasm before she even stopped talking.

"This is probably the right time to mention something I've been thinking about for a long time. You know how many complaints I've had from our on-call staff over the past several months. Well, I've been doing some checking. We can actually send our on-call to a medical ansewring service. We can stop relying on the hospital's switchboard. Our staff can enter their own call-schedules online and they can even contact one another directly over the phone, without waiting for the switchboard to mediate. We don't have to worry about lost phones. We can see to it that there aren't oversights, leaving only one person on-call."

"Nancy," Gwynn interrupted, "you know that's going to cost money. And, its money we don't have."

"Actually," Nancy replied quickly, "we are already paying the hospital for one FTE to cover our calls. We can switch to the answering service for substantially less."

"You're sure?" Gwynn asked.

"I've got the agreement in my desk. I've been a little reluctant to bring it up. I just kept getting these calls, with people yelling at me about the on-call schedule being messed up. I wanted to see if there was anything we could do differently. By the time they got through to you, they'd already yelled at me and calmed down."

"Do you know anything about this place? Are you sure they can actually live up to their promises?" Gwynn asked her.

"Well, we know that the hospital switchboard isn't working. That’s for sure. I actually got the idea by calling Cathy over at Hospice. She recommended them. They've been using an answering service for years, after the first time their budget was cut. She said nobody wanted to change, but in the end, it worked a lot better than passing the on-call cell phone around. Now everybody knows what’s going on, when, and why.

"Actually, she had some other good ideas too, like using part-time mothers who want like to maintain their clinical skills, but work a limited amount, as a stable on-call staff. She said that they’ve got two nurses like that already. The primary nurses only cover call when these part-timers are on vacation or ill. She said they're now fully staffed, mostly due to giving people their lives back."

"Let's take a look at the information, Gwynn said. We just can't lose anyone else over this."

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