Venty-vent-vent about work

[dirty ethel rackham]

I can't share on social media since some work people may see it and dh has already heard it.  I am so fed up with my hospital ultrasound job ... especially taking call.  It seems that every time I get called in, it takes me a day to recover.  So, all my days off are spent recovering instead of getting to all the "life" things that need to be done or even just do fun things.  Some of it is due to my age and inability to sleep on command.  But much of it is due to the stupid, inconsiderate people in the ER.  They don't abide by the rules of what we are supposed to be call in for (supposedly truly emergent conditions) and what they are supposed to do first before calling us in.  I'm having a blast😒of a Labor Day dealing with the exhaustion, tummy troubles and blood sugar instability from eating too late and 2 nights of less than 5 hours sleep.

My day shift on Saturday was pretty busy.  I picked up a stat ER case about an hour before  my regular shift ended.  Before I was done, but after my shift ended and during my on-call time, the ER dropped an order that wasn't on the non-emergent list "because I was still on site so I shouldn't mind."  So, I did it because I am low man on the totem pole.  Then they dropped an emergent exam and I waited for the patient to be ready for me.  But they took forever getting the necessary labs done.  And 2 more questionable exams dropped.  I didn't get to leave until nearly 5 hours after my shift ended and I had to eat cold Chinese takeout because our microwave is broken.  I couldn't sleep well and had to work the Sunday shift.   Sunday shift went pretty well and I got to go home and eat dinner.  Got called in after dinner, did the exam and another exam dropped before I left.  It is one of the "emergent" exams, but they hadn't even examined the patient or even drawn blood for her labs.   I called over to the ER to find out when they thought the patient would be ready.  "Soon."  3 hours later, the patient was still in the waiting room.  And it was the end of my call shift, but since the exam dropped during my shift, It was mine to do and I owed a favor to the person taking the next call shift.  An hour after my shift ended, the patient was finally ready.  A technically difficult exam and added time due to needing an interpreter.  I was so irritated that I couldn't sleep and made some inappropriate food choices again, which has my blood sugars peaking and troughing all day.  So much for spending quality time with dh.  

This just happens so often.  I only took this job because I needed more experience and time since my other job (my favorite one at the vascular lab with easy clinic hours) wasn't giving me enough hours.  I am so ready to quit.  But, the money is good, the experience is good, and my other job is only 2 days a week.  That is way too much time to fill with few IRL friends and low motivation to do things alone all the time.  

Thanks for listening.

[kbutton]

That really stinks!!!

19 minutes ago, dirty ethel rackham said:

I called over to the ER to find out when they thought the patient would be ready.  "Soon."  3 hours later, the patient was still in the waiting room. 

That's really just nuts. 

Your department should be working with the hospital to ensure that everyone is on board with the same plan--hospital stakeholders, nursing, the ER staffing group, etc.

I also think that the way call is done seems odd in some way. It seems more intrusive than it has to be, but I can't put my finger on exactly why.

[Katy]

This is crazy. I’ve never heard of call being handled this way.  Nothing should drop until the patient is actually ready. Why bother anyone until then? And why not staff for regular 12 hour shifts if they are that busy?  It sounds like terrible management. 

[LifeLovePassion]

I'm sorry, that sounds miserable. 

[Frances]

I’m so sorry to hear this. So much for hospital workers is bad now. I hope you can find a better position or they will start following the correct procedures.

[Harriet Vane]

That sounds horrible. I’m so sorry.

[Kassia]

I'm sorry too.  Miserable and so darn frustrating.  

[dirty ethel rackham]

1 hour ago, kbutton said:

That really stinks!!!

That's really just nuts. 

Your department should be working with the hospital to ensure that everyone is on board with the same plan--hospital stakeholders, nursing, the ER staffing group, etc.

I also think that the way call is done seems odd in some way. It seems more intrusive than it has to be, but I can't put my finger on exactly why.

Yeah, we wish.  Our manager and lead tech have had meetings on end with the ER department, and upper management, but docs and PAs do whatever the hell they want.  I don't have the authority to write things up.  And I don't want to text my lead tech every single shift.  The reality is that our ER is short-staffed and our department is short-staffed and its hard to fill the 2nd and 3rd shift positions. And we have a bunch of baby-docs and baby PAs (fresh grads) who don't know how to think critically. Unfortunately, this is a common issue in the industry.  

In one example, the ER manager won the fight over having patients needing pelvic ultrasounds fill their bladders.  They wait until the last minute to get a urine sample (for a UA and for a pregnancy test) so by the time we get them, they have just urinated. The docs think we can just see everything transvaginally.  We need a good transabdominal scan to get the lay of the land and need the window of a full bladder to push bowel out of the way and see the pelvic organs.  We can't changes the laws of physics where sound is concerned because they find it inconvenient.  

1 hour ago, Katy said:

This is crazy. I’ve never heard of call being handled this way.  Nothing should drop until the patient is actually ready. Why bother anyone until then? And why not staff for regular 12 hour shifts if they are that busy?  It sounds like terrible management. 

I totally agree that they shouldn't drop the exam until they have actually examined the patient and gotten labs.  I'm sorry but a little bit of pelvic pain is not torsion.  If I can push hard on the area with my probe and the patient doesn't make a peep, it's not torsion.  Pelvic pain?  1st trimester with any sort of pain or even a drop of bleeding?  They automatically get an ultrasound.  I can't tell you how many "pelvic pain and bleeding" ultrasounds I've done on women who are 4 weeks LMP.  Period, anyone?  A physical examination and a pregnancy test would have told them that.  Part of why they drop exams early is that, we are super busy, we don't get to all the exams as quickly as they want us to, so the docs/PAs drop them early hoping to get into the queue.  The nursing supervisor is supposed to not call us in until they have gone through the checklist to make sure that 1) it is needed and emergent, and 2) patient is or will be ready by the time the tech comes in.  But that doesn't always happen.  

None of our techs have opted for 12 hour shifts - mostly 8.5 hours.  I would not be able to handle a busy 12 hour shift.  I'm already exhausted after a busy 8 hour shift.  I've lost 15 lbs since January (needed weight loss) because it's such a physical job.  Its not a huge hospital, only 95 beds.  And since it is mostly medicaid or self-pay, they don't have a ton of $$ to play with.  We really can't predict demand.  Our scheduled outpatient exams numbers are down, but the ER can be quiet or all hell can break loose.  For the last 6 call shifts, I wasn't called in at all.  But weekends are tough because we don't have a 2nd shift tech - just an 8-4:30 shift who usually does call until 11 and someone else does overnight.  They used to have someone who worked overnights, but due to Covid staffing cuts, they had to let him go and they haven't staffed it yet.  Only the really big hospitals staff 24/7 rather than rely on call.  It is really hard to fill that position anyway.  And we do have to have call because the hospital would lose some important accreditation if they didn't have coverage.  I would love to do call less often, but we only have 5 techs.  I'm PRN and work 1 - 3 days a week.  There are 2 full-time techs and 2 part-time techs. 

[Catwoman]

Is there anyplace else where you can apply for some part time hours, so you could quit this job? It sounds pretty awful. 😞 

[wathe]

That sounds awful.  It sounds like you have a poor on-call system.  The healthcare system is under tremendous strain right now and we are all suffering.  A lot.  I am not liking my job right now either.  At all. I am getting pretty close to the point of quitting, actually. I hope you can come up with a solution - either drive system change (which IME is usually akin to banging head against wall, but sometimes actually works), or another job, maybe.  Until then, hang in there as best you can.

In defence of emerg docs:  They are ordering tests because they feel they have to.  Believe me, no wants their length-of-stay stats to be even one second longer than necessary.  It's also true that sometimes tests get ordered that aren't strictly necessary, and tests that maybe could wait get ordered emergently.  For 2 main reasons:

1) We are practicing in a very litigious environment, and

2) We are practicing in an environment that's largely driven by a consumer satisfaction model.

More on 1). Emergency medicine is right up there with neurosurgery and obstetrics for most sued specialty. The ED doc is the one holding the bag when there's a bad outcome. docs hate getting sued - emotionally exhausting/devastating and extremely time-consuming (all on personal time, of course).   To an ED doc, and to a court of law, on-call means available.  It is indefensible to fail to order an indicated test if it is available.  Tired, burnt-out techs with a bad call system is not a defensible reason to fail to order a test. The hospital may have an only-emergency-studies-after-a-certain-time-rule, but I can guarantee that after a bad outcome, in court or otherwise, the hospital will shift the blame to the ED doc for failing to order the test, and insist that the test was available (there was a tech on call!), so the doc should have ordered it.  I have a colleague who quit after exactly this scenario.  

Also, deciding whether or not a test is emergent is not an easy decision in real time.  20/20 hindsight and all that.  You can't know that there will be a bad outcome until after it happens, and we've all been caught.  Sometimes social issues (such as pt unlikely to return for followup) play a role, as well.  

We have radiologists gate-keeping afterhours US.  If I want an US after 10pm, I have to call the rad to approve.  The rad knows that if denied, I will chart defensively - "Case rw'd with Dr Radiologist by phone.  As per Dr Rad, US not available for this patient until x0'clock tomorrow". and if applicable, "Dr Rad aware of social circumstances" or "Dr Rad aware of my concern regarding x,y,z".  Dr Rad doesn't want to hang with me in court over a bad outcome for a pt Dr Rad has never actually seen, so Dr Rad will usually approve the study.  He knows as well as I do that On Call means Available. 

More on 2).  There is a lot of pressure to avoid complaints and keep patients happy.  Patient satisfaction metrics cause a lot of stress in the ED.  Admin demands efficiency, short as possible length of stay, low as possible number of admissions, and perfect patient satisfaction.  It's impossible. If the visit generates a complaint related to test access - whether or not there was an objectively bad outcome - hospital will not back up the MD for failing to order a test that was available (there was a tech on call!), even if only marginally indicated.

You are absolutely correct that inexperienced providers tend to order more tests than experienced providers.  That's necessary, though.  New providers don't have the benefit of experience.  They can't take the same clinical short-cuts and rely on their gestalt the way more experienced docs can.  They have to rely more on tests in order to provide safe care.  There's no way around that one.  They also don't have the same seniority and reputational clout within the institution  that comes with having been there a long time and being known - the hospital is less likely to have their backs, and they know it.  It's a catch 22.

[brehon]

Yes, to everything @wathe said. I don’t work in an ER but have seen everything Wathe described from my position hugging an ER wall for over an hour waiting for bed for my patient  

Re: (1) short staffing is going to cause the healthcare industry to collapse. It’s everywhere: hospital — especially the ERs (at least in my area), various techs, janitorial staff, cafeteria staff, ad nauseum; pre-hospital; clinics; etc.

Re: (2) I don’t know about Canada, but Press-Ganey scores have a lot to answer for in the US. It seems like a great idea - pull back the curtain on pricing, more transparency, rate doctors, clinics, hospitals, etc - and it is in principle. Unfortunately, the law of unintended consequences works exceptionally well in healthcare and P-G is driving clinical care in a way it was never intended.

 I am very sorry you’re having to deal with all this, @dirty ethel rackham. It absolutely takes a toll on mental and physical health. 

[dirty ethel rackham]

On 9/6/2022 at 11:53 AM, wathe said:

That sounds awful.  It sounds like you have a poor on-call system.  The healthcare system is under tremendous strain right now and we are all suffering.  A lot.  I am not liking my job right now either.  At all. I am getting pretty close to the point of quitting, actually. I hope you can come up with a solution - either drive system change (which IME is usually akin to banging head against wall, but sometimes actually works), or another job, maybe.  Until then, hang in there as best you can.

In defence of emerg docs:  They are ordering tests because they feel they have to.  Believe me, no wants their length-of-stay stats to be even one second longer than necessary.  It's also true that sometimes tests get ordered that aren't strictly necessary, and tests that maybe could wait get ordered emergently.  For 2 main reasons:

1) We are practicing in a very litigious environment, and

2) We are practicing in an environment that's largely driven by a consumer satisfaction model.

More on 1). Emergency medicine is right up there with neurosurgery and obstetrics for most sued specialty. The ED doc is the one holding the bag when there's a bad outcome. docs hate getting sued - emotionally exhausting/devastating and extremely time-consuming (all on personal time, of course).   To an ED doc, and to a court of law, on-call means available.  It is indefensible to fail to order an indicated test if it is available.  Tired, burnt-out techs with a bad call system is not a defensible reason to fail to order a test. The hospital may have an only-emergency-studies-after-a-certain-time-rule, but I can guarantee that after a bad outcome, in court or otherwise, the hospital will shift the blame to the ED doc for failing to order the test, and insist that the test was available (there was a tech on call!), so the doc should have ordered it.  I have a colleague who quit after exactly this scenario.  

Also, deciding whether or not a test is emergent is not an easy decision in real time.  20/20 hindsight and all that.  You can't know that there will be a bad outcome until after it happens, and we've all been caught.  Sometimes social issues (such as pt unlikely to return for followup) play a role, as well.  

We have radiologists gate-keeping afterhours US.  If I want an US after 10pm, I have to call the rad to approve.  The rad knows that if denied, I will chart defensively - "Case rw'd with Dr Radiologist by phone.  As per Dr Rad, US not available for this patient until x0'clock tomorrow". and if applicable, "Dr Rad aware of social circumstances" or "Dr Rad aware of my concern regarding x,y,z".  Dr Rad doesn't want to hang with me in court over a bad outcome for a pt Dr Rad has never actually seen, so Dr Rad will usually approve the study.  He knows as well as I do that On Call means Available. 

More on 2).  There is a lot of pressure to avoid complaints and keep patients happy.  Patient satisfaction metrics cause a lot of stress in the ED.  Admin demands efficiency, short as possible length of stay, low as possible number of admissions, and perfect patient satisfaction.  It's impossible. If the visit generates a complaint related to test access - whether or not there was an objectively bad outcome - hospital will not back up the MD for failing to order a test that was available (there was a tech on call!), even if only marginally indicated.

You are absolutely correct that inexperienced providers tend to order more tests than experienced providers.  That's necessary, though.  New providers don't have the benefit of experience.  They can't take the same clinical short-cuts and rely on their gestalt the way more experienced docs can.  They have to rely more on tests in order to provide safe care.  There's no way around that one.  They also don't have the same seniority and reputational clout within the institution  that comes with having been there a long time and being known - the hospital is less likely to have their backs, and they know it.  It's a catch 22.

I get what you are saying.  I know that defensive medicine is how things have to be done, especially with less seasoned practitioners.  And I do get that getting a patient back for follow-up in outpatient is difficult, especially with our patient population.   But I just can't understand ordering tests without getting a good history and examining the patient first.  Just looking for keywords from the triage nurse notes is bad care.  It's not just at my hospital, though.  I hear complaints like this everywhere.  Call is hard on the techs.  It is the number one reason why sonographers leave the hospital setting.  We have protocols and checklists for a reason.  To help with decision making on when it is appropriate to call in and what steps should be taken first (at least to prep the patient so that the exam is diagnostic.)  I wish we had radiology as gate-keepers because at least they could talk to someone about what the exams will and won't tell them.  I know that this is the policy with the echo department - nobody can get called in unless they contact a cardiologist who OKs it.  

What they aren't getting is that if they drive away techs due to abusive call practices, then they won't even be able to cover call shifts.  And then they have to send patients away by ambulance to another facility that does have ultrasound coverage.  They are shooting themselves in the foot. Until our latest student was hired on and took on some call rotations, this is the exact situation they were in and they were in danger of losing some accreditation.   And if I leave, they will be back in that situation.  Or the lead tech will end up working 80 hours a week again.  Despite paying well, they are having trouble attracting qualified applicants who bring anything to the table.  

[TechWife]

I'm sorry. Maybe you'll hear about an office tech position with fantastic pay and hours soon.

[dirty ethel rackham]

On 9/5/2022 at 8:02 PM, Catwoman said:

Is there anyplace else where you can apply for some part time hours, so you could quit this job? It sounds pretty awful. 😞 

I've been looking.  But most of the openings are 2nd shift and/or weekends, which isn't any better than what I have.   Or they are not flexible to work with my clinic job that I don't want to give up.  That is where I'd like to end up full-time.  I also don't want to be seen as a job-hopper.  The community is small and word gets around.  I don't want to outright quit because I'm still inexperienced and need to continue to grow my skills and knowledge.  That isn't going to happen with the limited hours at my clinic job right now.  Which is why I sought out this job in the first place.  I plan to stick it out until January.  If my clinic job doesn't pan out to full-time or at least a .8, then I may have to reevaluate.  

[EmilyGF]

Do you have a reasonable chain of command you can talk with? 

I can't tell you how many people recently have told me about employees who have "silent-quitted" by simply sending an email (if that) and then never showing up or responding again. The person who told me about this yesterday, in a 30-minute conversation, said, "She won't even respond to a call to tell me why she quit so that I can make the job better for the future." The hospital may be too big to listen to anyone, but it might be worth a try. Do you have anything to lose by initiating such a conversation? 

Emily

[kbutton]

16 hours ago, dirty ethel rackham said:

But I just can't understand ordering tests without getting a good history and examining the patient first.  Just looking for keywords from the triage nurse notes is bad care. 

It sounds like we've shifted to problem-solving. I hope that's okay. 🙂 

It's really hard because sometimes they have to do rapid assessment with triage when it's hitting the fan. Add in that sometimes the problem is, say, nursing not moving folks. The ER group is probably contracted by the hospital, but the nurses are hired by the hospital and so are the US people, etc. Sometimes, rapid assessment and ordering tests before seeing the patient is the only way to deal with the fact that you have empty rooms but no techs to place people in them. Or you have emptied rooms but are short staff to prep the room for the next patient. It's the wild west right now.

Sometimes the problem is further upstream, and sometimes it's even, "Oops, we shouldn't have scheduled that new doc to work with a new PA and a new NP because they have to sign all of the charts and learn the ropes." Or, sometimes that new doc is supervising experienced mid-levels, and the mid-levels are having to mentor up on the experience part while also having that mentor sign off due to scope of practice, lol! When that's happening, all bets are off on timing things--the mid-levels are being productive, and the new doc is being swamped. 

5 hours ago, EmilyGF said:

Do you have a reasonable chain of command you can talk with? 

I can't tell you how many people recently have told me about employees who have "silent-quitted" by simply sending an email (if that) and then never showing up or responding again. The person who told me about this yesterday, in a 30-minute conversation, said, "She won't even respond to a call to tell me why she quit so that I can make the job better for the future." The hospital may be too big to listen to anyone, but it might be worth a try. Do you have anything to lose by initiating such a conversation? 

Emily

I think this is becoming the norm. People don't want to fix the system, they just want to leave it. Sometimes fair, sometimes not--we all have our gifts and calling. Or they want to scapegoat insurance instead of telling the insurers why something doesn't work. My kid can't get adequate primary care right now because the model has changed due to insurance and a crammed system focused on productivity. We are the test people for finding all the holes when he needs something. Coordination of care is both amazing and a joke depending on what actually is wrong. (And the best coordination of care we had was with a surgeon that I gather raises heck when things aren't right.)

Sometimes you go over someone's head.

I hope you something gives for you in a good way.

[dirty ethel rackham]

6 hours ago, kbutton said:

It sounds like we've shifted to problem-solving. I hope that's okay. 🙂 

It's really hard because sometimes they have to do rapid assessment with triage when it's hitting the fan. Add in that sometimes the problem is, say, nursing not moving folks. The ER group is probably contracted by the hospital, but the nurses are hired by the hospital and so are the US people, etc. Sometimes, rapid assessment and ordering tests before seeing the patient is the only way to deal with the fact that you have empty rooms but no techs to place people in them. Or you have emptied rooms but are short staff to prep the room for the next patient. It's the wild west right now.

Sometimes the problem is further upstream, and sometimes it's even, "Oops, we shouldn't have scheduled that new doc to work with a new PA and a new NP because they have to sign all of the charts and learn the ropes." Or, sometimes that new doc is supervising experienced mid-levels, and the mid-levels are having to mentor up on the experience part while also having that mentor sign off due to scope of practice, lol! When that's happening, all bets are off on timing things--the mid-levels are being productive, and the new doc is being swamped. 

Yeah, I can see all those scenarios happening.  But you know what??  All of those are outside of my control.  I have absolutely no control over what happens in the ER.  l'm just the stupid minion ultrasound tech who doesn't deserve the courtesy of an adequate patient history and proper patient prep before getting me out of bed at 2 am for a minimum 2 hour call-back.  Which means my sleep for the night is toast and I either have to get up to work again at 8am or my day off is totally wasted recovering.  

Quote

 

I think this is becoming the norm. People don't want to fix the system, they just want to leave it. Sometimes fair, sometimes not--we all have our gifts and calling. Or they want to scapegoat insurance instead of telling the insurers why something doesn't work. My kid can't get adequate primary care right now because the model has changed due to insurance and a crammed system focused on productivity. We are the test people for finding all the holes when he needs something. Coordination of care is both amazing and a joke depending on what actually is wrong. (And the best coordination of care we had was with a surgeon that I gather raises heck when things aren't right.)

Sometimes you go over someone's head.

I hope you something gives for you in a good way.

 

All I can do is complain to my lead tech or the imaging manager.  And I have but I have to be careful not to be seen as a whiner to the experienced techs who've experience this for much longer than me.  The imaging manager has had meetings with the emergency room management.  But not because I have complained but because the lead tech has experienced these issues.  However, she has clout and can go toe-to-toe with the powers that be.  I can't.  Since I mostly work evenings, weekends and call, I get maybe 20 minutes a day in the same building with them, but they are not usually accessible.  I have to communicate via email and text.   I have seen some improvement on weeknight call, but weekend call still sucks big time.  I had one weekend with a 16 hour day and a 14 hour day and barely got to eat both days (was scheduled for 2 eight hour shifts and call.)  Then I had to work Monday at my other job and I totally sucked at my job that day. 

[dirty ethel rackham]

11 hours ago, EmilyGF said:

Do you have a reasonable chain of command you can talk with? 

I can't tell you how many people recently have told me about employees who have "silent-quitted" by simply sending an email (if that) and then never showing up or responding again. The person who told me about this yesterday, in a 30-minute conversation, said, "She won't even respond to a call to tell me why she quit so that I can make the job better for the future." The hospital may be too big to listen to anyone, but it might be worth a try. Do you have anything to lose by initiating such a conversation? 

Emily

BTDT regarding talking up the chain of command.  They are aware of the situation and have had some meetings.  So, if they don't know what is driving people away, they aren't paying attention.  They have lost techs due to the call situation.  

[pinball]

On 9/5/2022 at 6:20 PM, Katy said:

This is crazy. I’ve never heard of call being handled this way.  Nothing should drop until the patient is actually ready. Why bother anyone until then? And why not staff for regular 12 hour shifts if they are that busy?  It sounds like terrible management. 

It’s not crazy. Stuff changes on the fly all the time in emergency medicine. 
 

you sound like management LOL

[pinball]

On 9/5/2022 at 5:43 PM, dirty ethel rackham said:

I can't share on social media since some work people may see it and dh has already heard it.  I am so fed up with my hospital ultrasound job ... especially taking call.  It seems that every time I get called in, it takes me a day to recover.  So, all my days off are spent recovering instead of getting to all the "life" things that need to be done or even just do fun things.  Some of it is due to my age and inability to sleep on command.  But much of it is due to the stupid, inconsiderate people in the ER.  They don't abide by the rules of what we are supposed to be call in for (supposedly truly emergent conditions) and what they are supposed to do first before calling us in.  I'm having a blast😒of a Labor Day dealing with the exhaustion, tummy troubles and blood sugar instability from eating too late and 2 nights of less than 5 hours sleep.

My day shift on Saturday was pretty busy.  I picked up a stat ER case about an hour before  my regular shift ended.  Before I was done, but after my shift ended and during my on-call time, the ER dropped an order that wasn't on the non-emergent list "because I was still on site so I shouldn't mind."  So, I did it because I am low man on the totem pole.  Then they dropped an emergent exam and I waited for the patient to be ready for me.  But they took forever getting the necessary labs done.  And 2 more questionable exams dropped.  I didn't get to leave until nearly 5 hours after my shift ended and I had to eat cold Chinese takeout because our microwave is broken.  I couldn't sleep well and had to work the Sunday shift.   Sunday shift went pretty well and I got to go home and eat dinner.  Got called in after dinner, did the exam and another exam dropped before I left.  It is one of the "emergent" exams, but they hadn't even examined the patient or even drawn blood for her labs.   I called over to the ER to find out when they thought the patient would be ready.  "Soon."  3 hours later, the patient was still in the waiting room.  And it was the end of my call shift, but since the exam dropped during my shift, It was mine to do and I owed a favor to the person taking the next call shift.  An hour after my shift ended, the patient was finally ready.  A technically difficult exam and added time due to needing an interpreter.  I was so irritated that I couldn't sleep and made some inappropriate food choices again, which has my blood sugars peaking and troughing all day.  So much for spending quality time with dh.  

This just happens so often.  I only took this job because I needed more experience and time since my other job (my favorite one at the vascular lab with easy clinic hours) wasn't giving me enough hours.  I am so ready to quit.  But, the money is good, the experience is good, and my other job is only 2 days a week.  That is way too much time to fill with few IRL friends and low motivation to do things alone all the time.  

Thanks for listening.

That sounds stressful.
 

on call is tough and it takes a toll on the body and family time. 

i hope you can work things out