Please remember, as you read this, that I can only speak of my own job as assigned by my hospice. Hospices, throughout the country, handle their "after hours" emergency cases in many, different ways...
Many hospices rotate their day shift nurses to be "on call" at night.
Thankfully, my hospice has nurses that are dedicated only to the night shift. It's a staffing "plus" that allows the day shift nurses a full night's sleep thus allowing them to fully tend to their patients during the ususal 8A-5P hours. I truly believe that having dedicated night nurses contributes greatly to staff retention. A nurse that has devoted a full day to tending his/her patients and then has to be repeatedly "on call" during the night rapidly becomes an unhappy nurse. Unhappy nurses will soon look for work elsewhere.
I work alone, from home, and am responsible for approximately 180 patients scattered within an area of at least 1,500 square miles. At night, an on-call hospice physician and nursing supervisor are available if I should need them. They, of course, have also worked a long day and are surely hoping that I don't need to wake them up. I take great pride in that I rarely ever have to disturb anyone's sleep.
Some hospices assign a "back-up" to the night nurse. This nurse, from the day shift, is to assist in the event that multiple emergencies happen simultaneously. I don't have a "back-up". When all hell breaks loose, I take a deep breath, mentally triage the events and just "do it". I also very carefully explain the situation to the caregivers and assure them that they will be seen as quickly as possible. Caregivers are almost always very understanding in these situations. They also understand that the needs of the living patient will always override the needs of the dead.
Emergencies are as varied as the patients. Intractable pain, terminal restlessness,respiratory distress, malfunctioning equipment, occluded Foley caths, family "freak outs" ... the list is endless. Unfortunately, some caregivers are disappointed in my reluctance to respond. Linen changes, dirty diapers and constipation will almost never warrant a visit from an emergency night nurse.
It's a lonely and sometimes, dangerous job; but the rewards are beyond compare. The caregivers are very appreciative and relieved when I walk into their home and I'm happy to be there... because I know that I can help. I am one of the lucky few that can say, "I love my job."