On-call or cancelled? That is the question!

[Eschell2971]

Hello:

What is the cancellation/on-call policy at your facility? Last week, my facility instituted a new/updated on-call/cancellation policy. Basically, nurses are no longer cancelled, they are placed on-call, for their whole shift, up to the last two hours of their shift. Additionally, nurses are now being paid $3.00 per hour, for every hour they are on-call. Personal time can be used in addition to this new on-call premium, or nurses can elect not to use their personal time and only receive the $3.00 per hour. Previously, nurses were paid zero/zilch/nada/nothing for being on-call (which only lasted for up to 4hours, at which time the nurse was either cancelled for the rest of the shift or called to report to work by 11am/2300hrs).

So, the differences in the new policy are: Nurses are not cancelled, they are placed on-call for their whole shift (up to 5am/1700hrs); nurses are paid an on-call payment of $3.00 per every hour they are on-call; nurses can be called to work at anytime during their shift once they are placed on-call; and nurses can be placed on-call as late as 2 hours before their shift begins. Also, nurses are to report within 1hour after being notified they need to come to work.

As you might imagine, there are more negative responses towards this policy than positive responses. For example, night shift nurses are especially concerned about their safety/leaving their homes in the dead of night (sleepy, driving, safety); many nurses live more than an hour away; since nurses are now on-call their whole shift, other plans still cannot be made or events will be missed because there is no longer a time limit that a nurse can reasonably expect not to be called in to work (even at 2am or 4am); once a nurse is called in, the nurse is guaranteed to work the rest of the shift. More than a few single nurses with young children have been asking, "What am I supposed to do with my child(ren) once I am placed on call?" One nurse mentioned that she uses a night-care service, but she cannot drop off her child after 8pm.

To be fair, so far, those of us who have been placed on-call were called either not called in to work at all, or were called at 2am (night shift) notifying us that we were not needed for the rest of our shift. But, I think many of us had already decided that we were going to bed, whether we were called or not.

I predict that not many nurses will be signing up for overtime because those on OT are usually the first to be cancelled, and now, since there is no cancellation, only on-call, why put yourself in the position to wait around to be called for only $3.00? At least, if you only work your 3-12hr shifts, it is unlikely that you will be cancelled (or rare), and if you are not scheduled on a given day, if the census is high, they will call you and ask you to work (at least in this case, you're not waiting to be called to come in after being placed on-call).

Let me close by saying these are the kinds of policies that I believe put good, competent, staff in the position or mindset to leave the unit/employer/profession. At the very least, policies like these put nurses more at risk of receiving disciplinary warnings because they are made to feel there is no work-life balance. Other nurses talk about how, "All this is not worth $3.00," and still others say, "Well, they're gonna write me up because how can I be expected to come in at 1am or even 3am, and work for the rest of my shift." The nurses who are single parents feel even more stress because they feel their kids' safety and lives are now at risk.

Bottom-line: many nurses are saying, "It seems no matter what, nothing gets better for us; we're damned if we do, damned if we don't. Management just doesn't care about us, yet, we're supposed to be the caring/compassionate profession."

What say you? Maybe you have some good suggestions, thoughts, and ideas!

[feelix, RN]

Our hospital pays us zilch for being on call. You get paid $50 only if you are called in. You are expected to arrive within 45 minutes of being called. That is why my girlfriend attended her daughter's wedding in uniform. I have been sent home at 4:00 am and called to work at 2:00 a.m. People don't quit because it is a major health system with huge reputation.

[BSN_TN, BSN]

Happens twice a pay period for me needless to say my eyes are open.

[kevler]

1) do you have a union?

2) once a called is the shift considered OT?

[BirdieRN]

I find it interesting that no one brought Staffing up in this discussion. Most of the facilities have done this to be fiscally responsible & and to provide safe Staffing. Safety is hugely important especially for the night shift. At a previous facility the scheduling and Staffing committee actually had the staff vote on night shift standby hours. The 7 p.m. to 7 a.m. night shift staff would not be called in after 1 a.m. per their votes which meant the night shift staff would have to deal with any change in Acuity or census. The cost when ended leveling out with some overtime as opposed to calling someone in.

Granted no one ever wanted to call someone in with just two hours left of their shift unless it was an emergency.

What Staffing policy would you want to implement to ensure that staff was available when needed to support stay safe Staffing?

[gettingbsn2msn, MSN, RN]

This is called push back. I believe some woman wrote a book on it. Corporate will push as far as they can. It's like the frog in the pot thought. The hope is that one becomes used to it and it becomes the new norm. After that a new push is put in place. I saw this 10 years ago in Georgia. I was a night nurse. We were not called off but if not needed at 7 pm we would be on call until 11 pm. This was with zero pay for 4 hours. Nurses complained but eventually they complied. This seems to be the next push. May I ask if this is happening in a southeast state. Conditions are the worst down here, especially in the smaller towns and rural areas.

[JKL33]

I find it interesting that no one brought Staffing up in this discussion. Most of the facilities have done this to be fiscally responsible & and to provide safe Staffing. Safety is hugely important especially for the night shift. At a previous facility the scheduling and Staffing committee actually had the staff vote on night shift standby hours. The 7 p.m. to 7 a.m. night shift staff would not be called in after 1 a.m. per their votes which meant the night shift staff would have to deal with any change in Acuity or census. The cost when ended leveling out with some overtime as opposed to calling someone in.

Granted no one ever wanted to call someone in with just two hours left of their shift unless it was an emergency.

What Staffing policy would you want to implement to ensure that staff was available when needed to support stay safe Staffing?

What I would NOT do is steal from employees.

Let me put this into perspective. I've been around long enough to remember a time when it was 100% acceptable to take an acetaminophen tablet from the employer's stock for personal use. Although I never needed to use this option, sometimes people did and it generally wasn't abused. From the employer's POV it helped the employee and enabled them to continue working.

Business practices have changed. It is well-known now that it is not the employer's responsibility to provide things like this for the employee. If one were to take a $.02 tablet from the employer, they would be stealing. Any of us who experienced this change in trends has heard this line repeatedly.

Now, please tell me how hiring someone at X dollars per hour to work X hours per week, and then, when it suits you, demanding that - as a condition of their continued employment - they sit at home at your beck and call for ZERO dollars (or a pittance, same difference) is not stealing. The market cost of "retaining" a skilled professional is not being paid. It's not even being acknowledged!

There is NO attempt to be ethical with this practice. Fair compensation is not offered - I mean, wouldn't the employer also save money by paying only 60% or 50% of the usual wage? Although those figures still don't represent the terms under which the employee was hired, they are certainly more fair. I've also never heard of the employer providing a statement of financial donation to the employee who donates 4, 8, 12 hours' worth of time. Again, that doesn't really cover it, but it would at least be an acknowledgment and a gesture of integrity.

Instead, what they are doing is taking 50% of the employment agreement and using it to their advantage: "You're on the schedule for this shift, we can tell you to stay home if we want to." FINE!!! The other 50% of that is that if you're going to say I'm on the schedule, that means you intended to pay me what we agreed upon, or you can take me off the schedule. You can't have it both ways.

It's really pretty simple.

[dream'n, BSN, RN]

I just got home from night shift and my brain might be tired, but can anyone else think of a professional career that routinely cancels/on calls their regular scheduled employees to save money? I know Dr's are on call at times, but they are salaried. I honestly can't think of any other profession (except commission jobs) where employees can't trust that they will receive a full paycheck without having to use their PTO time.

[guest974915]

What I would NOT do is steal from employees.

Let me put this into perspective. I've been around long enough to remember a time when it was 100% acceptable to take an acetaminophen tablet from the employer's stock for personal use. Although I never needed to use this option, sometimes people did and it generally wasn't abused. From the employer's POV it helped the employee and enabled them to continue working.

Business practices have changed. It is well-known now that it is not the employer's responsibility to provide things like this for the employee. If one were to take a $.02 tablet from the employer, they would be stealing. Any of us who experienced this change in trends has heard this line repeatedly.

Now, please tell me how hiring someone at X dollars per hour to work X hours per week, and then, when it suits you, demanding that - as a condition of their continued employment - they sit at home at your beck and call for ZERO dollars (or a pittance, same difference) is not stealing. The market cost of "retaining" a skilled professional is not being paid. It's not even being acknowledged!

There is NO attempt to be ethical with this practice. Fair compensation is not offered - I mean, wouldn't the employer also save money by paying only 60% or 50% of the usual wage? Although those figures still don't represent the terms under which the employee was hired, they are certainly more fair. I've also never heard of the employer providing a statement of financial donation to the employee who donates 4, 8, 12 hours' worth of time. Again, that doesn't really cover it, but it would at least be an acknowledgment and a gesture of integrity.

Instead, what they are doing is taking 50% of the employment agreement and using it to their advantage: "You're on the schedule for this shift, we can tell you to stay home if we want to." FINE!!! The other 50% of that is that if you're going to say I'm on the schedule, that means you intended to pay me what we agreed upon, or you can take me off the schedule. You can't have it both ways.

It's really pretty simple.

I absolutely agree with the 'frog and the pot' analogy. This practice is stealing, unethical, and just another insult to all of the dedicated caregivers that are the true lifeblood of any hospital. As JKL33 pointed out, this practice, in effect 'deprofessionalizes' nursing-when was the last time you recall hearing of any professional not being fairly compensated for their time? Only when nurses organize or there is a mass, mass exodus and hospital administration loses lots of revenue because they can't adequately staff their beds, will this ever change. Here's an idea, how about trimming the salary or some of the fringe benefits of Mr Hospital CEO or perhaps, getting rid of some of the dead wood at the top?

[old&improved]

When we are put on call we get $2 or 3/hr and are put on call in 4 hr increments. So 7-11, 11-3, 3-7. If you get called in within that 4 hr period you get time and a half until the end of the 4 hr period then straight time the rest of the shift. You have to call around 10 to see if they will need you at 11 or not. It used to be that if you got called in it was time and a half for the whole shift and there were no 4 hr increments. The CNA's are quitting because they're getting put on call or cancelled twice a pay period lately. They can't pay their bills.

[NurseStrong]

I think there aren't any ideal scenarios. For example, on our unit, if we sign up for an extra on-call shift, there is a $3.00/hour at-home pay. If called in, then recall pay is given. However, if placed on standby for a shift already scheduled, we are still technically on-call, and can be asked to come in at any time during the shift with a 1 hour window. On stand-by, however, there is no at-home pay. You can opt to use PTO or not. Sometimes, there is a volunteer to stay home on stand-by. If no one wants it, though, then mandatory stand-by can be implemented. At that time, you are mandated to stay home, not get paid or use PTO, and remain ready to report to work at any time during the 12 hour period. (I did once see a nurse get called in around 11pm, only to be sent back home at 3:00am.)

Honestly, it becomes a bit of a game on whether or not to accept stand-by... when it's an option. To be fair, it doesn't often come down to mandatory stand-by, though.

[fisherco]

Honestly this is very similar to the procedure my hospital uses and there's not really a problem and hasn't been for the 4 years I've worked there.

In times of low census in our unit we have a rotation of both being on call and floating. You always have the option to say no and they continue on down the list and hope someone says, "Yes I want to be on call" or it comes back around and it's your time and that's that. You also have people who request call more than others.

We have a hospital wide book for requests to be on call which gets consulted when they're making staffing requests. We don't low census employees. We get paid $4/hr to be on call and if called in it's time and a half with an hour of travel time. Generally you don't get called in after 5, but I have been called in as late as 3 AM because it was what needed to happen. You don't have to use PTO if you don't want to but you also can to make up the hours.

[dudette10, MSN, RN]

My last bedside job eliminated the on-call pay all together, but required you to be available after cancellation until four hours after start of shift.

I had one instance where I was cancelled, I was called at 11 and told that I wasn't needed, but that I had to remain on-call until 3 p.m. I said, "No, I'm not required to do that. Do you need me now or not?" The answer was "no," so I said, "Then I am no longer on-call" and hung up.