Call Off's

[Annointed_RNStudent]

I will be a new grad in May with the option of going to straight L&D as a new grad in a tertiary hospital (3500 deliveries a year), or going to a birth center type place that does about 400 deliveries a year. While I am interested in the birth center setting for close enviornment etc, I am worried about being called off for low census, Does anyoen have any advice or experiences with this?

Thanks

[crysobrn]

Hi there. I work in a smaller hospital. We all do L&D, PP, mother baby, intermediate care nursery. We don't have a big problem with call offs for low census. We have to have at least two RN's on at any one time and we generally only have 3 scheduled. IF we do have a low census then we rotate call off's. We have a sheet of paper that we keep track of who took one and when. That way the person who just had one last week will not be forced to take one again if they don't want to. We have a couple nurses that will take them whenever available. Honestly there are not a lot of times that we actually have them available so when we do we are often fighting over them LOL. Good luck!!

[KulRN]

we too get call offs from where I work, as a matter of fact, we have that going on right now. Our unit has been closed for almost a week now due to a low census in the hospital. I work in med-surg unit, we actually have 2 med-surg units in our hospital...the only difference is that our unit is a clean unit (meaning, we have no isolation patients....most of our patients are post surgical patients...ob-gyn/ortho/gastric).....whenever the census is low we are the first one to get hit and when this happens, we also rotate our LOA/call off's..if it's not your turn, you will be floated to med-surg/tele floor..which most of the time sucks because since you're a floater the assignment given to you will be more challenging than what the regular staff would get (like they'll give you patients with attitude problems or frequent flyers who are not compliant..and the like)...so it sucks! The only thing that scares me is how long will this last and how long do we have to float? Should I look for another job or should I apply to a different unit in the hospital? I'm kinda stuck because I have been working in this hospital for almost 2 years and I don't want to lose my seniority.... It really sucks!

[Jolie, BSN]

I am about to give you advice that you didn't ask for, but I sincerely hope you will consider.

Working in a setting that does approx. 400 deliveries/year will significantly limit your practical, hands-on learning experience, necessitating a very lengthy orientation (probably more than 6 months) in order for you to have the opportunity to develop a knowledge base, skill set, organizational skills, proficiency in emergencies, etc. With 400 deliveries per year, your facility will do roughly 1 delivery per day. Assuming that you will work a 40 hour week, it is not likely that you will be present for more than 2 births per week. At that pace, it will take a LOONNG time to become an expert care-giver. If you choose to work in this facility, PLEASE insist on a written plan of orientation that is sufficient in length, and the presence of sufficient experienced staff members to facilitate your learning and patient safety.

In the tertiary care setting, you will see and do more in terms of advanced skills in a few months than you would in years at the birth center. Please don't misunderstand me, I'm not bashing the birth center environment (I desperately wanted to deliver in one myself!) But RNs who staff such centers MUST be highly skilled and experienced because of the lack of immediate resources when complications occur. Most centers recruit experienced nurses who are ready to move to a lower-intervention setting, and most have experienced nurses knocking down their doors for positions.

I spent most of my career in the NICU, which I see as similar to L&D in many respects. I found it ideal for new grads and nurses new to the NICU to work in a tertiary care setting for at least a year or two before moving to Level II NICU's, whose patient populations usually do not support an adequate orientation for a newbie.

Good luck on your decision.

[OC_An Khe]

First I agree totally with Jolie's advice.

Are call offs common in your area of the country? It is very rare we I work and then only prns can be called off. If you are hired for 40 hours you get 40 hours without regard to census.

[bagladyrn, RN]

Jolie definitely has it right - the tertiary care center will give you a chance to get experience with a large number of deliveries and situations that you may only see on rare occasions in a small birthing center. Also keep in mind that just because a place only does low risk doesn't mean that you won't see the problems and have to handle them in a low tech environment with less help until they can be stabilized and shipped.

I contract at a lot of small rural facilities and do see a lot of call offs for low census. The facilitiy I'm currently at has someone on "low census day" almost every shift. The other option that happens in these facilities is that you may find yourself pulled to work in another unit such as M/S or Peds when OB has no patients.

[BirthingBabies]

i work at a level II hospital where we have pp, nursery, level II nursery, l & d and antes are mixed in on the floor. we did 70 deliveries this month and we had to take low census this month like crazy... usually we do 80-90 and it isn't as bad...