Call/scheduling in the OR...please help!

[OR-RN<3]

Hello fellow RN's! Recently my hospital/unit has made some changes and I wanted to get your thoughts and advice. In our OR, we have 3 shifts (7a-3p, 11a-7p, and 3p-11p...11p-7a is call during the week and on weekends).

Even though we are a level 3 trauma center, we have WORK shifts on Saturdays and now recently changed, we work Sundays (not call, straight work time). The staff is very unhappy because surgeons know we have a scheduled shift on Sundays (with a back up emergency team) so they schedule non-emergent cases ALL day. The 7a-3p shift works weekends, and the mid shift and night shift take call 11pm-7am during the week (no weekends). I think that is fair...however, the 7a-3p shift takes call now from 3-11p during the week to help out if cases go over and if we're busy. So rather than staffing the evening shift appropriately, they call the morning shift back in or we stay over after working 7-3 which is exhausting.

I hope all of this makes sense. I have met with my director and manager about these issues and was hoping any of u could share how ur call works, and if it works for you. Myself and other nurses are very unhappy because we are taking a lot of call. AND working sat & sun...what is that?!

In addition, they changed call pay on holidays to time and a half rather than double time. We earn time and a half when we come in on any day! So now there is no incentive to work holidays. How does ur OR work?

Thanks for ur time

[Rose_Queen, BSN, MSN, RN]

We staff 24/7 (level 2 trauma) with one team in house after 11p, which means those on call after 11 get called in if there is any case whatsoever. Call in main OR is in 8 hour blocks (3p-11p or 11p-7a). Required one call shift per week. Work every 3rd weekend, generally 3 shifts of any combination (1 work, 2 call/ 2 work, 1 call/ etc.). Time and a half on holidays whether working or called in. Time and a half if called in or staying past end of shift. If working the weekend, definitely get a day off during the week so that scheduled shifts are not more than 40 hours per week. We do get a lot of non-emergent cases on weekends, but the reasoning behind it is that waiting for surgery is the only thing keeping the patient in the hospital. Insurances aren't paying to keep people in the hospital an extra day or two because it happens to be the weekend, so it's actually more cost-effective to get the patient through surgery and out the door. We see a lot of fracture management and lap choles, as well as many many many endo procedures.

[canesdukegirl, BSN, RN]

Oh my goodness! That's a lot of call for the day shift to take.

I work in a L1 trauma center, so we staff evenings, nights and 4 teams on the weekends. Our shifts are as follows:

0700-1730

0700-1930

0900-1930

1100-2330

1300-2330

1500-2330

1900-0730

Evening shift (defined as 0900 or later) is not required to take call.

We have specialty teams that take call, such as hearts, vascular, eyes,etc.

Because we are a L1TC, only emergent cases are posted on weekends, although we are required to do any case if the surgeon declares it an emergency.

Just to make sure I am understanding you correctly, I'll sketch out a scenario. Tell me if I understand...

It's Monday, and you woke up at 0530. You go to work, do your cases. The time now is 1500. You are on call. Your case is expected to end around 1945, so you don't get relieved. There are complications in the case, and it goes on until 2300. You give report, change, and clock out at 2320. You drive 20 minutes home, and after you have prepped for bed, your head hits the pillow at 0030.

The alarm clock blares at 0530 on Tuesday. You are tired! But long ago you made friends with Starbucks, and you are ready to face your shift. You are in a bilateral knee replacement, and the case runs over until 1800. You call report, get your pt OTD, and finish charting. You clean up supplies left in your room, and go change. You clock out at 1900. You get home around 1920, make dinner, relax, and then your phone rings. You get called in to do a lap appy. You don't leave work until midnight, because the nurse who was supposed to take 2300-0700 call called out sick. You end up getting home (again) at 0025.

Wednesday rolls around, and you just want to throw the alarm clock across the room, but you don't have the strength. You work your shift, and cases finish on time. You go home at 1530. You are exhausted, and can't keep your eyes open after you have eaten dinner. You crash at 2030.

Thursday...ahhh...nobody called you in! But there is a bug going around and several people called out. Thursday is a heavy elective day, and you hit the ground running. You end up staying until 2300. You go home, exhausted, but really mad that you have to face another day of this call nonsense.

Friday morning, you are in a daze. You are completely sleep deprived, haven't had one second of downtime, and you have several emergency cases rolling in. You get through the day and only have to stay until 2030.

You sleep in late on Saturday, but your phone wakes you up at 0930. "We have a total joint replacement today, so come on in!" your manager/charge nurse sings (which totally grates your nerves). During the procedure, the surgeon hits the popliteal artery, and vascular is called in to help out. You don't get out of there until 2000.

This is RIDICULOUS. No one should be expected to keep this kind of schedule. Well...except for surgical residents. However, they are expected to report duty hours, and they cannot exceed a certain amount of hours per week.

Ask your NM if s/he can hire some evening staff. Do some research about mistakes made as the result of sleep deprivation to support your case.

[LaRN]

canesdukegirl, I dont even work where you do and I'm ready to quit !!

[krwrnbsn]

Oh my goodness! That's a lot of call for the day shift to take. I work in a L1 trauma center so we staff evenings, nights and 4 teams on the weekends. Our shifts are as follows: 0700-1730 0700-1930 0900-1930 1100-2330 1300-2330 1500-2330 1900-0730 Evening shift (defined as 0900 or later) is not required to take call. We have specialty teams that take call, such as hearts, vascular, eyes,etc. Because we are a L1TC, only emergent cases are posted on weekends, although we are required to do any case if the surgeon declares it an emergency. Just to make sure I am understanding you correctly, I'll sketch out a scenario. Tell me if I understand... It's Monday, and you woke up at 0530. You go to work, do your cases. The time now is 1500. You are on call. Your case is expected to end around 1945, so you don't get relieved. There are complications in the case, and it goes on until 2300. You give report, change, and clock out at 2320. You drive 20 minutes home, and after you have prepped for bed, your head hits the pillow at 0030. The alarm clock blares at 0530 on Tuesday. You are tired! But long ago you made friends with Starbucks, and you are ready to face your shift. You are in a bilateral knee replacement, and the case runs over until 1800. You call report, get your pt OTD, and finish charting. You clean up supplies left in your room, and go change. You clock out at 1900. You get home around 1920, make dinner, relax, and then your phone rings. You get called in to do a lap appy. You don't leave work until midnight, because the nurse who was supposed to take 2300-0700 call called out sick. You end up getting home (again) at 0025. Wednesday rolls around, and you just want to throw the alarm clock across the room, but you don't have the strength. You work your shift, and cases finish on time. You go home at 1530. You are exhausted, and can't keep your eyes open after you have eaten dinner. You crash at 2030. Thursday...ahhh...nobody called you in! But there is a bug going around and several people called out. Thursday is a heavy elective day, and you hit the ground running. You end up staying until 2300. You go home, exhausted, but really mad that you have to face another day of this call nonsense. Friday morning, you are in a daze. You are completely sleep deprived, haven't had one second of downtime, and you have several emergency cases rolling in. You get through the day and only have to stay until 2030. You sleep in late on Saturday, but your phone wakes you up at 0930. "We have a total joint replacement today, so come on in!" your manager/charge nurse sings (which totally grates your nerves). During the procedure, the surgeon hits the popliteal artery, and vascular is called in to help out. You don't get out of there until 2000. This is RIDICULOUS. No one should be expected to keep this kind of schedule. Well...except for surgical residents. However, they are expected to report duty hours, and they cannot exceed a certain amount of hours per week. Ask your NM if s/he can hire some evening staff. Do some research about mistakes made as the result of sleep deprivation to support your case.[/quote']

Bless your heart! I need a vacation after reading this.

[Argo]

Canes, this sounds like my life for 4 years doing hearts and trauma..... Gets old but I was hungry for he experience, knowledge and money so It all worked out.

I have done scheduling in all of my facilities from 30 ORs with 100+ to 4 ORs with 35 staff.. It's a matter of basic math and ability to fill the numbers.....