Calling in the “On Call” person when someone calls out

[Ginger27, BSN, RN]

I was told that there’s some kind of ethics/legality with calling in the on call person when someone calls out sick. For example: Susie says she’s sick today so she calls out. There is on call staff available to call in. Is it ethical/legal for the on call person to be called in for that?

A coworker told me that on call staff is for emergencies (when there is an overflow of patients), not to replace people who call out sick. The hospital is supposed to staff the call out position with someone who is present for their scheduled shift (rather than bringing in an additional person). 

For reference I work in Postpartum OB. Just wondering if this is a thing or not!

A coworker called on a Saturday to ask if she could be canceled on the upcoming Monday night because she didn’t feel like working (and is notorious for calling out because she doesn’t feel like working). I am on call during her scheduled shift, and likely will be called in when she calls out.

Just wondering if there is any truth to what the other nurse said about how it isn’t ethical/legal to call in staff when the hospital needs to find a scheduled replacement/use currently present staff. If it isn’t ethical/legal I’d love to see some references! It’s not in my hospital policy as an FYI. 

[TheMoonisMyLantern, ADN, LPN, RN]

There's certainly no legal/ethical dilemma when calling an on call person. I assume this person is the administrator or nurse manager that's on call? If so, then your co-worker is right, they typically are contacted for emergencies. Sometimes they get contacted for critical staff shortages but not for routine call ins. Also at a lot of the facilities I worked only the shift supervisor was allowed to contact an on call manager, not the staff nurses. That said, it can vary by facility, I'm just going off my experience. 

[Ginger27, BSN, RN]

For my OB unit we have staff nurses on call when we need them. We are required to schedule ourselves for 24 hours of on call time per 6 weeks. A coworker wants to call off several days ahead of time and we’re already short staffed leaving the on call person (me) to come in, in place of her (which is what I expected with no issues there). A coworker told me that there’s some legal/ethical issue with that and the hospital should be providing already scheduled staff to cover the hole made by the call out and on call staff are reserved for when there’s a surge in patients coming in. I have no problem coming in, just curious if this was a thing because I can’t find any evidence of it!

[Rose_Queen, BSN, MSN, RN]

Sounds like something that should be discussed in policies for the facility. There wouldn’t be any legal/ethical issues that I can see. 

I work in periop, and we have on call folks. We do not use them just for emergencies- if it’s end of day and more surgeries are ongoing than evening shift staff, the call people stay to finish. If someone calls off, the call person works the shift and someone else either volunteers or, via the rotation list, whoever is up to be mandatory call coverage takes the call. All spelled out in our policies. 

[JKL33]

No this is not a legal or ethical issue.

35 minutes ago, Ginger27 said:

The hospital is supposed to staff the call out position with someone who is present for their scheduled shift (rather than bringing in an additional person).

If there is somehow true overstaff on a unit that can reasonably float someone to cover the hole, they will do that first. They don't want to pay call-in rates if they don't have to. But if that scenario doesn't exist then expecting them to cover the hole with someone already there is just shifting the holes around, not actually covering them.

There aren't going to be references for this. There just isn't a legal problem with it and I don't know what would be significantly unethical about it. You might get further by asking your coworker where s/he ever got the idea in the first place. I would say the only reason this isn't even more common is because of the extra expense, as opposed to the  much more common shrug and "we called everyone and no one will come in" approach that saves them money.

Unless you're in a union and there's some agreement about on-call that relates to this topic, there's nothing here.

[Ginger27, BSN, RN]

Thank you everyone! That’s what I was thinking also but my coworker insisted on it that it was true. There’s no formal policy for it so I wasn’t sure myself. I’m new to the on call world! 

[Nunya, BSN]

I agree, no legal or ethical problems but if I knew someone had asked to be off and was refused and then called off you bet I'd be letting my boss know.  That's BS.

[kp2016]

This is a policy issue. I've had plenty of on-call jobs and there was normally some written or at least informal policy on when on call staff were to be called in.

Having said that we were not called because certain staff "didn't feel like working". In fact one time a co-worker had the audacity to actually tell me she didn't feel like working the rest of her shift and I should call in the on-call person so they could go home, our supervisor told her "No, you will finish your own shift". Probably because I told the supervisor that she had told me she wasn't actually sick.

In your case if Susi called you Saturday night to basically tell you she plans to be sick Monday, I would be passing that information onto your manager so they can deal with it. Lots of hospitals actually having disciplinary policies for staff who abuse sick leave. 

[Sweetheart2005, ASN]

My unit doesn’t do on call. If we have a call off that makes us short, we’ll pull from float pool first if a reasonable   option (there’s only one or max of two per shift in the hospital if that—small hospital)  they go to where it’s needed most. Then We pull from another area if they have extra staff. Then will call people who are off but will sometimes come in to see if available. We have a free charge nurse so sometimes she’ll take an assignment depending on meetings she is required to attend and how short we are. Otherwise we just do a higher nurse:patient ratio.

I would see no issue using on call for any staff call out, however If I was on call, I wouldn’t mind covering Suzie Sick-girl, but the lazy “I don’t feel like working” I wouldn’t be happy with. Management needs to let her know that she can’t just choose to call out because she doesn’t feel like working. 

[JBMmom, MSN, NP]

Maybe it varies by department as well. If we have someone on call in our unit, they are called in for any reason, including call outs. However, we did have a time recently than an ICU overflow patient was going to have to go to PACU and our PACU isn't staffed 24/7 so they were going to call in staff. I guess the PACU nurses refused to come in because it wasn't an OR issue, it was a hospital staffing issue- because we had no open critical care beds and there was a code on the floor. We ended up having a ICU nurse care for the patient on the floor until day shift came in. Then they told us it shouldn't have happened and the PACU nurses should have come in, but of course no one can actually address things on nights. Oh well. 

[0.9%NormalSarah, BSN, RN]

I’ve been on call and called in when others have called out sick, it’s not bothersome. I agreed to take call knowing full well I would potentially be called in. I can’t judge them anyway. However, for the buttheads that plan to call out or do this frequently just because they know they’ll get covered...all I can say is people are typically good at getting themselves in trouble without my help. 

[kp2016]

On 1/27/2021 at 2:56 PM, JBMmom said:

Maybe it varies by department as well. If we have someone on call in our unit, they are called in for any reason, including call outs. However, we did have a time recently than an ICU overflow patient was going to have to go to PACU and our PACU isn't staffed 24/7 so they were going to call in staff. I guess the PACU nurses refused to come in because it wasn't an OR issue, it was a hospital staffing issue- because we had no open critical care beds and there was a code on the floor. We ended up having a ICU nurse care for the patient on the floor until day shift came in. Then they told us it shouldn't have happened and the PACU nurses should have come in, but of course no one can actually address things on nights. Oh well. 

The problem with using your PACU on call staff to cover ICU overflow is that they are then not available to do emergency surgery cases. It depends on the hospital but a lot of smaller hospitals expect the PACU nurses to collect the patient, bring them to the OR and check them in while the OR staff open up for the case. The management answer to that is always, well "it probably won't happen", the ward / ER/ ICU staff can bring the patient to the PACU/ come get them, the Supervisor will come and help....blah blah blah

Trust me it does happen and "everyone" is always too busy to "do your job for you". Having a clear written policy on the role of your on call staff and the exact criteria for calling them in saves lots of middle of the night drama.