Have You Ever Refused to Come in for Call?

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Specializes in PACU,Trauma ICU,CVICU,Med-Surg,EENT.

in december,a colleague and i,assigned to be on call 2300-0700 on this particular night, were called in at 2300 and stayed until 0220,then returned to our homes. at 0540 my phone rang - i was called in again. now,in our pacu we are given one hour to get in from the time we are called. it normally takes just about that long from where i live, and it would be at least that long on this snowy,icy (roads) night with winds gusting to 104km/hr (i guess about 60 mph). the conditions at 0230 when i went home were not great. we were assigned to be on again at 1500, but they don't care ("hey,you chose to work pacu!")

so,that would bring my arrival time at 0640...20 minutes before the day staff was due in. i called the or and told the charge that i would not be coming in all that way for 20 minutes. my colleague,whom i'd called and consulted before i called the or, was going in - she lives right in the city,about 20 minutes away - i,in a suburb.

yesterday,i received a note from my nurse manager requesting that we meet to discuss. she'd included an email she'd received from the nurse manager of the or to whom the charge nurse had reported me that night. interesting that the or nm decided it was fine to pad her argument by saying that i refused to come in for "30 minutes". my clock read 0640 not 0630. i won't back down on that!

i expect i'll be told i had no right to refuse to come in. i'm sure that under the terms any of us work in pacu,that the rule is: you do whatever you need to do to be in on whatever call shift you're assigned...no matter what. fine!

but, in your opinions,......is there a reasonable time at which you can refuse to come in - a point that is just common sense!?

for instance,if they call you at 0555 and your arrival time is 0655....5 minutes before the day staff is due....is it reasonable to refuse to come in...this has actually happened! it has even happened that on call staff here were called at 0600 to come in....right when the day staff walk through the door.

have we no say at all? you certainly hear lots of examples of anesthetists refusing to come in at night to do a case the surgeon wants to do! is it too much to ask for someone already there to wrap a bp cuff on,do a resp count,get warm blankets,sit with the pt - especially for a mere 20 mins on a winter night when we'd already been in. i think their (implied) response, "tough! i wanna go home!" is just a little bit 'precious'.

my question is: is there a cut off time (official or assumed) in your pacu after which you can refuse to come in?

maybe i need to leave pacu...maybe 28 years is long enough to be a nurse,maybe i'm burnt out...i just hate that we nurses spend our entire careers doing what we're told to do -by both doctors and administration.

i feel powerless.

thanks for your thoughts,

jen

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Specializes in Critical care.

If the night call is expected to be in for a case that's going to start around 4:30am or so, usually one of the day people will just come in early instead. The early people start arriving around 6am anyways, and the day charge RN is nice enough to actually come earlier for the previous shift's night call person. Of course, if he isn't available then YES, the night call is expected to come back. It totally sucks.

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Specializes in PACU,Trauma ICU,CVICU,Med-Surg,EENT.
If the night call is expected to be in for a case that's going to start around 4:30am or so, usually one of the day people will just come in early instead. The early people start arriving around 6am anyways, and the day charge RN is nice enough to actually come earlier for the previous shift's night call person. Of course, if he isn't available then YES, the night call is expected to come back. It totally sucks.

Thanks for your reply,Southern Fried! :)

We only do emergencies (or "emergencies") after 2300, so the call staff, as well as the oncoming day staff, don't have any idea what,if anything,is going to be done that particular night. We just know when we're called at home to come in.

Could you see your OR staff deciding to hold the pt in the OR for 5-20minutes before the day staff is due to come in anyway? Or would they call you in no matter what?

Btw,how much time are you given to get into the hospital after you're called?

Thanks again!

jen

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Specializes in OR, Nursing Professional Development.

We have a hospital wide policy that those on call must be at the hospital and ready to work in 30 min. That being said, there are several PACU nurses who are 45-90 min away. We also only do "emergencies" after 2300, but we work with bare bones staff (1 RN and 2 STs, both scrubbed) in the OR and if we call a code, the PACU nurse is supposed to come back and assist. Elsewhere in the hospital, the code team responds, but the OR is on its own. Because of that, I don't believe refusing to come in when called is acceptable at all.

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Specializes in CTICU.

I don't work in PACU, but I do take call. If I'm called to come in for a case starting at 07:15, and I know that the day staff will be there at 07:30, I'd call a colleague and asked if they minded taking it for me. If they couldn't, I'd go in. That's why I'm on call.

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I never refused to come in for call. I have spent the night at the hospital in blizzards tho, to avoid another drive in! I have been there until 6 a.m. and had to report back at 6:30 a.m. as well, however, our manager would always try his best to get us out of there ASAP- sometimes it would be after lunch, depending on the day. We were expected to come in when called- day shift took over as soon as they got there. We also had an hour response time, but until that day shift is THERE, there is no coverage for that patient. We've had staff with last minute call-ins, car problems, etc. It was always our responsibility to be there when called in- there really was no question. What was the outcome of the meeting w/your manager?

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Specializes in PACU,Trauma ICU,CVICU,Med-Surg,EENT.

The meeting is Monday. It may not sound like it,but I am not a person who has a history of challenging "that's just the way things are". Today has been a total ruin for me,I am so upset about this. I am dreading it -not because anything will be happen to me,but because I'll feel 100% frustrated that things are not going to change. I have never complained about my call shifts,sometimes I pick up extras -we all have to), and I've never missed one.

We are allowed one hour to get in - if,allowing for that block of time,the difference left before the day shift reports is 5 or 10 or even 15 minutes...doesn't anyone think it ludicrous that the call staff should be obligated to come in once again for that ridiculously short period of time period of time? Doesn't matter if "that's what on call means" - it defies common sense,imo.

It's about time that hospitals eased back on nurses a little - the mandatory call is a killer,we'd probably all agree -and reporting back at 1500 after being up most,if not all of the night is horrible,at best.It is hard enough to hire RNs into PACU as it is,let alone retain them (people have left in droves in this unit over the past year -one of the reasons is call and the other is having to do nothing but 8hr shifts). As well, the average nurse is well into middle age (the median here in Canada is 45 years old) - we are frequently injured,in pain,and/or sleep deprived. I think asking for this very small concession is definitely not too much to ask.

I am going to lobby for a 15 minute zone,during which time the anesthetic staff watch over the pt,as they do in the daytime when we have the theatres on hold. Or,maybe there could be a policy between the nurses that the day staff would be called to cover that 15 minute period.What's the point in having everyone overtired?

That being said,I expect my ideas will be squashed. :banghead:

PS. Of course there would be coverage for the pt - the anesthetic staff who did the case. Even if the call staff for whatever reason were not there -the pt would never be left alone. They may not be thrilled about it,but hey,sometimes life happens.

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Specializes in PACU,Trauma ICU,CVICU,Med-Surg,EENT.
I never refused to come in for call. I have spent the night at the hospital in blizzards tho, to avoid another drive in! I have been there until 6 a.m. and had to report back at 6:30 a.m. as well, however, our manager would always try his best to get us out of there ASAP- sometimes it would be after lunch, depending on the day. We were expected to come in when called- day shift took over as soon as they got there. We also had an hour response time, but until that day shift is THERE, there is no coverage for that patient. We've had staff with last minute call-ins, car problems, etc. It was always our responsibility to be there when called in- there really was no question. What was the outcome of the meeting w/your manager?

Hi Penquin,

Do you mean that in your rotation,a day shift may be scheduled to begin just as your call shift is ending?! The only shift allowed here after a call is a 1500-2300. Otherwise,there are serious pt safety issues due to lack of sleep. How is it handled if the call is all night...you still have to work? Wow,I can't believe your labour code allows that.

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Specializes in CTICU.

If you want to change the policy, that's one thing. You can go about doing that prospectively in various ways. Refusing to come in when you're on call is not one of them.

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Hi Penquin,

Do you mean that in your rotation,a day shift may be scheduled to begin just as your call shift is ending?! The only shift allowed here after a call is a 1500-2300. Otherwise,there are serious pt safety issues due to lack of sleep. How is it handled if the call is all night...you still have to work? Wow,I can't believe your labour code allows that.

Yes, that's right- a day shift would be starting just as my night call is ending. Our manager goes to great lengths to see that we're not there past lunches, and many times I have been sent home as soon as they arrive, depending on how much I was up during the night. If I was there all night- I would stay until day shift arrived, and was not expected to stay- they would float a nurse from another unit to cover pre-op and then send the pre-op nurse to PACU, since we are all cross-trained. However, I was still expected to stay until arrangements had been made. I work in a small but extremely busy rural hospital, so we have no 2nd or 3rd shifts for surgery. After hours call is for emergencies only- but that also includes OB, we also do a large amount of trauma as well. I have been doing this a long time as well, and the only compensation for the miserable call is it's all overtime for any callback, plus shift diff. I feel for you- I know what it's like to be sleep deprived. I was once called on the carpet b/c a 'stat' OR case was called, and I had to leave immediately to come in & help OR- when I got there 30 min later, no one was in the OR- the supervisor had 'forgotten' to cancel the staff!! I was very tired and short w/her and was reported the next day. Fortunately, I had written the supervisor up as well- as had several other members of the team- including our anesthesiologist- apparently the case had been cancelled w/in minutes of calling in the team, and everyone else had showed up as well & was irritated-- so I was 'off the hook'. I really don't think it is appreciated by other depts that PACU/OR may be up 1/2 the night and still have to work the next day. I have been called in 3 & 4 times in one night, and frankly I'm ready for a change! Since I love PACU & pre-op, I am considering transferring to a surgery center now. Good luck to you, and keep us posted.

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Specializes in ED, ICU, PACU.

I think the main problem you have is that you can be called back multiple times. Seems like that once you are called in you should be allowed to stay for a predetermined number of hours and if a new case comes in after that time, there should be some contingency call person assigned (maybe even the manager) to cover the situations like what you described. It just isn't fair that you have to travel back and forth multiple times during an on-call shift and then be expected to possibly do a scheduled shift.

Can certainly understand why your place has had the turnover. Maybe you could talk some sense into them. Good Luck. Wishing you the best.

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Well if there's nothing "in the wings" or in the ER or OB, we all go home w/the hope that we can sleep the rest of the night and NOT be called back!!-- it happens sometimes- we don't always get called in more than once, and sometimes we don't get called at all! Such is the nature of call- when you don't get called in you think "that wasn't so bad" but then you get slammed sometimes and wonder how much longer you can do it. We've had a high turnover of younger staff b/c call interferes w/a social life!! At first it seemed better than every other wkend and holidays, then it gets old. :twocents:

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