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Help! Asked to Write On Call Policy

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I work in OR and if we work past midnight we do not have to work the next day. This is creating shortages and problems

Help! Asked to Write On Call Policy

Dear Nurse Beth,

I was asked to write some standard work or policy for our On-Call hours. I work in an OR that has set hours of operation from 0645 to 1515, with on-call hours starting at last case of day or 1515 to 0700 the following morning. Currently, the mentality is that if you work an on-call case past midnight you do not have to work your scheduled shift the following day. This has created numerous problems as we have shortages with almost every position in our OR. I have been trying to reach out to other facilities to find out what their on-call policies are and thought I would give this a shot. Any information would be greatly appreciated!

Dear How to Write OR On-Call Policy,

My impression is that your problem is lack of a plan to cover unplanned and emergent cases, and not so much the call policy.

When there isn't enough staff to meet the required hours of service...nothing you can write or schedule will solve the musical chairs game.

How to Write a Policy

To write a policy, at a minimum, first research state labor laws, your facility's policies, and the Association of peri-Operative Registered Nurses (AORN). These guidelines and laws will provide a sound foundation for your policy.

Reference these sources in your policy reference list.

In writing the policy, it is not your primary goal to "fix" the problem- it is more important to write the guidelines that will be followed when staffing decisions are made.


Start with your state's labor laws. Your HR department can tell you how many consecutive hours a nurse can work (for example, 18 hours) and how much time off is required between shifts (for example, 8 hours). There must be a reasonable amount of time off for rest and recuperation between shifts.

Ideally, there should be call staff who are supplementary and additional. Alternatively, there has to be a system in place to relieve nurses of their regularly scheduled shift when they were on call after midnight.

Write your policy accordingly to state how many hours must elapse between working.

AORN Position Statement

The following is a direct quote from the Association of peri-Operative Registered Nurses (AORN) Position Statement on Perioperative Safe Staffing and On-Call Practices:

"Perioperative RNs should not be required to work in direct patient care for more than 12 consecutive hours in a 24-hour period and not more than 60 hours in a seven-day work week. All work hours (ie, regular hours and call hours worked) should be included in calculating total work hours.

The staffing plan should promote quality patient outcomes by using patient acuity and nursing workload guidelines to deliver safe patient care and support a safe work environment. The plan should identify strategies for cost-effective and efficient staffing priorities without compromising perioperative patient safety and outcomes.

The perioperative staffing plan should include provisions for unplanned, urgent, or emergent procedures and how to provide care for patients when procedures run over the scheduled time.

On-call staffing plans should be based on strategies that minimize extended work hours, allow for adequate recuperation, and retain the perioperative RN as circulator.

Call staffing should be provided in accordance with standards of perioperative and perianesthesia nursing practice".


Other Causes

If your doctors are regularly scheduling late cases, and the set hours of operation do not match the actual utilization, maybe that needs to be addressed.

Does another shift need to be added, such as 1400 to 2200?

HealthCare Fatigue

The primary concern here has to be patient safety.

Airline pilots are not required to work beyond the limits of safety, and the same should be true for nurses. OR nurses have to be alert and sharp.

Health care worker fatigue and patient safety is a growing concern and Joint Commission is beginning to focus on this area. The on-call schedule may require a larger pool of staff to provide ample staffing for coverage.

Best wishes,

Nurse Beth


Author, "Your Last Nursing Class: How to Land Your First Nursing Job"...and your next!


Nurse Beth is an Educator, Writer, Blogger and Subject Matter Expert who blogs about nursing career advice at http://nursecode.com

21 Likes, 5 Followers, 77 Articles, 222,296 Visitors, and 1,582 Posts.

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Your airline pilot comment reminded that even truck drivers have a restriction of hours on the road at ay one time. Like they have to show their log books to authorities when required, like at mandatory truck stops.

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I used to work in the OR and now I'm in the cath Lab so I've been on call almost all my life, and in every facility it is a different story with the call situation. The best so far was if you were working at a certain hour lets say 3 am, and go home close to your shift you were allow to go and rest for 8 hours and then return to work in case you are needed. The other I did like was that two teams were schedule to cover late cases, one team will stay to finish the day and the other will go home being on call. This way the on call team would rest in case of an emergency shows up.

I guess the main problem you are facing is the schedule, if you are working so late is because you are so busy, so you will need to change the schedule to 10 hours shift not 8 hours anymore. And even probably a late shift coming at 11 am. Hope this help

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I also work in the OR and as your place, the team that has worked in the wee hours of the morning for the most part are able to stay home and rest. Then call in by X hour (set by our policy) to see if they are needed. It's not about anyone's "mentality". It's called common courtesy and respect for that team. There is nothing worse than working a long tedious shift only to come back on call and work till the wee hours of the morning and still expected to come right back all fresh and sharp. That is simply not safe! If anyone came and changed that I can tell you that there would be a TON of disgruntled employees who would take a hike, start calling in and overall the our unit's morale would take a dive. We are actually "the" OR people want to work at in my large town because of our "mentality".

We have 3 shifts and they work beautifully and affords us to have strong support for keeping us safe, alert and home when we need to! We have 6:30-1500, 6:30-1700, 0700-1900 and 1100-2300. After 1700 we have 2 OR's going for any specialty except for heart. The heart team takes different call and are called back for only hearts if needed. We are all well rounded and do every service. It's a very nice unit to work because of that support. We take care of each other and do not see it as a drag or inconvenience if we are missing a team the next day because they got to stay home.

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Patient safety is the key issue. Sleep deprivation has been has been studied. Reaction times and the judgment of sleep deprived persons have been documented. Pilots can't fly, truck drivers can't drive, but Nurses and other OR staff can work? Hopefully, they will not be sleep deprived when they are taking care of me or my loved ones! I have worked many "On Call" night shifts. I worked 8 hrs during the day and came in at 11 pm till 2 or 3 am. I was expected to work the next day as well. I was was allowed to be the 1st to leave. If I worked more than 5.5 hour into the "Night Shift", then I would not be expected to work my scheduled shift for the following morning. Sleep deprivation leads to impaired reaction and judgement skills, no one should be expected to provide care to patients without a significant rest period. You may need to hire more staff. You may need to adjust the start time for those "On Call " the night before. 10 or 12 hour day shifts will not cover the 11p-7 a "On Call". I know that not having staff in the morning for the OR is a nightmare.

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