How Does Call Work? 1st Call 2nd Call? Etc.

[SweetSouthernLove, ASN, BSN]

I am a new grad entering the OR and will be starting the Periop101 course. My hospital has very distinct specialties. I have so far just observed ortho and neuro and both of which I wouldn't mind circulating or scrubbing for. I also would not mind participating in general cases to maintain a diversity in this specialty so that if I am called upon to do something I will have some sort of knowledge base and know how. Although, again, I am unsure how this works at my hospital and will be asking my coordinator for explanation.

My interest is in cardiac/open heart but I was told by my coworkers that I have shadowed that this specialty takes all of their own call and that they are on call up to a third of the month, which is the most extensive call of any specialty at my hospital that I have heard of. The call system has not been explained to me by my periop coordinator yet, but I do plan on getting a full and very clear run down before I commit to a service.

My main question is how does call work in general at your facility? I have heard of my coworkers saying they are on 1st call and 2nd call and have no idea what that means. If so, do you just report to a case or are you called or paged? Do you have to stay in house for the duration of your call if you are already on hospital campus or can you leave to go to home until you are needed? I just want to be as informed as I can be as I do not know anything about taking call in the OR. As previously stated, I will be asking my coordinator to explain this during our full orientation day coming up. Any helpful advice would be much appreciated!

[WhoDatWhoDare, BSN, RN]

Call is pretty much where the call person is "called in" for emergent cases or must stay late when there is insufficient staffing on duty to complete the scheduled cases at that time, typically during evenings and weekends. How often you get called in or required to stay late is based on the staffing levels, if your OR is staffed 24hr/day, the phase of the moon (just kidding, not kidding), and what call you are (1st, 2nd). There will be a separate call schedule for the RNs and the surgical techs.

1st call is just that, you'd be 1st to be called in or have to stay late... 2nd is called in 2nd if additional rooms are needed or 1st call is MIA (not a good thing). For emergent cases, there's usually only 1 RN and 1 surgical tech plus ancillary support personnel (SPD, anesthesia tech, recovery RNs, etc.) called in. An example would be a patient who presents to the ER with a ureteral obstruction like a kidney stone. This is emergent because it can cause acute kidney injury and a stent needs to be placed overnight until the patient can be brought back in as a scheduled case for lithotripsy. Occasionally, there could be up to 2 surgical techs called in depending on the type of case (e.g. laparoscopic cases where you have someone driving the HD camera and another passing instruments).

Hope this helps.

-WhoDatWhoDare

[Rose_Queen, BSN, MSN, RN]

It's really going to depend on your facility's policy. For everything except cardiac, we have 2 RNs and 2STs on call during 2nd and 3rd shift. If we do a case, one of each is called in. How that's decided could be what specialty the person spends the most time in, how close they are (if it's a trauma that's bad, I'd call the person who lives 5 minutes away before I'd call the one who lives 25 minutes away to get extra hands on deck ASAP), and other things up to the judgement of the charge. We don't designate 1st call or 2nd call. They do take turns on who comes in- if Nurse A and ST Z got called in to do a case and then went home, Nurse B and ST Y would get called in if a second were booked.

Cardiac is different- there is one team on all night long. Then, we have a second team (AKA loser list) who has to stay if there are 2 cases running at end of shift or come back in if the call team is still working and another emergent case pops up.

[SweetSouthernLove, ASN, BSN]

Thank you both so much for your responses! I did get clarity on the call system yesterday which after reading both of your posts seems very helpful. My coordinator said it is $3.00 per hour for call though. Does she mean that is ontop of base pay? I would hope so! Haha. Sorry if my questions seem really stupid. I am just not used to call, but I do think it is a fabulous way to make extra money!

[Rose_Queen, BSN, MSN, RN]

I doubt the $3/hour is on top of base pay. When I am on call, I get paid $2/hour. That is for any time not spent working ONLY. If I am called in, I get paid at time and a half for a minimum of 2 hours. So, if I get called in, clock in, and find out the case got cancelled, I just got paid a heck of a lot of money for 30 minutes of driving back and forth. But then, I've also been called in where I've worked for the entire call shift. Made some major bank (16 hours at time and a half? heck yeah!) but it was hell on the body.

[morenita0527]

At my job first and second call is for trauma only (rn and scrub). Third and 4th is urgent cases like appendectomy. We have to report within 15 minutes for trauma and an hour for call 3. More likely to get called in for urgent cases, not always trauma every night.

[Leighton126]

AWESOME POST FOR ME

[iverina]

call is very different depending on your facility. I would make sure to have them explain it very well to you. Call shifts can also greatly differ depending of staffing of different shifts. My hospital does not staff a lot of evening people and none overnight. IF you are call one you are working 80% of the time, call shifts are 24 hours.