NICU On-Call? How to make it work?

[brittjones24]

Our NICU initiated a "prescheduled on-call policy" about a year ago during a time of high census and high acuity. We are a level III, 28 bed unit. At that point a year ago, we were averaging around 18-20 babies for approximately a 3-4 month period. We were basically utilizing the call person every shift because of the high census/acuity. At that point in time, initiating this policy made sense... although we all hated it and unfortunately lost a decent amount of staff because of it.

In the last few months, I would say we have averaged 12 or so babies.. and somehow still justifying using our on-call nurses. Nurses are being called in most of the time to ultimately staff the unit or they are being left on call just in case.. even though there would need to be 2+ admissions to really need that on-call person. Nurses are also being called in to have the charge nurse free and having a 2:1 patient to nurse ratio including level II patients. There are plenty of days that we do not have an on-call nurse and we somehow figure it out.. but other days we are using 8 nurses for 12 babies (including a free charge). We are being paid $3.75/hr that we sit at home while on call and paid time and a half if we are called in.

For those of you on units that have call year round, how big is your unit and how many nurses are supposed to be staffed per day? Does the charge nurse take patients before calling your on-call nurse in? Are there certain criteria that have to be met before utilizing your on-call nurse? Are bonuses offered before the mandatory on-call? Is there a policy in place discussing the use of on-call? HELP!