On-Call Nursing: What it is and How to Prepare

Nursing has one of the most intense, unconventional schedules with 12-hour shifts, nights, weekends, and working regardless of weather conditions. On top of that, some nursing positions require the nurse to be on-call, so what does this mean exactly? On-call, in most hospitals, is for nights, weekends, and holidays when a department is closed for scheduled cases but is always ready for emergencies. This means that the staff member is available at all times during their call shift, typically with a pager, to do an unscheduled case.

Who Takes Call

On-call tends to be a schedule requirement for nurses in the Operating Room (OR), Cardiac Catheterization Lab (cath lab), and Interventional Radiology (IR). For cath lab, emergency cases are typically active heart attacks; for IR, they are usually strokes or traumas; and for the operating room, they are also traumas or any emergency operations. These departments do not often schedule cases/operations overnight or on the weekend, so in these emergencies, the on-call staff has to be ready to jump into action and provide life-saving treatment.

The Logistics

Are staff paid the entire time they are on-call? The answer is yes, but the logistics are more complex than a typical pay rate and will vary across hospitals, states, and department policies. A common practice is to pay nurses a low hourly rate for on-call hours they are not actively working. As an example, if a nurse is on-call overnight, but the pager never goes off, they still could have made $5 an hour because of the expectation that they would have been ready to work if needed. When a nurse is called in for an emergency case, the pay rate can range from their regular salary to time and a half, once again depending on their policy.

What do on-call nurses do when there are no cases? Because carrying a pager is a big responsibility, the on-call nurse must be mentally and physically ready to work at any time. This means no traveling far from the hospital and no getting drunk. If they are at home with kids, someone else must be ready to take charge if they need to leave. Yes, they may shower- as long as they can still hear their phone/pager go off and get the shampoo out of their hair reasonably quickly.

Getting There

The expectations for being on-call will also vary but will be clearly explained during the interview/hiring process. It's typical for there to be a 30-minute or a 60-minute response time once the pager goes off to let the call team know there is a case coming in. When the expectation is to be at the patient's bedside or in the OR within 30 minutes, an on-call room will typically be provided.

It may also be that staff don't stay in the hospital when on-call, and they must drive in for a case. Knowing these details is essential before signing an offer letter because proximity to the hospital is a legitimate factor to consider. Some nurses may live far from a hospital but have family/friends that live closer with whom they can stay with for their call-shift downtime. They may have to consider getting a hotel room, which can be expensive, further emphasizing the importance of planning/understanding the logistics before hiring.

Tips

Adrenaline kicks in when a pager goes off, so it's important to emphasize here- do not speed if driving to the hospital from home. It's one of the rules of being a paramedic as well, no running; it creates a loss of control over the situation and increases the risk of accidents. Safety is always the number one priority, and that includes the safety of the staff.

A good tip for preparing for an on-call shift is to have a 'to-go' bag ready. It's never clear how long cases will go, and it's not uncommon to have back-to-back cases. After several hours of working hard, having at least a water bottle and some snacks can be a lifesaver. If driving is involved, it's always wise to have a full tank of gas ready, so there's no added stress of having to stop on the drive-in and relief of not needing to stop on an exhausted ride out.

If the nurse is provided a place to sleep on hospital premises, like a call room, they may want to pack a bag as if they were staying in a hotel room; toiletries, a book/entertainment, pajamas, and food that can be prepared in just a microwave.

Understanding how these shifts work and having these tips to prepare, one is ready to provide excellent nursing care on their first on-call shift.