We are in a nursing crunch but have the support to fill in w/agency staffing until our 3 RN's on orientation are ready to fill in. When our staffing numbers are to par (RN's) we will be at call every 4th weekend and call 1 night a week from 1500-0700.......first call for 8 hours and second call for 8 hours. We have 2 RN's and ST's on call from 1500-0700 rotating this each night. We staff with 2 RN's and 2 ST's until 1930 and 2 RN's (one in charge) and 2 ST's until 2300. Cases after 1700+ should be for urgent/emergent type cases but we don't have a medical degree to determine what constitutes the urgent/emergent. What we can do is if a questionable urgent case gets added and we're busy we tell the MD an estimated start time and if he doesn't feel it is appropriate he can speak with the MD next to start and "bump" that case......it usually takes care of it but not always. If it is a true emergency (crani, AAA, or stat c-section) we do not ask them to make the call as no one can argue w/what it is.
Our weekends are a bit different as we have a RN that works 7-1900 every other weekend and then 2 RN's cover call and our 3 ST's also cover call 1500 Friday-0700 Monday morning. We have a staffing proposal that was given to staff a couple of months ago, it was reviewed, and altered by the staff and are now awaiting the staffing to work out so we can implement it hopefully in early 2007.
Right now weekends are worked/on call without a day off before or after unless requested and the schedule allows. The proposal is that we have planned worked shifts on the weekends for the RN's and ST's and they are then given at least 1 day off either before or after the weekend for that much needed time away. Amazingly enough, not many are fond of the proposal! The main objection seems to be the money that is lost due to it being a worked shift vs. all called in time.........something I understand but also feel strongly about balance of work and home as well as the time off needed to reduce errors, injuries to staff, and staff sanity.
Hope this makes sense and while I could go on and on, just wanted to give you a hint of how other places do things. Not saying ours is right as we're also trying to improve