OR call

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Hi everyone, I am wondering about OR call. I work a small rural hospital with 1 OR suite. Currently we do not have mandatory call, but coverage has been an issue. We have 1 FT RN, 2 RN's who work in the area PT and 1 RN who is casual. There are 3 additional RN's who can cover for us and take call. There is 1 surgery tech and three of the listed RN's can scrub. Mon-Fri 7a to 7p is well covered, it is (mostly) the weekend and some 7p-7a that is the problem. Of the 7 RN's who can work in the OR 5 also work outside the OR, they may work the floor or ER. They are already obligated to weekend shifts. What typically happens now is one/two the RN's who are working day shift will be on call for the night shift, same for the weekends. If however no one is scheduled for the weekend its not picked up for call. Most people feel they have already worked their three 12's and have probably taken at least one day of call, they simply do not want any more. I hope this makes sense, and hopefully someone out there will have been in a similar situation and can offer some advice.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

Welcome!

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Specializes in CST in general surgery, LDRs, & podiatry.

Curious ~ what makes the difference between a weekend that has scheduled call and one that doesn't? Now, before anyone says "it means one weekend is covered and one isn't" that's not at all what I mean. Obviously if some weekends have been scheduled, why aren't all of them? Does it have something to do with who is making out the schedule? With who has already worked and who hasn't?

Also, I'm having trouble with the concept of not "wanting" call because one has already done their three 12's. Call has always been over and above the hours already scheduled for regularly worked shifts from 7A to 7P, and I have worked just about every size hospital, from major metro teaching hospital to small county hospital (one where OR call began at 3P on Friday and ended at 7A on Monday when your regular shift began, and another even smaller where almost everything got sent to a larger metro area facility about 15 miles away on weekends), to surgery center. Nobody (almost) really "wants" call in addition to their shifts, but it's always been part of the job. There needs to be at minimum a scrub person and a circulator, where the circulator (or RN scrub) or even a floor nurse can double up as PACU nurse. How are the weekends being staffed now when nobody "picks up" an unscheduled weekend? Who comes in? How are they located, and what happens to the patient in the meantime?

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Thanks for the response. We don't have any mandatory call, everyone volunteers. There are a total of 7RN's and 1 scrub tech to cover the OR. 5 of the RNs also work in the ER or on the floor a combination of weekdays and we are obligated to every other weekend (for actual work hours). What typically happens is if I work anywhere in the hospital on say Mon. Thurs. and Sat. (7a-7p) I will take OR call those nights from 7p-7a. If none of the "OR" nurses are scheduled to work on Sun. of that week that call day will not be filled. What happens if there is an emergency surgery? either all the nurses are called in hopes that someone will say yes at the last minute or the ER is advised that we are not staffed and any surgeries will have to be transferred. By not wanting call (especially on the weekend) I mean that if I work the first and third weekend of the month on the floor or in the ER and so does another OR nurse and they sign up for call those day/nights before I do. I do not want to volunteer to be on call for 2nd or 4th weekend. I hope that clears a few things up.

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Specializes in CST in general surgery, LDRs, & podiatry.

Wow. To be perfectly honest, it sounds like a disaster waiting to happen. It looks like there are two options. Either Adminstration keeps on blindly as they are, simply hoping nothing bad ever happens to anyone, and putting their necks out for trouble, or some kind of mandatory coverage is established. I don't know where you are, or what kind of population your hospital is serving, but in today's litigious climate, it wouldn't take much to generate a major lawsuit, while someone suffers the physical consequences.

None of this is on you of course, but it sounds to me like whomever is in charge of it all needs to wake up. With only one OR it would certainly seem there isn't big demand, but the fact that it's there at all generates an expectation of service. I can't imagine a 21st century facility that wouldn't be able to cover its OR "off shift." Unless it's turned into some sortof "Surgery Center" for legal purposes, that doesn't provide 24/7 care.

I'm curious what the docs think about the inconsistent coverage?

Wishing you good luck!

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Specializes in ED, OR, Oncology.

It seems that the call staffing of the OR should mirror the call or availability of a surgeon on those days/hours. There are several specialties at my facility that we might do a call case if the surgeon happens to be available, but it is understood that if we dont have that specialty available, they ship if it is emergent. Perhaps in a small enough facility, it is that way with the general surgeon? I would assume with one OR, volume is low, so probably a very limited number of surgeons- quite possibly not enough for 24/7 availability.

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Specializes in O.R., ED, M/S.

Problem is the call shouldn't be on a "volunter" rotation. It is a disaster in the making unless your hospital makes it mandatory. Administration probably doesn't say anything to avoid paying stand-by pay. Do you get pay for this volunter work?

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Specializes in NICU, ER, OR.

so you have an OR that can sometimes do a case, and sometimes not? WOW never heard of such a thing. Sounds like management needs to step up and make call mandatory.

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