Weekend Call in the Operating Room

[Andie87]

Hello all!

Our staffing has recently been a topic of controversy in our operating room and I was just wondering how other ORs handled the issue of call.

Our main issue, as of late, is covering call when the previously scheduled "call person" is sick, goes on medical leave, has a death, etc. Our current policy is such:

Say Sally is on call this upcoming weekend (7am Saturday until 7am on Monday). On Wednesday, Sally has to have emergency surgery and will be gone for two weeks. Therefore, she will unable to fulfill her weekend call requirements. The supervisor will first ask for a volunteer to take the call. If there are no volunteers, the supervisor will draw a name from a hat for each day (One for Saturday and one for Sunday) and that person will then be assigned call. That person will then be exempt from any future drawings until the entire rotation of staff has been drawn. The employee's name will also be removed from the hat if said employee volunteers for a call shift.

This policy has been controversial for many reasons. The short notice of "randomly assigned call" is a huge issue for many, especially if you already have weekend plans, have a trip planned, have childcare issues, or perhaps even another weekend PRN job elsewhere. With barely 48 hours notice sometimes, it can be a headache.

So how does your facility handle this? Do you have back-up call? If so, are they paid the same as the "regular" call? Do you have some sort of list or rotation?

Please help me out!

[mhy12784]

Mine goes by seniority from the bottom up, with everyone taking a turn in the rotation

[nurseprnRN, BSN, RN]

My son isn't in hospital work, but has a similar situation for employees being sent to a remote site prn. Their union worked out a system that's fair for all.

Every staff member has his or her name on two lists.

1) The volunteer list. The manager calls the first person (call him A) on the volunteer list. If A doesn't respond or refuses, his name goes to the bottom of the list and B gets the next call. Lather, rinse, repeat. If after A-F don't answer the phone or say, "No, thanks," and G says, "Sure, I'll do it," the top person on the volunteer list is now H, who gets the first call to be a volunteer next time.

You get points for volunteering. If NOBODY wants to volunteer today, though, this will result in a 100% rollover in the volunteer list, so it's just the same as it was, with A at the top and B second. Then what?

2) The manager then goes to the force list. This list is based on points, which are earned by volunteering AND by being forced (mandated). The person at the top of the force list is the one with the fewest points, i.e., the guy who volunteers the least and hasn't been forced as much either. If nobody took the shift by volunteering, the guy at the top of the force list has to take it, and that's that.

Then he goes to the bottom of the force list. He keeps his same alphabetical position on the volunteer list-- everybody does; this never changes, because there's no penalty for not volunteering; there's only points FOR volunteering.

Everybody knows exactly what their position is on the force list; this can change, though, depending on how you and your peers choose to earn points. You get to choose how to manipulate this by choosing to volunteer a lot, or by getting more (but inconvenienced) if you get forced.

I know this sounds complicated, but there are a lot of interesting checks and balances in it. It's a little bit like names-in-a-hat, but has the benefit of letting you be able to strategize a bit. Suppose you look ahead on the schedule and realize that in eight weeks Sally Sue will be gone for a month, and her call nights will need coverage, but you can't do any in the last two weeks she'll be out. You can volunteer for some nights early on to earn points to put you at the bottom of the force list (they might call you anyway to volunteer if people above you don't want to take that opportunity, but it's your choice as to whether to take it), or if you feel lucky you can bet that there will be enough people who will want to volunteer when Sally Sue is out that the manager will never get to the force list. You feeling lucky?

Think about how you could put up such a system.

[Rose_Queen, BSN, MSN, RN]

I've actually never seen this issue for a weekend where I work- we're a trauma center so staffed 24/7 with an additional team on call for an 8 or 12 hour block. However, we do have quite a few weekday call we end up needing to cover for call offs. We post them in 4 hour blocks, although volunteers ar welcome to take more than a single block. Because of this, a lot more people are willing to volunteer, usually for the 4 hour block immediately following the end of the shift. If for some reason there are no volunteers, then we go to the mandate list, which goes alphabetically. We've been doing this for about 2 years, and haven't even made it through the Cs yet. Perhaps people would be more willing to cover smaller blocks than an entire weekend? I know that I usually have things planned for one day or the other, rarely both, so I'm usually volunteering for one extra weekend day.

[Andie87]

Thanks everyone for the suggestions! I like the idea of dividing it up into smaller blocks, and I also like the idea of giving "positive points" for volunteering. All good things to think about!

We too have staff there 24/7, but we always have call staff just in case!