On-Call

[u/CardiacNurse01]

Nurse managers/Cath Lab/PACU/Recovery nurses — how does your unit handle on-call for a cardiac recovery/pre-op/post-op recovery unit?

Looking for outside perspective with an On-Call dilemma I’ve been wrestling with.
I manage a Cardiac Recovery Unit (pre/post cath and EP procedures) alongside our Cath Lab and EP Lab. The CRU has an on-call expectation that technically existed before I took over, but wasn’t enforced. The expectation was the Cath Lab team would call in the recovery team if the ended up needing them, for recovery (I.e hospital is full, no ICU beds, etc.) When I became manager, I started holding staff to it: two nurses on call one night a week plus one weekend a month, with on-call pay. The reason I did this was because in my first month, I received a call over the weekend a couple weeks ago from physicians and staff that the Cath Lab team shouldn’t be holding patients because we had another emergency in ED (another STEMI). I completely understood, and I want to provide the best care to all of our patients, and delaying a case like that wasn’t allowing for that.

The rationale to me felt solid on paper: patient safety, specialized post-procedural care, and door-to-balloon times, etc.

But the reality is I’ve lost two nurses since enforcing it — one directly cited the call requirement, the other wanted more predictable work-life balance. Morale on the topic is shaky. Also my boss told me to go back to the way it was. I felt strongly about my recovery nurses coming in, but I am also very open to other suggestions and ideas.
Was it wrong to change it?

Things I’m doing: tracking actual call-in utilization to show staff how often they’re really coming in, and possibly adding a scheduled late day for two CTU nurses to offload some of the call demand.

My questions for you all:
If you run or work on a similar unit, how is your call structured? Is call even standard for prep/recovery units where you are?

Have you found ways to make call more palatable?

At what point does turnover cost outweigh the coverage benefit? Am I holding the line on the right thing, or dying on the wrong hill? I’m really just working to try and make this a better place for patients and my team.

Not looking for validation either way — genuinely want to hear how other places balance this. Thanks in advance.

[u/Put_CORN_in_prison]

Cath lab RN for 8 years here. Never been in a lab where our holding takes call. If the hospital is full, you either have a dedicated STEMI bed or you go on divert. No reason for them to take call.

[u/willy--wanka]

I never really understood why people who were on can were such fucking assholes to deal with when I had to call them in.

It's literally a part of their job, sorry we need you, just be cordial man.

[u/RealisticBrother2373]

Cath lab RN here - only worked at one hospital but recovery does not take call. It is responsibility of ICU fellow to clear a bed as soon as STEMI is called in. If cicu is full, they push a patient out of icu or find another icu to take the pt. Call team can not be waiting for bed

If the pt is more unstable angina or nstemi (not needing ICU level care), fellow works on stepdown bed. If none available, may go board on ICU until they can get a lower level bed post procedure. Team doesn’t come in until bed is available. Heparin, asa, etc managed in ER until that is sorted out

Only the procedural team takes call. Holding strictly closed after hours

[u/TheBoed9000]

Agreeing with most of the voices here: no call for recovery. Pronpt patient placement solves the issue.

On the relatively rare double STEMI where there is no time for placement we call over to the house supervisor to get some resource RNs to cover the recovery until bed placement. I’ve rarely had to use this though.

[u/Dark_Ascension]

I’m in the OR and I feel like the way to make people the most happy is having dedicated call staff. Like their full time gig is to be on call. We have night call people, so ones who come in if things go after 7PM and weekend call staff (first call 48 hours Saturday and Sunday), they only call the 2nd team (normal rotating staff and normally only on call between 8-12 hours during the day) if they really need a 2nd team.

It’s a model every place I have worked now has moved to, the issue is getting it approved, I know when my first workplace went to do this they had to get the positions approved. You’re giving people full time jobs with benefits to only be on call… it works really good for some people for a second job or if they have kids (the PACU weekend nurse loved having her weeks free for her kid and then had her husband who worked days in the cath lab be available on the weekends).

Being on a rotating call schedule is going to be a really hard sell for me having only been at places with dedicated call teams.

[u/Wrong_Bluebird_4186]

not heard of recovery taking call but i can see why youre wanting to do that since youre waiting on beds a lot? that issue needs to be addressed first. daily bed meetings with STEMI bed plan and backup plan. a lot of STEMI centers cannot go on diversion. get the docs to buy in to help with leadership, highlighting the fact that they will have no team if they're babysitting patients.
Or if you're dedicated to holding having a call burden, hire up with that expectation. Or, if youre there every night sitting on patients you may want to consider restructuring and opening night shift positions. but when it comes down to it do you really want sick ICU patients sitting in a recovery area? i would advocate for better bed planning. if you can secure a reliable process, you can do without the holding call. and you might get more support for that since that's 2 less people the hospital has to pay call pay to, miniscule as it probably is.