Nurses On Call Pay: What You Need To Know

Being on call as a nurse can be demanding, but it also comes with financial compensation. If you’re a nurse or interested in nursing, you may be wondering what on call pay entails. In short, nurses receive extra pay for being ‘on call’, meaning they’re available outside of normal work hours in case they need to cover a shift at the hospital.

In this comprehensive guide, we’ll explore common on call pay structures, factors that influence nurse on call compensation, and tips for understanding your potential on call earnings.

Defining On Call Shifts for Nurses

Being on call is a crucial aspect of the nursing profession. It refers to the period of time when nurses are available to respond to emergencies or provide care outside of their regular working hours. During on-call shifts, nurses must be ready to report to the healthcare facility at a moment’s notice.

What It Means to Be On Call

When nurses are on call, they are essentially “on standby” and remain accessible to their employer or supervisor. This means that they must be reachable by phone or other communication methods, and be prepared to return to work within a specified time frame.

On-call nurses may be required to provide various services, such as administering medications, responding to emergencies, or providing assistance to other healthcare professionals.

Typical On Call Shift Lengths and Frequencies

The length and frequency of on-call shifts can vary depending on the healthcare facility and the specific nursing role. Some nurses may have shorter on-call shifts that last a few hours, while others may be on call for an entire day or night.

The frequency of on-call shifts also varies, with some nurses being on call once a week, while others may have on-call responsibilities every few weeks or on a rotating basis.

It’s important to note that on-call shifts can be physically and mentally demanding, as nurses must be prepared to work during their off-duty hours. The unpredictable nature of on-call work can disrupt their personal lives and make it challenging to plan activities or commitments.

Voluntary vs. Mandatory On Call

On-call shifts can be either voluntary or mandatory, depending on the policies of the healthcare facility. Voluntary on-call allows nurses to choose whether or not they want to take on additional on-call responsibilities.

This flexibility can be beneficial for nurses who prefer to have more control over their work-life balance.

On the other hand, mandatory on-call shifts are required by the healthcare facility, and nurses may not have the option to decline. This often occurs in situations where there is a high demand for nursing services or during emergencies.

It’s important for nurses to understand the policies and expectations regarding on-call shifts in their workplace.

For more information on nurses on call pay and related topics, you can visit the American Nurses Association website, which provides valuable resources and guidelines for nurses regarding on-call shifts.

How On Call Pay is Calculated

When it comes to calculating on call pay for nurses, there are a few factors that come into play. Understanding how this pay is determined is important for both nurses and healthcare organizations. Here are some key considerations:

Hourly vs. Flat Rate Compensation

One method of calculating on call pay is through hourly compensation. In this case, nurses receive a set hourly rate for the time they spend on call, regardless of whether they are called in or not. This can provide a sense of security for nurses, knowing that they will be compensated for their availability.

On the other hand, some organizations may opt for a flat rate compensation, where nurses receive a predetermined amount for being on call, regardless of the hours worked. While this may simplify the payment process, it may not accurately reflect the actual time and effort put in by the nurse.

Differences Between Non-Exempt and Exempt Nurses

It’s important to note that the calculation of on call pay may vary depending on whether a nurse is classified as non-exempt or exempt. Non-exempt nurses are typically entitled to overtime pay for any hours worked beyond the standard 40-hour workweek.

This means that if a non-exempt nurse is called in during their on call shift and exceeds their regular hours, they may be eligible for additional compensation. On the other hand, exempt nurses, who are typically salaried and not eligible for overtime pay, may receive a flat rate compensation for being on call, regardless of the hours worked.

Premium Rates for Holidays and Weekends

In addition to the regular on call pay, nurses may also be eligible for premium rates on holidays and weekends. This is to compensate for the inconvenience of being on call during these times, when they may be sacrificing quality time with their loved ones.

Premium rates can vary depending on the organization and may be a percentage increase of the regular on call pay or a fixed bonus amount. It is important for nurses to familiarize themselves with their organization’s policies regarding premium rates for holidays and weekends.

Understanding how on call pay is calculated is crucial for nurses to ensure they are being fairly compensated for their availability and dedication to their profession. It is also important for healthcare organizations to have clear and transparent policies in place to avoid any misunderstandings or disputes regarding on call pay.

Factors that Impact On Call Pay

On-call pay is an important aspect of a nurse’s compensation package, and it can vary based on several factors. Understanding these factors can help nurses navigate their career choices and negotiate fair compensation. Here are some key factors that impact on-call pay:

Geographic Location and Cost of Living

One of the primary factors that influence on-call pay is the geographic location of the nurse’s workplace. Nurses working in high-cost-of-living areas, such as major cities or affluent suburbs, tend to receive higher on-call pay rates due to the increased expenses they face.

For example, nurses in New York City might receive a higher on-call pay rate compared to nurses in a smaller town in a rural area.

According to a study by the American Nurses Association, nurses in urban areas tend to receive on-call pay rates that are 15-20% higher than those in rural areas. This difference accounts for the higher cost of living, including housing, transportation, and other essential expenses.

Nursing Speciality

The nursing specialty also plays a significant role in determining on-call pay rates. Specialties that require specialized skills or knowledge, such as critical care or emergency room nursing, often command higher on-call pay rates.

The demand for nurses in these specialties is typically higher, and hospitals are willing to offer higher compensation to attract and retain experienced nurses.

For example, according to the Bureau of Labor Statistics, nurses working in intensive care units (ICUs) or operating rooms (ORs) may receive on-call pay rates that are 10-15% higher than those in other specialties.

The increased complexity and intensity of these settings warrant additional compensation for nurses who are on call.

Level of Experience

The level of experience also plays a role in determining on-call pay rates. Nurses with more experience and expertise may receive higher compensation for being on call. This is because experienced nurses are often entrusted with more complex and critical patient cases, which require a higher level of skill and judgment.

In some cases, hospitals may offer higher on-call pay rates for nurses who have earned advanced certifications or have demonstrated exceptional performance in their field. These incentives are designed to reward and recognize the expertise and dedication of experienced nurses.

Union vs. Non-Union Hospitals

Whether a hospital is unionized or not can also impact on-call pay rates. Nurses working in unionized hospitals often have the advantage of collective bargaining, where the union negotiates on their behalf for fair compensation and working conditions.

This can result in higher on-call pay rates compared to non-unionized hospitals.

According to a report by the National Bureau of Economic Research, nurses in unionized hospitals receive an average of 15-20% higher on-call pay rates compared to their counterparts in non-unionized hospitals.

The presence of a union ensures that nurses have a voice in determining their compensation, which can lead to better outcomes for their pay and working conditions.

Understanding the factors that impact on-call pay can help nurses make informed decisions about their career choices and negotiate fair compensation. By considering geographic location, nursing specialty, level of experience, and the presence of a union, nurses can ensure that they are appropriately compensated for their on-call responsibilities.

Understanding Your Potential Earnings

When it comes to working as a nurse on call, it’s important to understand how your potential earnings are determined. Whether you are a non-exempt hourly employee or an exempt salaried employee, there are specific guidelines and rates that dictate your pay.

Non-Exempt Hourly On Call Rates

For non-exempt hourly employees, on-call pay is typically calculated based on an agreed upon hourly rate. This rate is often higher than your regular hourly wage to compensate for the inconvenience and potential disruption to your personal time.

Depending on your employer and the specific circumstances, you may also be eligible for additional compensation for each hour you are required to be on call.

It’s important to note that some employers may have a minimum number of hours that you must be on call in order to receive pay. This can vary between organizations, so it’s crucial to familiarize yourself with your employer’s policies and procedures.

Exempt Salaried On Call Pay

As an exempt salaried employee, your on-call pay may be structured differently. Instead of receiving additional compensation for being on call, your salary already includes an allowance for this potential duty.

However, it’s important to ensure that your employer is following the Fair Labor Standards Act (FLSA) guidelines for exempt employees.

Under the FLSA, exempt employees must meet certain criteria, including receiving a predetermined salary that is not subject to reduction based on the quantity or quality of work performed. If you believe that you are misclassified as exempt when you should be non-exempt, it’s important to consult with a labor law attorney or your state’s labor department.

How Frequency of Being Called In Impacts Pay

The frequency of being called in while on call can also impact your pay as a nurse. If you are frequently called in, you may receive additional compensation or bonuses. Some employers have a tiered system where the rate of pay increases with each call-in.

This is often done to incentivize employees to be available and willing to come in when needed.

It’s important to be aware of your employer’s policies regarding frequency of being called in and how it affects your pay. By understanding these guidelines, you can better plan and manage your finances.

For more information on nurse on call pay rates and guidelines, you can visit websites such as Bureau of Labor Statistics or consult with your human resources department. Remember, being knowledgeable about your potential earnings as a nurse on call will help you make informed decisions about your career and financial goals.

Negotiating Your On Call Compensation

Know the Norms at Your Hospital

When negotiating your on call pay, it is important to understand the norms at your hospital or healthcare facility. Different hospitals may have different policies and rates for on call compensation. Do some research and find out what other nurses at your facility are being paid for being on call.

This will give you a good starting point for your negotiations. You can talk to your colleagues or even reach out to the hospital’s human resources department for more information.

Additionally, it can be helpful to look into industry standards for on call pay. Professional nursing organizations like the American Nurses Association (ANA) or the National League for Nursing (NLN) may have resources or guidelines regarding on call compensation.

These resources can provide valuable information and help you better advocate for fair compensation.

Consider Overall Compensation Package

When negotiating your on call pay, it is important to consider your overall compensation package. On call pay is just one aspect of your total earnings as a nurse. Take into account other benefits and bonuses that may be included in your compensation package, such as health insurance, retirement contributions, and performance-based incentives.

Sometimes, a lower on call pay can be offset by these additional benefits.

It is also worth considering the potential impact of on call duties on your work-life balance. If on call shifts often disrupt your personal time or affect your ability to make plans, it may be reasonable to negotiate for higher compensation.

Remember that your time and dedication are valuable, and it is important to find a balance that works for you.

Discuss Scheduling Accommodations

When negotiating your on call pay, it is a good idea to discuss any scheduling accommodations that may be available. Some hospitals or healthcare facilities may offer flexibility in scheduling on call shifts or allow nurses to trade shifts with colleagues.

These accommodations can help alleviate the burden of being on call and may be worth considering when discussing compensation.

It is important to approach these discussions with your employer in a professional and respectful manner. Highlight the benefits that more favorable scheduling accommodations can bring to both you and the hospital.

This approach can help create a win-win situation and increase the chances of reaching a satisfactory agreement.


Being on call as a nurse requires dedication, but it can also be a rewarding way to gain extra income. Understanding the ins and outs of on call pay structures, from hourly rates to flat fees, is key to maximizing your earnings potential.

With the negotiating tips provided, you can confidently approach your employer to ensure fair on call compensation. At the end of the day, your skills and availability as an on-call nurse provide a valuable service for patients in need.

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