On-Call and Call-Back Pay for Nurses

On-call pay is what you earn for being available to come in if you are needed. Call-back pay is what you earn once you are actually called in to work. On-call pay is usually a set standby rate for each hour of call, while call-back hours are often paid at a premium and may come with a guaranteed minimum. The exact rates and rules come from your employer's policy or union contract, so read them before you accept a job with call.

Which nurses take call

Call is most common in areas that need a team on short notice outside regular hours, such as:

• Operating room and PACU
• Cath lab and interventional radiology
• Endoscopy and other procedural units
• Dialysis
• Labor and delivery in some smaller hospitals
• Home health and hospice, where nurses often cover visits and phone calls after hours

If you are considering a procedural role, nurses in the OR and perioperative group can tell you how call really runs on their units.

How on-call pay usually works

On-call pay, sometimes called standby pay, is pay for the hours you are scheduled to be available. It is usually a set hourly amount that is lower than your regular rate, because you are not working unless called. Common variations include:

• A higher standby rate on weekends or holidays
• A flat amount per call shift instead of an hourly rate
• No separate on-call pay for some salaried roles, where call is built into the salary

Look for the on-call rate in writing, either in the offer letter, the pay policy or your contract.

When on-call time counts as hours worked

Under federal rules, whether on-call time counts as hours worked depends mostly on how much it restricts you.

• If you must stay at the facility, or you are so restricted that you cannot use the time for your own purposes, on-call time is generally counted as hours worked.
• If you can stay home or go about your day and simply need to answer your phone and respond within the required time, it generally is not hours worked, though your employer may still pay an on-call rate.

The details matter: how quickly you must respond, how often you are called and how far you can go all play into it. Being required to stay in an on-site call room is a different situation from being on call at home, so ask how each is paid.

Time spent actually working while on call is work time. If you take patient calls, give phone advice or chart from home, as many home health and hospice nurses do, that time should be paid. Ask how to record it. The home health and hospice nurses group is a good place to hear how other agencies handle after-hours phone time.

How call-back pay usually works

Call-back pay covers the hours you work after being called in. Policies differ, but they usually address:

1. The rate. Many policies pay call-back hours at a premium, either an overtime-style rate or a set call-back rate. Others pay your regular rate plus differentials.
2. A minimum guarantee. Some policies and contracts pay a minimum number of hours each time you are called in, even if the case is short.
3. When the clock starts. It may start when you are called, when you leave home, or when you clock in. This difference adds up over a year of call.
4. Whether standby pay stops. Some policies stop on-call pay during the hours you are paid call-back. Others pay both.
5. Travel. Ask whether travel time or mileage for a call-back is paid.

Call-back hours you work count as hours worked for overtime purposes under federal rules. Our guide to how nurse overtime is calculated walks through the math. For how call fits with base pay and differentials, see how nurse pay works.

Questions to ask before you take a job with call

Call can change your quality of life as much as your paycheck. Before you accept, ask:

• How many call shifts are expected per week or per schedule, and how are weekends and holidays rotated?
• What is the required response time from the call to arrival?
• What are the on-call and call-back rates, and can I see them in writing?
• Is there a minimum number of paid hours per call-back?
• When does call-back time start counting?
• If I am called in overnight, what happens with my next scheduled shift? Is there a policy on rest time?
• Is call mandatory, and how do swaps work?
• For salaried roles, is call included in the salary or paid separately?

Holiday call deserves its own question, since holiday premiums and call rules can interact. See holiday pay for nurses for what to check.

Common pitfalls

Comparing offers on base rate alone. A job with heavy call and a low standby rate can pay very differently from one with light call, even at the same base rate. Our guide to comparing nursing job offers shows how to line up schedule and benefits side by side.

Not keeping your own log. Write down when you were called, when you arrived, when you left and what you did. If a paycheck looks short, a log makes the conversation with payroll much easier.

Ignoring fatigue. Back-to-back call and scheduled shifts can leave you working tired. Know your facility's policy on rest and how to speak up if you are not safe to take another case.

Assuming every contract works the same. Per diem and travel contracts often spell out call requirements and rates separately. Read those terms before you sign, not after your first call week.

To estimate what a schedule with call might add to your pay, try the free pay calculator.

Next step

When you compare jobs with and without call, start with pay you can see. Browse nursing jobs on NurseTide, where every posting shows the pay.

General information for nurses, not medical, legal, tax or financial advice. Follow your facility's policies, your state board of nursing and the terms of your employer or contract.