What is the 'normal? protocol with off duty? Should it published on the wards well in advance? Once it is published is it up to the staff to change and swap shifts if it interferes with appointments that were made weeks in advance but because the off duty was not kept up-to-date or was over looked. Can you please advise me.
Whether it is called a 'protocol' or not, I would expect that 'off duty' should indeed be published on wards, theatres and other departments. Then, if members of staff want to change and swap shifts they should only do so in consultation with the senior colleague (e.g. sister?) who produced the 'off duty' list.
A further point is that I have seen a system that works very well in some hospital departments. The sister, or whoever is in charge runs a 'Request Book' in which the members of staff enter details of any time that they must have as 'Off Duty' well in advance so that appropriate work schedules can be produced. Thus unless there is a dire emergency there should be no need for staff to have to change and swap shifts.
I hope that this is helpful.