[babyktchr]

We finally got the ok to trial a closed unit, basically meaning we will staff ourselves and not be pulled to other units in the hospital. Being a specialty unit, we are essentially looking not to be pulled out of our "element" and putting others potentially at risk. It is also a goal to make our unit more cohesive, skilled and eventually lead others to want to stay (retention of the good nurses). I am wondering if any of you work in a closed unit, and how you handle call outs/holes in the schedule kinds of things. Do you have a call schedule or do you just deal with things as they pop up. I am looking for ideas, as we are in the fact finding stage, and trying to set up guidelines for taking responsibility when needs arise, and dealing with trying to have some sort of family/personal life. I would really really appreciate any and all input. I have a short time to gather some info. Any leads to online resources would be just as appreciated.

Thanks in advance

[shortstuff31117]

We're a closed unit, we can float if we want to, but don't have to. My shift is self scheduling right now, and we are overstaffed so I can't be much help with that - no holes here.
When people call off, we look first to see if anyone put an available by their name on the schedule for that day. Then we just start calling. Sometimes we'll try to get an LPN or a NAC if we're real busy, before we start calling RNs. If we can't get anyone to come in, then we just suffer.
I work in a small hospital if that makes a difference.

[Jolie]

I would definitely suggest having a staffing or on-call plan in advance. Trying to fill holes by the seat of your pants is never a good plan

I've only worked on one closed unit. It was a low-risk LDRP with a level II NICU. There had recently been an influx of new staff members, most of whom were not yet fully oriented to every aspect of care (ante-partum, L&D, mother-baby, NICU, C-section, and PACU) so it was imperative to have a call schedule that took each nurse's skill set into consideration. We worked 8-hour shifts, and took 8 hours of call per week, in 4 hour blocks. Most people took their call immediately before or after (or both) a regularly scheduled shift, creating the possibility of a 12 or 16 hour shift once a week. The hospital provided pagers, and there were a sufficient number of them that we didn't have to make a special trip into work to return them if we weren't called in. We just brought them back on our next shift. On call was not used as the method of choice for filling a call-out. The charge nurse tried to find a substitute, and called the on-call person only if there had been a sudden increase in census.

As far as floating to another unit, we could if we wanted to. A few of our nurses had previously worked med-surg in that hospital and didn't mind doing so. Most of us preferred to stay home rather than float if our census was low.

[LuckyoneRN]

Our MICU is closed, and we are required to sign up as "extra" (i.e. available to come in and work if needed, or to be placed "on-call" if needed) for 8 hours every 4 weeks. This is self-scheduled, and may be broken down into 4 hour blocks or a single 8 hour shift. Most RN's who work 8 hour shifts simply tack 4 hours before/after regularly scheduled shifts (which kinda works out nice since the RN then gets OT for anything above 8 hours/day). Some simply add an additional single 8 hour shift on scheduled days off. We are not helped with sick calls or unusual staffing requirements, except in DIRE emergencies (i.e. multiple 1:1 staffing issues like IABP, PRISMA, hypothermia, etc.) by ICU cluster float RN's (we once had three IABPs in our 12 bed unit and managed to self staff this). My hospital had each unit decide several years ago if they wished to remain open (and thus possibly have to float to other open units) or to close. About half the units went with each option. When we are up for MTO, we are given the option to mobile within the hospital if there is a need for mobile help (always is!).

[jenrninmi]

Our unit is closed. None of us get pulled to other units either. We have someone on call every day. Sometimes they are called in, sometimes not.

[SheaOBRN]

I am currently a traveling L&D nurse and all the units I have worked on have been closed units. I feel that it is safer this way-pople caring for the pt have been trained in OB (hopefully!) and I personally wouldn't want to float anywhere else because I dn't feel as if I would know half of what I was supposed to be watching for and that I would not give the pt the best care. I think it does bring the nurses closer together because you are all each other has....so you have to work out a call schedule and BE FLEXIBLE!