Staffing gaps and gaffs

[SunDazed, BSN, RN]

This thread is twofold.

1. I would like feedback on how often your hospital adjusts staffing during a 24 hour period, and how it is working. Where I am currently, the staffing is reassessed every 4 hours. On a unit with low numbers of admit, transfer, and discharge this is likely not to much for the charge nurse to manage. However, on a unit that regularly discharges every bed at some point in the day and then fills all of them up again before midnight... there are times when it looks like the census is very low and nurses are expected to be flexible and leave for 4 hours in the middle of their 12 hour shift. The hiccup is that they are finishing the discharge charting on the three people that have left, and likley have less than two hours before they will start getting a fresh post-op or procedural patient every hour. If you send a nurse away for four hours, those left behind end up drowning in admits every 30-45 minutes. Then the nurse comes back, and has to race to catch up?

2. I have been at 3 different hospitals that are still phasing out 8 hour shift workers, and only hiring 12 hour shift workers. The last hold outs on the 8's typically prefer the first and the third shift. I have yet to see someone on 8's still working the second shift. What does this mean? They go merrily on their way at 3pm, leaving the coworkers short unless someone working 7p-7a can be convinced to come in and pull a 16 hour shift. They assume no guilt, as they see it as management's fault for not having anyone to cover. Yet management isn't hiring anyone working 8s anymore. So maybe a manager steps in to fill the gap as the charge nurse from 3p-7p, pushing the charge out on to the floor to take a patient assignment for four hours. Often though, the manager filling in as charge is distracted by the barrel load of work on her own desk and is not very effective in the role. Often the charge wasn't expecting for this to be the decision made by the manager. Also the other 8 hour worker coming in at 11pm, causes someone working 12's (7p-7a) to be sent home or floated after 4 hours. The patient can end up having three different nurses in 12 hours and possible 6 in 24 hours. Whatever happened to continuity of care?

[Blondenurse83]

My facility also staffs in 4 hour increments. My unit has had low census lately, so we are being floated often. My floor only has nurses working 12 hour shifts, but our sister unit has some nurses still working 8s. We have been running into the issue you spoke of, where one of us floats to cover 7-11 and then that unit has their own 11-7 nurse and we end up being cancelled. I commute an hour each way so I hate coming in for 4 hours only. It does seem like there could be a better way!

[Mulan]

" They assume no guilt, as they see it as management's fault for not having anyone to cover."

Why should they assume guilt? They shouldn't, in my opinion, feel any guilt.

Management is the one who hired and allows people to continue to work 8 hour shifts.

[SunDazed, BSN, RN]

Maybe guilt is the wrong word. I personally would feel horrible leaving my coworkers in a situation that felt unsafe.

It is not management but the strong union that allows them to be grandfathered in for 8 hour shifts. The hospitals without unions that I have been in have eliminated 8 hour shifts all together.

[LadyFree28, BSN, LPN, RN]

Does the charge nurse already have an assignment?? How about resource nurses??

[SunDazed, BSN, RN]

The charge nurse doesn't have an assignment most of the time except for taking all the phone calls for potential admits, screening, bed boarding, etc. It is a pretty busy job. Different charge nurses help the other nurses in different ways... some help get new admits settled if you are tied up with providing care for another patient. Can you imagine your boss walking up and saying, "[charge] why don't you take that open assignment for 4 hours." Lots of bouncy around for charge nurse and others.

Besides the potential 4 hour flex off, staff can be floated to another unit for four hours in the middle of the shift and then might be pulled back to take a new assignment for the last 4 hours.

[LadyFree28, BSN, LPN, RN]

Flexing (in that way) seems to be a HUGE issue!

Why can't the "flex" be after 8 hours? It seems that it could work where the last 4 hours, or better yet, are there those "resource nurses" that can flex-like casual staff.

I would be mad if I came in for 12 and get sent home after 4...how many times is this occurring-I understand once in a while, but more frequently, I'd be in the nurse managers office as well as looking for another job.

You also stated that the hospital is union?? If so, why hasn't your rep been involved in this???? I'm sure these nurses who are getting sent home should file a grievance about flexing and then getting sent home.

[SunDazed, BSN, RN]

LadyFree28- thanks for your comments. My belief, though I may be wrong, is that the union is more interested in protecting the rights of the staff who have been there longer to keep their 8 hour shifts, than to make sure the new hires actually get their hours or have a reasonable shift. It is the baby boomer's protecting themselves at all cost. So some of the flexing at odd points in the shift is based on where there are gaps in the 8 hour staff leaving, with no one to fill that hole. So from 3p-11p there is a gap. But because the hospital readjusts staffing every 4 hours, it is all crazy.

I am trying to give it some time before I revolt. I had another non-union job a few years ago where the supervisor couldn't promise me days off for classes (tho the recruiter had stated it was the hospital policy). So I quit to avoid conflict. Most of my coworkers told me after I had turned in my notice (because I had another job lined up that was guaranteeing days off for class), that the supervisor said it because she had to. That she would likely have given me all my days off i needed. This was confusing to me because I am a stright shooter. I don't like a nuanced situation that results in an unlevel playing field. Plus, I think people just call in sick if they don't get what they want; and I can't do that. My social justice tendencies make me want to rise up out of principle.

I did check with the union rep though. The union rep said I should have been told about this staffing in the interview before hire. So she was willing to push it back on me and my supervisors. Not her fault and nothing for the union to look at.

So, I am waiting to see what happens. I hope I get my hours. If it weren't for travelers being the first to float at all times, I am sure I would end up looking for a new job. Tho I feel bad for the travelers. And you have to worry about the safety of the patients, right? There is no way I will stay in a job where I am regularly flexed or floated every four hours. I don't mind floating for a shift on occassion. I would never have even thought to ask about this type of staffing when I was being interviewed. I could never have imagined that this type of system existed! The ones that have been there the longest have tons of PTO, so don't mind just taking off for four hours. A lot of staff live out in the country though, not worth driving home and back for 4 hours in the middle of the shift. I suppose that is why they like the 8's. Either they come in 4 hours late or leave 4 hours early, it was just a half day. Doing it to a 12 hour staffer.... maybe they haven't done it yet to the regular staff... maybe it is only travelers being bouncy balls??? hmmm

[Nurse Kyles, BSN, RN]

I work in a non-union hospital. RNs do not float. This was changed several years ago, and RN job satisfaction improved. We assess staffing and make changes at 7am, 3pm, 7pm & 11pm. I think not reassessing staffing at 11am helps, because census has usually dropped. The unit fills up just as quickly! My unit has about 50/50 of 12 hour and 8 hour nurses. Everyone is hired to working 8 hours, and as a rotator between 2 shifts. This gives the scheduled flexibility to fill in the gaps such as the less desirable PM shift. When we get put on call it is based on a rotating list of last call date. It usually works out ok.

[xoemmylouox, ASN, RN]

Ok I've got to ask.. So your unit reassess staffing every 4 hours. If someone is scheduled for 12 sent home after 4, but then are needed for the last 4 does your employer expect them to come back in?

[Meriwhen, ASN, BSN, MSN, RN]

I just wanted to throw in a thought about something in item #2, the 8 hour workers who merrily go their way at 1500. It's not the fault of the 8 hour workers that the facility decided to shift to 12s. Why should they feel guilty? They are working their assigned shift and leaving at its completion, the same as any other nurse is entitled to do.

If the facility wants to correct this problem for good, then they need to eliminate all 8 hour shifts instead of waiting for the holdouts to concede to 12s or leave their jobs. However, I just saw the word "union" in one of your replies, so that may be far easier said than done.

Until they do that, it remains 100% staffing's fault if the unit is short-staffed come 1501. Fair? Not always, especially to the staff doing 12s who have to deal with it. But it's not the fault of the 8s in the least.

[OCNRN63, RN]

Maybe guilt is the wrong word. I personally would feel horrible leaving my coworkers in a situation that felt unsafe.

It is not management but the strong union that allows them to be grandfathered in for 8 hour shifts. The hospitals without unions that I have been in have eliminated 8 hour shifts all together.

If that's the shift they want to work and it's in the contract for them to retain that position, then the hospital needs to work something out. It's not the employee's fault, nor is it the fault of the union.