Staffing Issues Looking for Research Support

Nurses General Nursing

Published

Hello,

I am a staff RN in an ICU. Our medical center is very keen on reducing overtime and this has raised some issues with our staffing measures on the unit which I have brought up to our management, presented my ideas, and have been charged with investigating research to back change in staffing practice. So I'll explain the issue and then if anyone has any ideas or knows of some research I could look over, please share! I've spent a few hours already searching and coming up rather empty on specific research.

The unit runs like this, we self-schedule our FTE's for 8 week periods (I schedule 3 12hr shifts). After the schedule is reviewed by the committee and released, we are encouraged to pick up extra shifts to meet the staffing needs (typically 7 nurses scheduled on a shift as we have a 20 bed ICU/PCU unit to staff for at max).

When it comes to who gets put on call it is based on who has scheduled above their FTE and then who is up for call date (I assume just like any other unit anywhere). Those who are like me try to pick up a 4th shift every other week or so to be put on call for to avoid taking low-census call and losing out on FTEs. This I have no problem with.

The trouble arises when we have a massive influx of ICU patients to where the needs exceed the 7 scheduled RNs and other nurses are called on their nights off to come in and help. Recently I did this to help out going in 5 hours into a shift and working the last 7 hours. So this puts me 31 hours for the week and if I were to get my next scheduled shift I would incur overtime and thus will jump to the top of the call list...so by being willing to come in and help on my night off I not only give up a night off but more than that I give up approximately $200 that I would have gotten had I just worked by 3 scheduled shifts and not gone in to help when they desperately needed the help.

My suggestion for change is that when staff scheduled above their FTE they should understand they will jump the call list and will most likely not receive overtime hours (which we are all understanding of), but when a staff is called in on their night off to provide extra help in times of need this should be overlooked on total hours and the staff should be allowed to still work their 3 scheduled shifts to me their FTEs even if this leads to overtime.

I hope that makes since and that someone will have similar experience and suggestions/research to back it for making a change - I feel if this doesn't change then others will lean toward refusing to come in to help out knowing it will cost them money in the end (you miss out on getting full hours, you don't get overtime for providing additional help, and you have to use PTO hours in the end to meet your full FTE for the week).

Thanks for reading and for providing input, I'm not the type to simply complain - rather I'd like to present change that is favorable to both the staff RNs as well as the medical center budget.

Matthew Schneider, RN

What kind of research support are you looking to find? I think your proposal makes sense in terms of being fair and not punishing a worker for helping but I'm not sure there would be evidence to support or not support this practice.

Well I suppose the managers would like to see another organization who has employed such a staffing policy and if it's effectiveness could be demonstrated both to the facility finances as well as employee satisfaction.

I suppose one of the best things would be just having our management look at a cost analysis in terms of how often we are actually called in on nights off and how much that overtime costs over the quarter. If it's an acceptable "minimal" level that could justify my recommendation, however if it appears that it would be a frequent occurrence then it certainly would not fit the budget.

It's extremely difficult to find studies where units present data from their units policies.

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Hello,

I am a staff RN in an ICU. Our medical center is very keen on reducing overtime and this has raised some issues with our staffing measures on the unit which I have brought up to our management, presented my ideas, and have been charged with investigating research to back change in staffing practice. So I'll explain the issue and then if anyone has any ideas or knows of some research I could look over, please share! I've spent a few hours already searching and coming up rather empty on specific research.

The unit runs like this, we self-schedule our FTE's for 8 week periods (I schedule 3 12hr shifts). After the schedule is reviewed by the committee and released, we are encouraged to pick up extra shifts to meet the staffing needs (typically 7 nurses scheduled on a shift as we have a 20 bed ICU/PCU unit to staff for at max). When it comes to who gets put on call it is based on who has scheduled above their FTE and then who is up for call date (I assume just like any other unit anywhere). Those who are like me try to pick up a 4th shift every other week or so to be put on call for to avoid taking low-census call and losing out on FTEs. This I have no problem with.

The trouble arises when we have a massive influx of ICU patients to where the needs exceed the 7 scheduled RNs and other nurses are called on their nights off to come in and help. Recently I did this to help out going in 5 hours into a shift and working the last 7 hours. So this puts me 31 hours for the week and if I were to get my next scheduled shift I would incur overtime and thus will jump to the top of the call list...so by being willing to come in and help on my night off I not only give up a night off but more than that I give up approximately $200 that I would have gotten had I just worked by 3 scheduled shifts and not gone in to help when they desperately needed the help.

My suggestion for change is that when staff scheduled above their FTE they should understand they will jump the call list and will most likely not receive overtime hours (which we are all understanding of), but when a staff is called in on their night off to provide extra help in times of need this should be overlooked on total hours and the staff should be allowed to still work their 3 scheduled shifts to me their FTEs even if this leads to overtime.

I hope that makes since and that someone will have similar experience and suggestions/research to back it for making a change - I feel if this doesn't change then others will lean toward refusing to come in to help out knowing it will cost them money in the end (you miss out on getting full hours, you don't get overtime for providing additional help, and you have to use PTO hours in the end to meet your full FTE for the week).

Thanks for reading and for providing input, I'm not the type to simply complain - rather I'd like to present change that is favorable to both the staff RNs as well as the medical center budget.

Matthew Schneider, RN

OK...as a manager your proposal doesn't cut the OT. If your facility is really looking to cut the OT...this will not be it.

It is tough for me to say without knowing your facility policies. Does your facility pay 8/80 or 40 hour weeks. In other words are you paid PT for over 8 hours in a day or more that 80 hours in 2 weeks. Or just OT for anything over 40 hours.

Where I have worked it is a 40/hr work week.

Anything over 40 hours/week is paid OT. ALL extra time over 40 hours (OT) is up for cancel/call AFTER the employees benefited hours are worked for that week. The goal is to cut ANY OT in any given week. This does mean if you come in extra earlier in the week for high census and the census drops at the end of the week...anyone that is OT on that day is canceled and placed on call...including the one who came in to help.

Does this stink? Yes. Is it inevitable? probably. Does it keep some people from coming in? probably...at least at first. Does it lower the budget? yes.

Some nurses I know have looked for extra time elsewhere (at least in the old days before the plethora of nurses started in the workforce) and gone agency. Most of them come back as thier chances of cancel are actually less at their primary employment.

The reality of nursing today.

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