I work in LTC and when I started at my current facility the new DON started the same day (I am an ADON). Prior to our arrival there was a lot of agency staff being used.
We met as a team with some of the staff to see what we could do to reduce the use of agency staff.
First thing we did was tell the charge nurse that before any agency was called to fill a position the On-Call supervisor had to be called. We asked how many of our own staff have you called and asked to pick up an extra shift. (We found that if there was a call-in the nurse would replace with agency staff without calling our own people.)
So now there is a form where the nurse lists who she contacted. We also look at what is the census. We have 2 buildings with 3 units.
My unit is capable of holding 47 beds, but in actuality we use 44. My census runs 38-41.
I staff days and pms the same 2 nurses 3 CNAs, my residents are pretty much ICF classification. The other 2 units have the Medicare beds. There are 54 beds, but because some are choosing to have a larger room, they pay more and we actually have 50 beds. There are 25 on each floor, there is a nurse (and sometimes a med pass person) and 3 CNAs.
The night shift on my unit is 1 nurse 2 CNAs the other 2 units have 1 nurse and 2 CNAs.
We have plenty of staff so if there is a call in we can rearrange. Sometimes we use a CNA to float to 2 units, when there is a call-in.
We have a pretty fair number of nurses and CNAs that are "internal" pool. We require them to work one weekend a month, Many of them choose to pick up more. And we give those people first consideration when we have a benefit position.
Gloria, our scheduler has learned to wheel and deal. Work a double today take off tomorrow. Offer time and 3/4's or double time. It still works out to be less than you would pay an outside agency and you would have the continuity of care.
I am not sure my ramblings help, feel free to e-mail me if you have questions. NA