We had a meeting with the bosses today, and our DON asked what ideas we had to recruit and retain nursing staff. I shared that due to my website, I have communicated with several nurses who do not work weekends or holidays. Well I know we could even consider cutting weekends, but why not Holidays? I pointed out all the pluses, saves agency money for OT, and how it would be an enticement to new nurses and a wonderful reward to the staff who stay, since our staff have been dropping like flies. We lost 2 now who haven't been replaced, and in 3 weeks, my caseload is going to grow another 10 pt's to pick up the slack. (And I just broke my own news to them that I will be cutting back to PT in the summer, 2 days a week and every weekend, so they will be more short)
The DON truly did not feel that we could not consider closing on holidays, as she feels we get the business we do b/c the hospitals know we will take anything. Well, there is already problems at times getting a spot for new admits, so what is waiting another day? We can still take the referrrals for Christmas, but open it the next day, or do a visit and save the OASIS for the next day, for daily wound, that is legal. But, I can see the subject is a brick wall.
Just in case, if your agency does not work Holidays and/or weekends, please let me know how you do that? Do you never take daily wounds? Do you have someone on call? Has it hurt the number of referrals you get? If not is this b/c you are the only agency around? We compete with 2 other agencies in the same county.
Also, they are considering flex scheduling. Anyone doing 12 hour shifts in HH? What kind of alternate staffing do you use??
All input wanted. Thanks!
Last edit by hoolahan on Apr 11, '02
Apr 15, '02
Our agency office is closed on the weekends and on Holidays. Don't get excited yet. There are 7 nurses that rotate call for weekends so we are available 24 /7. At Christmas time we all sign up for what Holiday we want to be on call for the whole year. I took call Thanksgiving weekend and July 4th last year. This year I picked Mother's Day and Thanksgiving Day(which does not include the wknd). We have PRN staff that may pick up visits on holidays but ultimately we are responsible for visits on our call. Alot of times during the major holidays we teach a family member to do a dsng chg if it is not to involved (i.e no major packing or medical apps basically w/d or dry). We also suggest DR use newer dsng applications when pt is admitted to avoid a daily or BID. Most of the time we heal them faster anyway w/ Tenderwet, Polymem etc. We still have a few completely unavoidable dailys but the person who assigns our case loads tries to never give one nurse more than one daily. Hope this helps.
Apr 15, '02
oh as for referrals on a major holiday-- we take them but usually won't admit til the next day.
Apr 29, '02
Only clients that need to be serviced are seen on the holidays. My agency accepts new admits though and there is always a nurse on-call.
We are open every weekend. We are encouraged to take turns working the weekends and holidays, but some nurses always take them off.
May 2, '02
Our office is closed weekends and holidays but of course we have patients we have to see. We have an on-call nurse all the time (rotates between me and my assistant). We try desperately NOT to do visits when we are on call, but sometimes we have to. Usually we can defer admissions referred on a major holiday until the day after. We don't have to worry about overtime because all of the field staff is paid per visit and no one is a full-time nurse. There is usually someone around who will do the visit. I start planning early for big holidays like Christmas, finding out who wants to be off and who can cover the daily patients.
May 24, '02
Our agency is closed every weekend and holiday. Our agency covers a large geographic, rural county so on weekends and holidays 2 "on call" nurses cover the patients including daily dressings, IV's and opens. We get double time for working OT so it's an incentive to work weekends and holidays. Rarely does the agency have trouble covering weekends or holidays because of this. The caseload can vary from 3-4 patients to 11-12.
Jun 7, '02
We are closed on weekends and holidays but there is always a nurse or 2 on call. We only do admits if absolutely nessecary.
Jul 11, '02
I would suggest that you check the regs as well. If your agency is Medicare certified, you are required to see a patient within 48 hours of referral unless you have a physician's order. Therefore any referrals made two days before a holiday or weekend would require that they be seen even if it is on a holiday/weekend. Additionally, you have to have on-call staff available 24/7 for emergencies (Medicare rule) and your state regs probably require it as well. Our agency (and every agency I've worked for - four in all) have always provided "on-call" staff on weekends and holidays. Often we do put visits off to the next day if staffing is a concern, but we insure that the referral source is aware and an appropriate MD Order is written.
Jul 11, '02
we are open qd....have oncall rn 24/7.....
Jul 11, '02
You know you mentioned "recruitment and retention" - Closing your agency down on weekends and holidays may not be feasible, but there are other "perks" in home care. What is your agency currently doing to recruit staff? And what reasons are people giving when they resign/quit?
The beauty of home care is the flexibility and whoever is in charge of recruitment should really be stressing that as on of the perks.
There's the independence and autonomy home care nurses have.
Then there's the things the agency can do to compete with other agencies such mileage reimbursement, tuition reimbursement, paying "differentials" for seeing patient's not in your usual area, etc.
Of course, if you're primarily medicare your agency can't afford to provide too many costly perks, but if you're doing a lot of private pay - the agency can provide the cell phones, beepers, notebook computers, etc.
Just some thoughts.
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