I work about 50-55 hours a week (not incuding work related reading done at home). I have been in this job 6 months- was a staff nurse on the unit prior to this. My staff are unionized and there are provisions made in their contract to be compensated for each hour they work and for overtime they incur. Recently we have lost a few core staff members due to increased job opportunities in the OR that has recently become busier.
It is difficult to get staff to cover sick calls as we have very little extra staff right now and a lot of them are new to the unit and nursing. We are not allowed to mandate staff to come in and I am not sure that mandation would work as people would get good at ignoring their phones. Since Sept. 11, I have noticed a dramatic difference in the number of times people will actually come in at the drop of a hat to cover a sick call. The burden has been falling on me and a couple of wonderful staff nurses.
I am paid a straight salary and with the hours I work, I make less than my staff. On evenings, nights and weekends, there are nursing supervisors who are supposed to take care of things like staffing and other managerial issues when I am not at work.
I really like my managerial job, but I have been called by these supervisors at least once per week to cover the unit in some way.
I don't mind doing patient care (in fact, I miss it), but I feel as if these supervisors feel that I am supposed to "live" for the hospital 24 hours a day and to come in for free. One "supervisor" called me last Saturday to come in to work 7p to 9p since the day girls did not want to stay 2 hours past their shift while waiting for the 9pm person. So...the expectation is there- that I should come in on my weekend off to work 2 hours for free. Managers at this hospital are not compensated for coming in like the staff are. My boss says that I can take compensatory time..."Comp time" is an illusion as the pile of work is always there waiting for you no matter what comp time you take. No one does it for you while you are gone. There are times I have wished for a fairy godmother!!
Sometimes, my working as a staff nurse shows that I care about patients and staff and I feel like a team player when I do it, BUT for the most part- I feel that some of the staff really do not care if I have family life as long as they are getting their 4 days off per week. I also feel that some of them may secretly have some satisfaction in seeing me work all kinds of odd hours.
Most of my staff members have the this lack of understanding regarding the "life" of a manager with the exception of a few. One of my staff members was a manager not too long ago and one of my most helpful staff. Thank God for her and her sense of humor! I need to be careful not to tire her out!
Due to the difficulties in covering the unit and for patient safety reasons, I felt the need to initiate a call schedule. I do not think it is much to ask the nurses working three 12 hour shifts/wk to take a shift of call every week or two. They get paid for every hour they work and paid to be on call. When they are called in, they get time and one half for each hour worked. Some of my staff feel that I am expecting a lot- and one member verbalized that I should make myself a part of the call group in addition to my managerial job and responsibilities. She didn't say much more after I told her that my being on call and working the unit thereafter is a "freebie".
For those of you who may be thinking that I should hire more staff: the people are NOT there. I have "stolen" as many of the med/surg nurses as I can and I continue to look for new nurses everyday. On one hand, my staff say that they are "burning out" due to orienting new people to the unit and on the other hand, they ask me to hire more people. I could use per diem nurses, but my some of my unionized staff do not want them in our unit. Administration has also discouraged us from using per diems to cover for vacations this summer.
In light of the national nursing shortage, lack of extra staff in my unit, and the fact that we already have so many new nurses on nights, do you think that I am asking too much with having a call schedule to cover our unit? I feel that the burden of staffing should be shared by the whole team until we hire more staff.
I would like to know what the rest of you are doing out there and if you have a problem with having a couple of days off to yourself or any part of "a life"?? Are you expected to be at the beck and call of the hospital 24 hours a day? How are you handling the nursing shortage?
I am new at this and welcome any comments.
Apr 28, '02
At the facility where I work, very few nurse managers will come in to cover for staff shortages. I suspect it is for the reasons you mention...no compensation. We too have nursing supervisor coverage 24/7 who are supposed to fill in when staff is short. At the very least, they are supposed to come to the ward for break relief when we are short staffed. Very few do.
The solution as I see it is very simple. When there are not enough nurses to safely care for patients, then beds MUST be closed. As long as you and staff nurses continue to work overtime, the reality of the worldwide nursing shortage will continue to be ignored and denied by governments and administration. They continue to ask their employees to work more with fewer resources.
Although I admire your dedication, I also feel sorry for you. It is a catch 22 situation, as when beds are closed, then patients have to wait longer for treatment. I personally decided that 2 years ago, I could no longer continue to work overtime. It was affecting my health, my family life and my nursing attitude and judgement. Although I could have used the money, the final decision was based on whether I could live with the prospect of harming a patient due to a medication error due to fatigue and stress. I decided that I could not live with that possibility, that it violated the reason I became a nurse. As professionals, we all have an obligation to recognize and acknowledge our limitations and draw a line when it comes to patient safety.
I believe that the best thing that you can do is to resist mandating overtime and to talk to your admin about using the resources you have to provide the highest quality of care given your current resources as opposed to pushing to squeeze out more from your staff. It will be in the best interests of your patients AND staff.
Last edit by Patience911 on Apr 28, '02
Apr 28, '02
Yes, Patience 911...I agree with you. The problem is that we have used all of the resources that I have. We staff with 2 nurses per shift and when one of them calls in sick, that leaves only one nurse and we cannot keep one nurse by herself.
I felt that it was best to initiate a call schedule and to spread out the burden on the team as a whole instead of burning out the few nurses that are the only ones who ever come in to cover the unit. In time, I hope to get new staff so that the staff do not need to think of working more than 36 hours a week.
I feel the same way you do. The tremendous responsibility that comes with managing the unit AND the added pressures of having to also be a staff nurse on call is beginning to make me have the same thoughts as you. After working 50 hours a week and then being expected to work as a staff nurse for free is depressing. I plan on talking with administration about this to see what they have to say.
Please share any ideas on how to avoid using a call schedule. All I know is that our unit cannot continue to be covered by just a few nurses. We all need to share the burden and take care of each other until our unit is built up again.
Apr 29, '02
Travellers is one option you didn't mention- they come experienced and lots are looking for OT and the big bucks it gives them.
But I also need to say that the more you put up with the more they will give it to you...
I say take the comp time...let it all build up and go out of town for an extra long weekend- you've earned it. Then the hospital as a whole will need to cover the shortages for a bit. If you work too much as a staff nurse you cannot physically complete admin work. The hospital needs to shell out whatever is necessary to get reliable staffing or close beds that cannot be staffed safely.
A voluntary on call schedule might be taken well (with time and a half if called in for the shift). I don't think any staff nurse has an obligation to work past her hired hours, or to do MOT, as adequate staffing is an admin responsibility. Unfortunately the job you signed up for is poorly planned re coverage, so now you'll have to renegotiate with those around you.
Are there other managers in the hospital with the same issues? A brainstorming session, or a united proposal to your DON might be helpful.
Apr 29, '02
We don't even get comp time here.
Travelers have really helped out here because so much of the short shifts were nights. Try do some of those and then attend that mandatory leaders meeting the next day. But they are a HUGE budget eater and then you have to answer for being over your budget. (interestingly, if I take the agency out of the equation, we would be only 5-6000/mo short because they raised the wages and sign on bonuses but didn't add that to our budgets)
I am leaving after just less than 2 years and am so looking forward to doing patient care again.
I would have loved management if we had enough nurses to cover the shifts. I work for a place who's administration actually supports nurses. My nurses have great patient ratios (5 on days, 6 on nights. I went in when they were taking on more than 8 a piece on nights.) I enjoyed the leadership and coaching and mentoring it involved. I didn't even mind the harder parts of the job such as correction or firing as long as I could get rest.
Apr 29, '02
One of the variables that make your situation more difficult is that of the size of your unit. Managing staff shortages is easier if the staffing complement is larger. As you say, missing one nurse leaves a tremendous gap that must be filled. Larger units can more easier cut their beds for a period of time. A unit such as yours would have to close completely unless a nurse is expected to work alone.
Although my unit is a bit larger, we were where you are a few years ago. We have 3 nurses around the clock, and have just obtained approval to increase to a 4th. Over the past year, I have implemented a voluntary on-call schedule to get us over difficult times when the unit is ++ busy. It worked well. Staff were happier knowing the possibility of coming into work as opposed to dodging the telephone that rang off the hook each day.
I agree with Patience911, although not coming in to fill the gaps is easier said than done sometimes.
Apr 30, '02
Thanks, Stormy and Canoehead. I appreciate the support and suggestions. My DON plans to address this issue as there is another manager in the hospital who has the same problem on her unit. We had a great brainstorming session yesterday. I am hoping that we come up with some more answers when we meet again.
I am going ahead with the call schedule covering the nights and weekend days so that no one has to work more than 12 consecutive hours. We have discussed the possibility of closing the unit and no one wants to do that, so I think that the staff will pull together and do what they have to do to maintain their job security.
I have thought of travellers, but I think that it is not just a money issue. My biggest problem with staffing occurs when there are sick calls. There is little staff to cover them. This is why we need the call coverage. I don't know if there is a way that I can get a traveller to be on standby for sick calls. I haven't used them before.
Thanks again. If you think of any new ideas, please pass them along.
May 1, '02
Agency and travel nurses may be one way to go. I would not implement MOT or mandatory on-call schedules either. In this day and age, expecting mandatory anything above and beyond what the employee had agreed to may (and probably will) put you in a worse staffing situation than you are already in. Remember nursing positions are a dime a dozen and if you go ahead and initiate mandatory OT or on-call, you may just see a mass exodus from your facility.
Also, you can not expect these nurses to give you all this OT, for the same reasons that you are having problems doing it, family time is becomming increasingly important to people, and rightfully. I have always believed that you can not expect an employee to do something that you would not do yourself.
Unfortunately, staffing is not the staff nurses problem, and it sounds like they are all getting burned out by this situation and are looking to you for some kind of solution. Having experienced this myself, I have found that the staff nurses will fill in for only so long and then will stop doing so because they feel that by doing so, it doesn't give management any incentive to hire more nurses. This is why nurses are so against MOT. They feel like many times facilities use MOT so that they do not have to hire more employees. I would be really careful as to not let your facility get that kind of reputation.
I agree that a volunteer call staff may be at least part of the answer as long as you make it worth their while. If you make the offer really good, you may have more people signing up for call than you need. Why can't you utilize the prn staff more? If you don't have prn staff, maybe that would be an option.
In my facility we have what we call the manager on call. There are four of them and they each have one week per month that they cover call for emergencies. That way none get really burned out, this may be an option. I started as a night 7p to 7a charge nurse in Oct and we have only had to resort to calling in a manager twice on my shift. However sometimes just having the opportunity to call a manager and consult with them about staffing helps, as then I have a fresh point of view on how to handle the situation. I only call them into the hospital if absolutely need be and the staffing is just not safe without their help.
I hope some of this helps. You sound like you are really getting burned out. I hope you take some time to take care of yourself.
I also agree with an above poster regarding closing beds, if the staffing is not there. You may have to postpone some of the elective surgeries in order to provide safe staffing.
Last edit by JillR on May 1, '02
May 2, '02
Thanks for your response. I do only have one prn staff member right now, with one in training. I am always working on hiring staff, but due to our location, experienced staff are few and far between. The staff do not want to close the unit and they are willing to do what they need to until we build up our staff. I am here tonight working a night shift due to lack of staff. Yes, it is hard for me to do my manager job at 50 hours per week and then fill in as staff on top of it all. I decided to only cover nights and weekends with the call schedule which gives each staff person one to two 12 hour shifts every 2 weeks. I did't think it was too bad for a temporary fix until new staff is trained. Our full timers are scheduled for 36 hours per week. If they end up working one call shift, they work 48 hours total during the week. When they are on call, they make $3/hour and then time and a half with shift diff. for call back pay...more than what I get as a salaried employee.
I just wish that there were nurses out there who want to live in this area.
Please pass on any other ideas you may have.
For my own FYI, I will be looking into travellers. Can anyone recommend a company to go with??
May 2, '02
I wish I could help you more. I also live in a rural area, we had extreme staffing issues, such as yours, last year and it took a toll on everyone. It was so bad that the DON and the clinical director of OR worked the floor (med/surg) on Christmas. They did use agency nurses and one stayed here as a staff nurse. WE had two supervisors, and three staff nurses all put in resignations within a week of each other. As you know, for such a small place, this is a good percentage of the RN staff.
In response to this, they started a weekend plan, which really helps. Regardless, we seem to always have openings for RN's, LPN's and CNA's. Job hopping is very common in this area.
Good luck and take care of yourself.
May 2, '02
Thanks, Jill. I like your story of how an agency nurse stayed on as staff. I didn't think of that as a possible benefit of bringing agency nurses in. I was talking with one of the union reps last night and he told me that bringing in agency nurses may bring hard feelings. I don't know if that would be the case or not. My staff might be thankful for this as there would be less demands on them.
We start our call schedule this month. I will see how it goes.
Thanks for your support.
May 2, '02
Further to my comments on staff shortages and implementation of a voluntary call schedule in my unit...
In preparation of my budget for this coming year, I put together a presentation of numbers of patients diverted from our hospital due to staff shortages, numbers of surgical cases cancelled due to staff/bed shortages and amount of money spent on overtime. I also emphasized efforts put forth by the staff nurses to accomodate shortages and their willingness to work a call schedule when necessary. I made sure there was an understanding that the nursing staff could not be pushed any farther than they currently are. Quality of worklife issues were discussed, as were recruitment and retention issues.
As a result, I have just recently gotten approval to hire another nurse around the clock as a result of these efforts.
You bet we are all very excited. I believe we were successful in our bid for more staff because of staff willingness and cooperation to do the best they could.:kiss
May 2, '02
That is a great idea! I will talk to my staff about this study. It is the only way to increase staffing. Administration bases decisions on numbers and they are interested in recruitment and retention. I will certainly take this path to improve staffing in our unit.
I will keep you posted!
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