I'm a fairly new nurse manager (since September) who works in a pediatric hospital. I've worked on the same unit for years so I'm intimately familiar with the ins/outs of the unit and staffing required.
This year is one of the first that our unit has not met budget, and after meeting with finance, we have found that the biggest overage expenditure is regular labor hours; and we are not meeting budget not because we overhired, but because our average daily census has not met what we budgeted for.
I am being asked to "get rid" of approximately 4.2 FTE's in assistant staff (nursing assistants, unit clerks, monitor technicians). Short of terminating people or requesting reassignments, (both of which I refuse to do), I am looking for ways to trim the overages. We have already cut out OT and put serious limits on PTO usage. Of course I will be looking at tightening up staffing, but we hired to our budgeted FTE's so even then, may have staff who cannot get in their hours in a given week!
I am welcoming ANY ideas, advice, or simply good wishes that anyone has. We have a wonderful unit and everyone really works together for the good of the patients. I absolutely hate to be in this type of situation and want to do what's best for the unit. I have a great boss who is helping out, but want to be creative and get as much input as possible.
Thank you so much for your time!!!
May 10, '13
Does your staff know about the budget situation? I would tell them -- explaining that positions may be cut if hours aren't reduced. With any luck, some of your staff may see the writing on the wall and find new jobs that are more secure -- which would give them the opportunity to leave under their own terms and headed towards a good job -- while simultaneously fixing your budget problem.
Not giving the opportunity to transfer, and then later having to lay them off ... would be more cruel.
If you don't have enough patients to justify having such a large staff, the only way around it is for some people to leave (or go part time, etc.). People can either do that voluntarily or you can force them leave. I think most people would prefer to leave after having found another job rather than wait to be laid off.
Another thought ... Can you suggest other work that they could do for the facility while remaining part of your staff? For example, could you "loan" an employee to another unit for a little while. Or you could pick up a task for the hospital to give your unit some extra work to do that would justify the larger staff. Have a special training program that would make your staff the "go to people" when they need a resource somewhere else? That could justify keeping them a part of your staff, ready when needed on your unit should the census go back up ... but being productive by fulfilling other needs when the census is low.
Last edit by llg on May 10, '13
May 12, '13
I am currently challenged with this also. Decreased FTE's and a decreased Unit of Service per patient. I spoke with my staff immediately about all of the changes. We approached it together as a team. So far we realigned the schedule but have found that with the new UOS we are too lean. I am currenlty working on a presentation to lobby administration to increase the UOS.
May 12, '13
I have been there done that. It's very stressful and finance hold us all hostage. I agree presenting it to the staff and see if they may be willing to make some type of change so everyone can keep their job or perhaps reallocate them to other areas that have openings. Healthcare is tough right now. 2 yrs ago after we got a new COO and he came in and made big cuts in a already flat organization. My managerial position was eliminated after I worked there 20 yrs. so the area I was over was given to a manager with 3 departments. Makes sense??? NOT!
May 14, '13
The painful part of being a manager is making the hard decisions, but I don't see how you can "refuse" to take steps to control costs.
Your not meeting your budget, but are you operating in the black..or the red? Controlling OT is important, as well making sure your staffing is appropriate to your census and acuity. We will flex down staff, canceling our registry nurses first, then voluntary flexes. Involuntary flexing can be either unpaid, or using PTO. Since PTO is an accrued benefit, there's really no need to limit it. If they want to take a day, or a week off, let them.
I'd suggest meeting with the staff, find out their plans. See if anyone is thinking of retiring or would like to reduce their hours. Would it be possible or desirable for the staff to decrease their FTE ?
For example, if 10 FTE employees reduce to 0.9 that's the equivalent of on less employee.
Are there any supply or capital expenditures that can be trimmed to save some dollars?
Staff reductions are difficult, never easy for anyone, but unfortunately necessary.
May 14, '13
It's tough to go through for sure. It's better to lay off some people than continue the further downward spiral for sure. What I would look at is your census. Is it bimodal? Can you staff by the census trends? For example, our unit census drops significantly during the summer. When we had to cut FTE's we converted a few staff to 9 month employees who have the summer off. It works great for folks with children home from school and we call less staff off in our low summer census months. Be creative. I would also encourage you to contact other like units that are in your compare group for staffing benchmarks. Call them and see how they staff. I've learned a ton by networking with colleagues from around the state and nation. Good luck - it's not a fun position for sure. Keep us posted!
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