Sick call policy - page 4

Hi everyone, I am a Nursing Director at a very small rural facility. Our professional staff is also limited, and we do not have a pool to draw from, so when we have sick call ins it really impacts... Read More

  1. by   PhantomRN
    i am not mngt but i dont think it is fair or even a good idea to have them come in and work to fill holes in the schedule.
    at my last place our manager would do that rarely, but it had been such a long time since she had worked the floor that she had a very hard time.

    then to add insult to injury the charge nurse gave her the heaviest assignment possible. totally unfair. there was no way she could handle it so the rest of us, who were already swamped had to make up the slack.....so who did our charge nurse slam?????? us her fellow nurses with an extra patient to look after!!!!
    and the manager. now if i were that manager i would not have had a warm and fuzzy feeling toward my fellow nurses if they did that to me.

    but believe it or not despite that treatment she still went to bat for us and tried to get us more staffing. i dont know if i would have been that forgiving.
  2. by   BadBird
    First of all I don't believe in punishing sick employees. That said, did you ever think about using Agency nurses, starting a pool of inhouse nurses to pull from. Do you have a sick day, vacation day policy or have you given any thought to PTO (paid time off) where both vacation and sick days are lumped together. Some times the nurse just needs a mental day off, if you use PTO you may be able to plan ahead. Most importantly I would not punish the sick employee by making them make up a weekend that just leads to poor morale and there is enough of that already.
  3. by   bbnurse
    For my observations, you may be missing a few points about the topic here.
    Let's suppose all the good, positive suggestions are in place.
    1. pool is utilized, have "prn" staff too
    2. good weekend diff is paid
    3. OT is time&1/2 guaranteed
    4. Bonus is also paid $200
    5. Agencies are used, but hard to staff on a "late call"
    6. NM helps when short
    7. Retention bonus paid
    8. Recruitment bonus available
    9. Week end option available
    10.Competitive pay
    11. On call is used for "potential" short shifts
    12. OT is voluntary
    13. Occurances are given for absences and lateness.
    14. poor behaviors are handled one to one
    Yet, there are call ins every week end. We pick up the slack but are getting tired of the others who seem to call in to extend their weekends, or the ones who call during football season only... Why not just "TRADE" with someone?? Or Request a PTO instead of the last minute calls? Or the ones who say in the morning, "I'm calling in tonight"....but wait until the agency couldn't possibly fill it and the pool is all assigned, to call in. Does she care?? Doesn't look like it to me.
    What if we like our NM and she does care for us? How can she change the climate of the dept or hospital if that isn't the problem anyway?
    How can KlareRN improve the climate, if the hospital is already working short? Who will be attracted to a place where there is a shortage that just gets worse daily?
    What happens to the patients?????Substandard care. Why? So I could use my sick time? I think not. Who takes care of them?
    Instead of calling this a "management" issue, I think it is more than placing blame. If all the good stuff IS in place, why do call ins happen that we all know are not legit? IS it OK to hurt the hospital (translated to mean "patients") so that I can use my benefits? When legit, yes. When bogus, NO!
    How can anyone, staff or management, produce a nurse and provide care to the patients when there isn't anyone? Tell, me where do we look for that nurse ? (taking into account, all the other good ideas you mention as do I, are in place) Where?
    Last I knew, there were no magic wanes issued anymore.
  4. by   OC_An Khe
    If all the good thingd are being done, then last minute call ins are an acceptable part of the facilities culture, from both a staff and management perspective. To change the culture will be difficult but it can be done over time, positive reinforcement and peer pressure are a start. Also the design of sick time is it a use it or lose it design? Can you cash in unused sick time?
  5. by   globalRN
    Carrots work better than sticks.
    Sick time is a benefit so if you are asked to work it back on another day off while also working your regular hours...well, that happened to me at one job and I refused!!! There was no attempt to replace me while I was sick because management
    though I could be made to work on my day off to finish the work.
    I left the job at the end of my contract because it was an insensitive boorish management style which I absolutely refuse to endure ever again. I voted with my feet...out the door.

    Interestingly, after 'my precedent' the manager drafted a policy that all staff must cover their own sick time...get the work done.
    Totally neanderthal thinking!!

    I like the idea of self scheduling...if all staff know they have to work x number of days, nights and w/e within say, 8 week time period....then leave them to it. Let staff work out when they want to work. then there is less likelihood that people call in sick for schedules they have chosen themselves.
  6. by   susanmary
    Mandating staff to make up sick time they've taken -- weekend or not -- is EXTREMELY PUNITIVE. In fact, nursing is extremely punitive in far too many ways. We are professionals who should be treated with respect (we must also act respectful of our coworkers.) If I'm sick, then I stay home. If my kids are so sick that they required me to be home, then I stay home. Period. My family comes first. My health also comes before my job. I do not abuse sick time -- nor do I expect to have to make up any days.
    As a team player, I have worked to cover sick calls. I work on a great floor with many team players -- we cover our own holes/sick calls. No whining, no mandating, we just pull together and do it. Period.

    Do I take my job and the responsibility of being a nurse seriously? Absolutely. I am also responsible for not infecting my patients if I have a bad cold, flu, etc. I also take the responsibility that I must feel well enough to make safe, sound, clinical decisions and med passes. I will NOT put my license on the line by coming to work when I am sick.

    Mandate me to make up sick time, and I will mandate myself out of the facility. A little respect/support goes a long way. Stop the demands -- increase the pay & get a float pool for sick calls (not just to cover the hard-to-hire units.)
  7. by   Gardengal
    I just encountered this thread and read it with great interest because I too struggle with weekend coverage at times with call offs. We too have bonus for extra shifts, travelers, local agency nurses, posted extra shift availability lists and I truly try to be an understanding manager. Sometimes though I get so tired I could cry when I get that call from the weekend offshift supervisor that there were call offs. (I've figured out that sometimes it's better to just plan to work a tough to staff weekend shift and take a day off mid week than hope not to get called on a known difficult weekend, it's those call offs that are tough)

    My staff is absolutely wonderful overall, though and more often than not when I call and see what's going on in the unit they say they'll call me back...they're trying to figure it out as to how to cover that call off. They don't want me to have to come in. i think that's because they know I will if I need to and that I try to respect their time too. There have been times that merely discussing with them a change in pairing of patients, sharing cardiac arrest responsibility with other ICUs or triaging beds and potentially blocking a bed if possible after transferring a patient will avert a crisis. Some shifts have been pretty tight, and I'll just go in at lunch time to cover assignments to make sure everyone gets a break. It's kind of funny though, because everytime I do that it's kind of like a gab fest because I usually try to bring in some kind of edible treat and we all end up going in and out of the break room eating together.

    Sure, I have some people who have obvious trends in call offs.I try to deal with those on an individual basis. [ People who have patterns of call offs (especially around holidays )days they've tried to trade and then call off, excuses to others that they can't do schedule switches to help others, persons who make more requests on the schedule than they are allotted on a routine basis]......those people do have to do an additional weekend at the scheduling committee's and my discretion when they call off. I think that's only fair.

    Like many others I have been living with the nursing shortage. I took my present job with a nursing vacancy rate of 40% in my department, and many nurses fearing mandation. Within my first month in my job the vacancy progressed to 50% and stabilized. I closed 2 ICU beds in my unit and actively recruited travelers. I knew that our local area would not be able to get me enough recruits quick enough to fix the problem. It took me almost 3 months to get my traveler contracts in place so that they would all start close to the same time, and I reopened the 2 beds. It would have just increased cost and not open any more beds if I acted too quickly and just brought in one at a time. I explained to the staff my rationale, and asked for everyone to tell me what their most important times were and asked how much extra they could give or wanted to give. I discovered that many nurses wanted the extra time and money, but only on certain days and circumstances. we worked really hard to take advantage of all of the available opportunities of time from everyone. Frequently at the end of a 4 week schedule you couldn't recognize what the original schedule was, because we did so many switches.(I do not believe in mandating nurses, however I do think that it is something that has happened and will happen forever to a minimal degree. We just didn't call it mandation 20 years ago. I think that there will always be that rare occurrence when someone just has to stay another shift or portion of a shift because of a late call off or a sudden rise in acuity and we can't cover the patients, despite all efforts. My staff knows that the potential is so low that they accept those rare occurrences. At least I think that's the case. They tell me they understand, it's only happened twice in the 15 months I've been in this position)

    I think one of the biggest positives in my unit is the team spirit that we have. Our rules are clearly spelled out and everyone knows that the rules are followed-within my discretion. I do schedule everyone to every other weekend. The hospital policy is 1/2 of the weekends/yr and my staff prefers the predictability of every other as opposed to 4 weekend shifts out of 8 which was also discussed. My scheduling committee balances all of the schedule requests. When there is conflict I mediate and make the ugly decisions, but usually it's based on trends tracked by my scheduling group.

    My staff knows that if they call off on a weekend that hospital policy states that they may have to work another weekend at the managers discretion, but it doesn't really happen too much. The attendance policy also says that you may have to switch with someone to coordinate your weekend. An approved week of vacation by policy includes the weekend off before and after, but the weekend which you should work might need to be switched with someone else. In my department we have chosen to not switch that weekend, but rather to utilize other people's availability on that weekend. We asked who wanted to work extra weekends and use them. We also call our casual staff and supplement there. It is also understood that in order to honor nice vacations for all we will shoot for core minimum staffing on weekends sometimes although we would like ideal staffing (ideal includes a charge nurse without a patient assignment which allows us to respond to ICU patient acuity changes more easily) With the efforts that we make to make sure that the big requests are honored, it is understood if you call off on weekends you may be placed on an additional weekend later when needed. A called off weekend may be made up anytime in the next year. If that weekend shift does not need to be made up in the year it will be erased as being due. Typically I have seen that those who have called off on a weekend tell the scheduling committee that they are available for an extra weekend on a particular wekend and we can use that time.

    I usually will allow the decision for the need for a make up to be made by the committee, who trends weekend call offs. Persons who give me notice of a particular need with enough notice typically can get that day off. If I am not able to just grant the day because of tight staffing, I frequently can tell them which person is most likely to be able to switch. If it's a really important request to a staff member and I am able, if no one is able to switch I will sometimes take a weekday off and come in for the weekend as my schedule allows. My staff knows that if you want people to be flexible with you, you need to be flexible back.

    I am happy to say that finally after a tough year of balancing day by day,life started to improve. We finally were able to recruit a few nurses to build more stability. We now only have a 35% vacancy and are undergoing my phase out plan for travelers. I continue to have several local agency people who we use routinely to supplement my core staff. A few of these nurses have asked me to warn them for the time I have enough staff that I won't have as much routine time. I believe that they will come on board as regular staff.

    I guess in retrospect I'm lucky. I have panic moments when I look at particular weekends, but somehow we always get it figured out. I give credit to my staff who trusted me to pick qualified travelers and agency nurses to supplement them and work around their schedules. It's been a tough ride, but next week I take 2 nurses off of orientation and will again be able to run at 95% occupancy. In the past year we have maintained 89% and the docs are happy with getting their patients in most of the time. My biggest pleasure is that I am now taking extra days off.
    I am taking Friday off with my weekend and have signed off my pager for a 3 day weekend! I am a happy woman!
    Last edit by Gardengal on Nov 15, '02
  8. by   canoehead
    That is wonderful work. I wanted to give you a pat on the back for working out a way to have give and take and being a part of the team with your nurses.
  9. by   Youda
    The last time I called in on a weekend, I had a nasty NM say (you know the haughty parent voice), "Well, if you call in on the weekend, you'll have to work next weekend to make it up."

    I said, "Well, since I ONLY work weekends, was hired for weekends, I'd rather planned on working next weekend anyway, so go ahead and schedule me."

    Here's the simple facts, as has already been said: people will call in on weekends. Some are legitimate, some are not. So, what are you going to do about it? Punitively taking away a "benefit" hasn't worked, has it? So think of another way.

    One place I worked, towards the end of the month, the NM put a big calendar in the breakroom. You signed up for "on-call" days. People got to choose when they would be "on call" and you got to choose by order of seniority. The hospital paid for two cellphones. When you were on-call, you carried it with you, so you didn't have to be stuck by the phone. YOU GOT PAID HALF-TIME WAGE FOR BEING ON-CALL EVEN IF YOU DIDN'T GET CALLED IN!!!! If you were called in, you got time-and-a-half.

    It worked. Everyone was happy. No one was punished. Most of the time you got paid for carrying a cellphone to the movies, or to the mall. And we didn't work short.

    Find other solutions. Have you ever held a nurses meeting and explained your problem to them and asked THEM for solutions? Have you ever thought to make the people who cause the problems part of the solution by asking for their input? Maybe they call in because morale is low and they're fed up and close to quitting. Maybe your scheduling is screwed-up.

    I've worked in places where the nurses all got together per unit and made out our own schedules. We traded days when we needed a day off at the last minute. But, we also never scheduled ourselves for the day of a doctor's appointment or a daughter's dance recital. Call-ins dropped considerably when we got to make our own schedules.

    It's amazing to me that NMs are so quick to punish. I realize the starter of this thread is looking for input. You are a rare exception. Usually, these rules are just cramped down our throats, and they doesn't even solve the problem that the "rules" were made to correct.

    Try talking to your nurses. Try asking for their input. Allow them to use some of that "critical thinking" we're suppose to have. Give them the problem and see what they do with it. When THEY find the solution, they'll abide by it and feel that they have some control and power in the workplace. Your morale will go up, call ins will slow down . . . . because you treated them like the intelligent, adults that they are.
  10. by   hoolahan
    Half-time pay for on-call is an excellent incentive.

    At one facility I worked at, we had a double-time incentive. Anyone, no matter their FTE status, if they signed up for any unscheduled time, got double time. Man, this was so hot, we had to start a list like the pull list so we could be fair to everyone who was signing up for it.

    NEVER EVER had a problem with call-outs when doulble time was in effect. Double time was stopped once we had enough staff, attarcted through the double time incentive. Many agacey staff came on board to the hospital, and if you think about it, that is what the hospital was paying agency anyway, why not reward their own staff? Hubby used to say to me, I can't believe you are driving out to work, 45 min one-way, for a four hr shift. Hone, it's double time, like being paid for eight! this was so wonderful, esp when kids were small. I could easily pick up four hrs of db time.

    Double time! Sorry I forgot to mention it before. A VERY effectove incentive!!
  11. by   kmchugh
    Originally posted by KlareRN
    I am not frightened to defend myself...what I am is frustrated. Some nurses just continue to justify their poor behavior. Remember I never said ALL call-ins were avoidable. What we are talking about here are nurses who have abused more lenient attendance policies leaving no choice. Those who are abusing the sick benefit are the ones who are making it so difficult for everyone else. They are usually the ones who start defending their "right" to call in.
    "Poor behavior?" Calling in? I suppose you think nurses expecting to be paid at the agreed rate is "poor behavior" as well! Face it. Sick days are a benefit, by your own admission, given by your hospital. If you turn around and require the nurse to "make up" sick days, you take that benefit away. Remember, the nurse is also receiving PTO for the sick day, unless of course your policy takes that away as well.

    So, if upon hiring, suppose I tell you that I don't often take sick days, but when I do, I expect that I am exercizing my rights and using a promised benefit. I do not expect that I will be told that I have to make that up at your convienence. Now what? There's a nursing shortage, and if you won't hire me, someone will. And be happy about it.

    Why do you presume, that because some people improperly use sick time on weekends, everyone does? Why do you proactively punish all your nurses? Why not identify the nurses who cause the problems, then deal with them? For example, if a nurse calls in sick repeatedly on the weekend, counsel that nurse about it. On her next weekend call in, tell her to come on in, and you will arrange for her to see a physician in the ER, or employee health. If she's ill, fine, send her home. If not, give her the choice of getting to work or leaving, for good. Finally, if this repeats itself, fire her. But don't punish all employees for the bad behaviour of a few.

    Kevin McHugh
  12. by   fergus51
    Kevin, love your reasoning and everything, BUT,
    I just have to say working at my hospital that would never fly. The reason is we are a unionized workplace and you can bet the nurse who is targetted because of excessive weeend call ins would file a grievance with the union before you could say call in. If a standard is applied to one nurse it has to be applied to all or the union would never let it go. Sort of ties the hands of the manger. It's either put up with poor behavior of those who abuse sick time, or force all employees to make up weekend time.
    I also love the ideas about more pay for weekends on call and such, but with our budget restrants it would never happen here either. The only thing that keeps me from constant call outs on weekends is my own sense of professionalism, just like it does for the vast majority of nurses.

    Fortunately I have recently changed jobs and this doesn't seem to be such a problem. It's amazing how the behavior of one nurse at my old job affected the entire unit's morale.
  13. by   maple
    I work as an LPN in a rural area,we have only 4 full timers,one part timer and one casual.I a lumpectomy one day and 2 days later had to work because no one would cover me!Thats staff for you!But to call in sick-hey nurses have cruddy jobs its no picnic being a nurse-has its rewards of course,but no picnic many times,if we're sick,we're sick!Give us a break!maple

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