nursing supervisors all shifts?

I worked at a large pediatric facility where there were nursing supervisors on the 7p - 7a shift. This was always a troubled system, however due to the small size of the facility, the problems were managed. The facility added several new units . At this point, the cracks began to show. Issues regarding staffing and patient placement began to cause excessive waits in the ER and recovery room, nurse staffing was poorly managed with certain unit charges not revealing when the beds were emptied or scheduling changes that resulted in more or less nurses. Unit managers were involved in day to day managemement meetings etc.. that staffing issues were not addressed in a timely manner. I would highly recommend 24 hr nursing supervisor. Someone needs to be in place who "can manage the needs of the house" who has the time and ability to follow up on staffing and patient placement issues. In the two facilities where I worked in this role, each went to 24 hr nursing supervisor to resolve those issues. It would be staep backward to change the system. I think that your institution is not aware of the problems that will result. Here is a short list of problems:

1) Managers (and or charge) would refuse patients when they had beds availiable because "this was not their type of patient" therefore physicians were angry to find their patient waiting on a bed when there were beds availiable. - Nursing supervisor made and enforced decisions on patient placement

2) Frequently staff would not remove patients from the census (computer) and available beds were not being used - nursing supervisors "walked" the house and talked with charge and knew which patients were leaving and when as well as getting social work involoved when discharged families occupied rooms because there was "no ride" - Nursing supervisors facilitate the flow of patients and reduce patient wait times

3) Often staffing was not regularly update - Nursing supervisors knew through their "rounds" what staff was availble, they ensured that all units were fairly staffed

4) Charge nurse would state they could not take patients because of staffing - Nursing supervisors reviewed patient acuity and staffing and decided if moving a patient to another unit was appropiate or not

I think it will be a comedy of inefficiency and mismanagement to depend entirely on each unit manager to work with the other unit managers on these issues.

Hi,
I work 7A-7P as an Administrative Nursing Supervisor at an acute care medical center with 142 licensed beds. We all work 12 hour shifts in Nursing here and there are supervisors on both shifts 24/7. During the week when I am working the directors are here but they enough to do within their depts and jobs, I maintain bedflow via ER, Direct Admits, PACU, CATH LAB, etc:, deal with night shift staffing/callouts etc: help out staff wherever/whenever from starting IV's to feeding babies in the nursery; pharmacy and materials management when the dept is closed; so my day can get really hectic at times. flaerman

I agree with MYDESYGN, I am a Nursing Supervisor and we have coverage 24/7/365. We stay on top of staffingatient ratio. Our CEO would like to staff totally by numbers, but we stand our ground and staff by acquity. It would be a "MESS" if we didn't have 24 hour coverage. Our Managers are responsible for the initial schedule and we cover call-ins, increased staffing needs, etc. (not for holes that are left in the schedule). After I've exhausted all avenues, I don't hesitate to call the manager in to help staff her/his unit. We manage to do it without using a staffing agency. We can offer incentive pay in emergencies (that helps).

legalnurse22 Mississippi
RN, CLNC

We currently have a nurse supervisor for all shifts. What we are going to try is making the day supervisor become a bed flow coordinator (they do nothing but work on patient flow and bed management)and add a staffing clerk to work on the staffing issues with nurse managers M-F. We will have nurse supervisors from 4P-12Aand 12-8P and 24 hours on the weekend.

Has anyone else tried something similar?

I really strongly feel that there should always be a dedicated nurse supervisor to facilitate bed flow and staffing/ 24 hours. The facility I worked for used to do something similar and it failed. Bottom line- unit managers are busy and don't have a lot of time to spend in patient flow issues nor a sense of the needs of the "house" as opposed to their own units. You set yourself up for unnecessary patient delays. I would highly recommend against it.

It's funny how some facilities continue to try to save money by going around "best practice". One of the facilities I worked for had bed control located in admissions and had 1 clerk and her manager was trained in registration. There were constant delays. Neither the clerk nor the admitting manager could handle all the issues with nursing and staffing. It took the physician complaints to finally get the system changed. It was never the clerks or the registrations managers' faults - they were asked to do a job that was outside their scope of expertise. Unfortunately, the right people need to put their foot down and refuse to allow a system that depends entirely on a clerk to handle staffing/patient flow. It simply isn't fair to place a clerk in that position.

Typically, a clerk is a data entry position. Making decisions regarding staffing requires a strong knowledge of patient acuity, diagnosis, nursing skills, and critical thinking. Often, there is limited staff and the clerk will need to decide which area has the most need - and whether to float a nurse and leave a unit short in order to fulfill a need elsewhere. The clerk does not have the background to make those decisions nor the credibility. I would suggest using the clerk for bed assignments and using either a nursing supervisor or a single dedicated nursing manager to resolve staffing issues - this would also give the clerk a go-to person to resolve issues with bed assignments when they arise as well as an expert to facilitate bed assignments and staffing.

We have supervisors here M-F, 8-5, unless there is a reason for them to be here otherwise. The rest of the time the charge nurses and house supervisor takes care of things, including staffing issues. We have 165 beds. House Sup initiates the chain of command when needed and will contact the administrator or clinical person on call. Otherwise, the house sup handles a lot of things.