staffing stradegies

[RockyCreek]

I am trying to impliment a fair and workable staffing plan so, being new to this, I talked to 4 other managers to see how they did it:

1. Just in time - does her 'balancing' just in time for the start of shift [staff hates having so many last minute adjustments - never has a schedule out more than 2 weeks in advance]

2. Staff for average - assumes a certain number of patients and always staffs the same numbers every day [staff is usually happy but has no plan for the above average days so the staff can be stretched way over grid with no extra staff available]

3. High and dry - assigns like there are always the max number of patients and then 'calls off' any unneeded staff an hour before shift [staff hates using all their 'ETO' to guarantee a full pay check]

4. self-staffing - just puts a 4 week schedule down and lets everyone fill in their days and then has to deal with too many nurses on one day and not enough on another [again staff hates the late call offs one day and short staffing on the other days]

All of these managers tell me that schedules are a top complaint in their units but none of them were working on new ideas but would love to hear what I come up with! [Floating and on-call pay are not used on any of these units]

What works? What about most senior nurses on units getting 'fixed' schedules? Do full-time get priority over part-time or per diem? 12-hours over 8 hour? One unit staffs on a 4 hour pattern [except for 11p-7a] so you might come in for 4 hours, be sent home for 4 hours, and come back for 4 hours -- does this make sense to anyone but accountants?

Thanks for the input!

Ruthann

[carolCCRN]

Wow, what you describe is a HOT MESS. No wonder the staff complains.

I've been doing our schedule for 8 years and we've pretty much been doing self-scheduling. We staff for 20 beds (ICU unit, RN/Pt ratio 1:2) and the schedule is opened for self-scheduling 6 weeks before the start of that schedule, and final 2 weeks before the start of that schedule. Any shift that isn't staffed with 10 RNs is open for extras/OT.

Self-scheduling, however, does not mean staff gets whatever they want. I can't have 15 RNs working on Wed and 3 on Fri. Adjustments have to be made. We don't have set schedules, but we do take special consideration for school or on a case-by-case basis. I think the staff is by-and-large happy with the way we do things because I really try to mess everybody over equally. It forces them to take responsibility for their own time, for finding solutions to their scheduling conflicts, and looking to each other as a team. I believe in rewarding performance and flexibility as opposed to longevity but I know others feel differently.

On a daily basis, if our census doesn't support 10 RNs, we have to give LOW (lack-of work) for which they can either use banked PTO or sign up for another shift - bumping extras/OT and supplemental(PT) staff. It is what it is. We cancel in 4hr increments. If I call you off at 5am (for 7a-11a) I may call you in @ 11, but I would NEVER make someone work 7a-11a, call them off 11-3, and call them back in 3-7. That just bites.

Overtime gets cancelled first, then supplemental (PT), then extras (non-OT), then regular staff.

Holiday time is another matter. We have 3 holiday rotations (Thanksgiving, Christmas, New Years and other minor and hard to fill holidays like Memorial Day, 4th of July, Labor Day) each RN is assigned to a group. They stay in that group until they quit or die. If they are in the Thanksgiving rotation this year, they do Christmas next year, and New Years the next. Holidays are always stressful, but no so much for me now, because the staff knows well in advance what they'll be working, and they take the responibility of working out issues with their buddies.

The schedule is not set in stone, and deals can always be made. Empathize with the staff while keeping your eye on the needs of the unit. Sometimes you will need a Margarita. God bless and good luck!

[mama_d, BSN, RN]

I'm not a manager, but I thought I'd chime in with the way my unit does it:

A planner (covering four weeks) is posted about five-six weeks ahead of time. Staff fills out when they want to work, with special notation of days which they cannot work(limited to four per schedule), when they have school, and when they have workshops/inservices to attend. Weekends and required holidays are pre-filled in. If you sign up for extra shifts, those that are chosen to be OT are also indicated. Vacation days have to be pre-arranged in writing before they can be put on the planner, only so many people are allowed vacation days at any one time (depends on job title).

The person in charge of scheduling picks up the planner after it's been out for 1-2 weeks, takes about 1-2 weeks to determine a final schedule, and posts it. There are times when adjustments have to be made, but they are fairly few, since noone really wants to be the extra staff that is pulled most people will take a look at the planner before it gets picked up and make adjustments at the last minute to balance things out. The notation of PTO, cannot work, and school/workshop/inservice days allow for the adjustments to be made without scheduling someone for one of those days when they can't work. Additionally, there is a list of requests, like who refuses to work x # of days in row, that the scheduler has. If they do have to change shifts around from when someone scheduled themselves, they try to rotate it so that noone gets "picked on" more than anyone else.

People still complain, but it is at the bottom of the list of complaints on our floor.

[MB15YRS]

My unit has about 145 employees and within the last year went to self scheduling. We post their weekends/holidays and they post the rest. We have a self scheduling committee that oversees this 6 week schedule. Once the schedule comes down, the committee counts each day and matches to the number that we need for average staffing for that day. It starts low for the beginning of the week, higher toward the end. If we have too many on a day, and not enough on the other, the committee takes the schedule back to those staff and make changes to better staff other days. It has worked very well in our area, staff are much happier and don't mind making the necessary changes.

Our holidays are on a rotation. We have group A, and group B. You are assigned to a list, and your holidays are listed as headings. Example, group A holidays are July 4, Labor Day, Christmas, and New Year's Eve, and group B has Memorial Day, Thanksgiving, Christmas Eve, and New Year's Day. At the end of the year, you switch to the other group. This has also worked very well. The self scheduling committee oversee this list.

Before posting new positions, I discuss with the self scheduling team. They have wonderful insight regarding scheduling needs/shift needs. My committee consists of RN's and PCA's. It has been a pleasure working with them. :wink2:

[RockyCreek]

Can I bring up another issue?

In order to keep administration happy about budget compliance, we have had to do 4 hour staffing. This is NOT popular. Of course, we have to ask people to 'pick up' the odd unscheduled 4 hours - this is usually not as big an issue as the rest of the problems. Some people will be asked to stay home for the first 4, go home early for the last 4 or [least popular of all] sent away for the MIDDLE 4 of a 12 hour shift but work the 4 before and 4 after.

I am having a real hard time wrapping my head around the concept. Sure, it makes the accountants happy but what about the patients and staff? They both HATE it! Is anyone else doing this? How do you make it work?

[SICU Queen]

Can I bring up another issue?

In order to keep administration happy about budget compliance, we have had to do 4 hour staffing. This is NOT popular. Of course, we have to ask people to 'pick up' the odd unscheduled 4 hours - this is usually not as big an issue as the rest of the problems. Some people will be asked to stay home for the first 4, go home early for the last 4 or [least popular of all] sent away for the MIDDLE 4 of a 12 hour shift but work the 4 before and 4 after.

I am having a real hard time wrapping my head around the concept. Sure, it makes the accountants happy but what about the patients and staff? They both HATE it! Is anyone else doing this? How do you make it work?

That sounds just awful.

Sending a nurse "away" for the middle 4 hours of a 12 hour shift is ridiculous. They'd do that to me - ONCE - and I wouldn't be back. How disrespectful and inconsiderate.

[Sunflowerinsc, ADN, RN]

Can I bring up another issue?

In order to keep administration happy about budget compliance, we have had to do 4 hour staffing. This is NOT popular. Of course, we have to ask people to 'pick up' the odd unscheduled 4 hours - this is usually not as big an issue as the rest of the problems. Some people will be asked to stay home for the first 4, go home early for the last 4 or [least popular of all] sent away for the MIDDLE 4 of a 12 hour shift but work the 4 before and 4 after.

I am having a real hard time wrapping my head around the concept. Sure, it makes the accountants happy but what about the patients and staff? They both HATE it! Is anyone else doing this? How do you make it work?

Never heard of this. If someone comes in 4 hrs late, doesn't someone have to stay over 4 hrs, ect? Go home in the middle? Who covers for that 4 hrs? I don't understand how that keeps the budget down? It must to total confusion for assignments, patients and staff. What is the point of it?

[RockyCreek]

I'm sorry -- I guess I didn't add enough information. The staffing is 'flexed' according to the present census. So, if we discharge a couple of patients we end up sending a nurse home; if we then admit a couple of patients, we need that nurse to come back. Frankly, I hate it! Yes, we have to stay in business and we can't do that if we lose too much money. We also can't stay in business if all the good nurses quit!