picu scheduling

Pediatric Critical Care Columnist · Mar 12, 2007

Sorry for the delayed response, kbray.

There's no magic formula or simple recipe for scheduling in a PICU. The easiest is perhaps the team approach. You decide how many weeks your master rotation will be and develop it, then divide up your staff into that many teams, being careful to balance out the junior-to-senior nurse ratio so that there will be adequate resources at all times. Each team will start on a different week of the rotation... for example, if your unit is on 12 hour shifts, the rotation is four weeks and pay periods run Sunday to Saturday, on the first Sunday you would have Team A working days, Team B would be off, Team C would be on nights and Team D would be off. The next Sunday Team A would be off, Team B on days, Team C off and Team D on nights. On the third Sunday, Team A would now be on nights and Team C on days, and so on. Full timers would work alternate weekends and part timers would work a percentage. Each team would end up working a number of holidays with compensatory time off. Vacations are a known liability and there are a number of formulae to determine how many people may have the same weeks off, based on the number of staff, the number of weeks; vacation entitlement in total and the number of beds. Complex stuff.

Self scheduling, in my experience, is really a misnomer. It's very complex too, because of the huge number of variables that need to be considered; staff mix, compliance with HR regulations and contractual obligations, individual preferences, fairness all come into it, or should. Our unit has self scheduling for those who wish to do so. I tried it and hated it. We seemed always to be in the process of either selecting our shifts or negotiating to fill the gaps, with schedules being plotted for sometimes eight months in the future. (We're scheduled up to September 27 already.) The way it's supposed to work is this: The committee releases a blank schedule for X number of weeks (multiples of six as our master rotation is six weeks) with a deadline for submissions usually of two weeks. Each self scheduler then indicates on the grid the shifts they wish to work. The committee then takes the grid, plots out the number of staff on rotation and the self schedulers desiring to work each shift, and develops an over-and-under list. Once that's ready, it's sent back to the group for negotiations, wherein each person is expected to look at it, take themselves off over shifts where they can and move themselves to under shifts where they can. Once that's done, the committee takes it all back and makes arbitrary changes to ensure there are enough people, the staff mix is acceptable and the schedule is contract-compliant. In practice I don't find it works all that well. Problems arise when people only want day shifts or only want night shifts, but the numbers aren't balanced; there are others who never put themselves down for weekends, even though we have a contract stipulating full timers are to work 1 in 2. If it worked the way it's supposed to, there would be no gaps in staffing, but that's not the case in reality. We have some shifts where we have five people standing around or we're floating... mostly weekday days, and others where we're seven short... mostly weekend nights. There are days when next to me, the most senior person in the unit has less than a year of experience... very hard to feel safe and comfortable, or to make safe and reasonable assignments. I tried it for three years and felt like I was being singled out to always have my selections totally ignored. There were some whose choices were never touched, always the same handful, while mine never even came close to what I'd chosen. So I went on a rotation a year and a half ago and am so glad I did. I can take a calendar and count the weeks forward and know in minutes if I'm working or off. It makes choosing my vacation weeks easier too, because I can put them at one end of my scheduled six days off and have eleven for the price of two.

I'm not an expert in scheduling by any stretch of the imagination, but I know what doesn't work well, and it's what we're doing!

AliRae · Mar 13, 2007

Everything on our unit is based on seniority. As low-woman on the totem pole, it's been rough on me!

Our schedules are in 4 week blocks and we do a sort of self-scheduling. When we start a new schedule, the next schedule after that one is posted, and we have to have our requests filled out 2 weeks prior to the schedule being posted. We have a grid in our book with dates and names, and we fill out the days we'd like to work. We all work every other weekend, no exceptions except for the one Baylor nurse. Weeks start on Sunday and end on saturday, which really stinks because when we want to switch weekend days once the schedule is posted, you have you switch within the same week. (Basically, you're narrowed down to one day that you can switch for.) Each schedule you're allowed 4 "R" days ... "request off" which they will honour whenever possible. The schedule goes to the head nurse who moves people around (starting at the bottom) to fill gaps and ensure proper staffing. Pretty much I fill the thing out and forget about it because the schedule I end up with never looks much like the one I asked for.

Holidays are paired. If you work one, you're off the other, again by seniority. (4th of July and Memorial Day, for example ... I think. I never know what days are holidays until I see a highlighted date in the book.) Christmas and New Year's are complicated and I don't really get it, but I plan on working 12 hours on Christmas Eve and Christmas day for the next long while...

I'm sure other places have a better way of doing it. But I figure if I stick it out, I'll move on up the list one of these days and actually have a say in my life! =)

Pediatric Critical Care Columnist · Mar 13, 2007

Ah yes... Christmas and New Year. How could I forget about them? Our contract stipulates that we must work one or the other, and in general we will alternate, working Christmas (the 24th-26th) one year and New Year (the 31st and 1st) the next, unless we have enough seniority to get vacation. (HAHAHAHAHAHAHA!!! I'll be 79 before that happens...) There are some who have no family nearby and are willing to work Christmas every year, a few people get stuck working parts of both (like me usually) and there are some who always end up working neither, through some magical act-of-God. If we're overstaffed on any shift between the week before the holidays until the weekend after New Year everyone's name goes into a hat and the unit clerk makes a draw for time off. If your name is pulled, you have the choice of taking the time as vacation or statutory holiday, or working. I usually work; I like to take my vacation when it's a good time for me, not when it benefits my employer. Lately though we haven't been overstaffed during the holidays. In fact, last year we were so short we had four in on overtime Christmas Day night shift. Let me just crunch those numbers... works out to about $95 an hour. The list of people who had been given time off in advance (regardless of seniority I might add) was longer than the list of people scheduled. It was brutal.