Small hospital staffing concerns for high census

[Northernlights]

I'm curious about how other small hospitals staff when census goes through the roof.

I'm an ER nurse in a 25 bed hospital that has a 24-hr ER. The hospital does OB, med-surg and takes a few rehab type patients (swing bed or transitional care). My concern is not the ER, but the med-surg area. This past weekend I was turning patients over to the floor nurses who already had 7 or 8 patients. I felt awful knowing they were in over their heads, but we were backed up in ER and couldn't keep them.

My question is, how do other small hospitals deal with large shifts in patient census. We don't seem to have a contingency plan. When we talk to our director, she says staffing is based on average census, which is averaged over a year's time and is 12 patients. However when we are at top census, our patient number is 25. And we seem to be hitting our top numbers much more often lately. We have never refused admissions due to nursing staff availability, but I wonder if we should sometimes. (Our next available hospital is 60 miles away).

[alphaetomega]

I agree whole heartedly!! And nor does the nurse deserve to have to deal with that stress or potentially loosing her liscence over greediness. I feel for you sister! Let me know if anything I can do to help!!!

[herrera2]

I worked small town hospital and the night shift got stiffed. I have to admit some nights we only had 4 patients but it seemed the biggest majority of the time we had 8 to 14 patients. All of us nurses got together and decided that it was to the point that it was unsafe. One of the nurses went to the head of the floor nursing mananger (who didnt work nights) and complained. The director of med surg said and I quote "Here is my shoulder cause that is all I have to offer". I felt bad for our charge nurses at night because I know they felt bad for us. We would always get the "all the patients sleep at night so we dont see what the big deal is" excuse. One bad nursing manager can really leave a sour taste in your mouth.

[weatherwoman]

As a nursing supervisor on the 4p-12mn shift, one of my responsibilities is staffing the nursing units. Abrupt surges in hospital patient census has been a concern of mine. With the nursing shortage, it is difficult to hire multiple RNs for a shift about to begin or in process. If you get one RN to join the staff last minute you are thrilled. Because of this situation, I started doing research to identify factors which precede and/or parallel critical surges in patient census. On November 5, 2008 my hospital is sponsoring a conference that focuses on the meteorologic conditions that are associated with abrupt shifts in hospital patient census. The goal is to be able to forecast abrupt patient census increases 24 to 72 hours in advance. Networking between hospitals and nurses could advance this concept. If anyone is interested in this subject please reply.

[SuesquatchRN, BSN, RN]

I'm in a 14 bed CAH.

Staffing is based on census by month here, not year. We get a lot of summer people and census goes much higher, as does staffing.

And we ship. If it's not COPD, CHF, pneumonia, or something like a severe asthma attack we get 'em stable and off they go.

[ruralnurs]

Hi,

I can see that the original post is pretty old but this is an issue for rural hospitals every where. We are a 16 bed CAH and have the same problems with more patients than nursing capabilities. We handle much of it with having a "call nurse". There are about 12 of us and we all (per union contract) take call 2-3 days per month. We get paid $5 an hour to be on-call and then time and a half if we are called in. We have a few PRN people that work very seldom and just take call as well, we had an RN who retired but just took OB call (for L&D). We are all a big team here and sometimes our surgery nurses come out to the floor and help as well. Our ER is 4 bed and the ER nurse often takes a pateint load (and isusually the charge nurse too). We also have a wonderful manager that puts on scrubs and digs right in to help too.

When we are really crazy like with high floor census and then 3 chest pain pts present to the ER (like I had last weekend) or a multi victim trauma, even radiology and RT as well as lab jumps in to help. They will take pts to the BR, clean gurneys and wipe up vomit. Team work really comes in to play in these rural areas.