Does your hospital mandate nurses or other staff?

[JBMmom, MSN, NP]

I'm sure like everyone else, my hospital is dealing with staffing shortages unlike anything we've seen before. We are about a 200 bed hospital and according to our union we are just over 400 nurses across the hospital and a few outpatient facilities. Over the weekend, the supervisor said 52 nurses are currently out sick or on disability/FMLA, etc. Obviously this is a pretty big percentage and we are constantly running short. The fix for this has been to mandate nurses. I work in the ICU and we had two nurses mandated yesterday afternoon and then rolled into a nurse mandated from 3-7am and then another from 7-11am. This is after working 8 or 12 hours shifts for a maximum of 16 hours. I work nights and one supervisor on my shift said he mandated 29 times in November and over 40 times in December. That's only one shift and one of the supervisors. I've been mandated only once, but our poor 3-11 nurses have each been mandated multiple times because nights is the most poorly staffed, and we're mostly 12 hour shifts so there are only a few 3-11 staff. Our administrators say we aren't getting any applications from travelers because they can make more money out west where the pay is better. There are constant text messages on days off to pick up shifts and there's currently an incentive program offering $50 per 4 hours picked up, but only for shifts picked up 48 hours in advance- no incentive to pick up last minute. (which seems ridiculous and does nothing to help in emergent situations). I'm just wondering how other hospitals are dealing with shortages. Do you mandate nurses? Are you just working short? When I left this morning they wanted us to have 5 nurses for 11 patients including 8 vented COVIDs, four of whom were proned, multiple pressors running, of course almost everyone is still full code, and with only one tech on the floor. So someone was mandated to keep us a 1:2. When nurses have multiple COVID rooms we're often stuck looking for someone at the desk to help us out, but when we're short, there's no one there. We've had patients extubate themselves, disconnect from ventilators, pressors switch to KVO, etc., because nurses get pulled into a COVID room and there's no one that can keep an ear out for the rest of the unit. Fortunately, none of those incidents have lead to a patient death yet, but it seems we're riding a fine line until that happens. Our management's mantra is "well, it's a pandemic", as if that makes everything okay. I'm not saying I know the solution, and maybe there just isn't one. Anyone find themselves in a facility that's still able to maintain appropriate staffing when many are out? I know that for myself I've averaged 56-60 hours a week for the past few months, and I'm really for a break. I hate to leave my coworkers short, but I'm not going to pick up as many shifts myself. It's not even financial at this point, I like the extra money with pick-up shifts, but it's not worth it right now mostly due to exhaustion. 

[Davey Do]

Interesting question and post, JBMom! 

Averaging 56-60 hours a week?! Wow.

In the '90s, nurses were mandated at the state hospital, but by the time I got to Wrongway in '03, they couldn't mandate RNs or LPNs.

Wrongway was extravantly paying as much as triple bonus points to get staff to come in or work over. However, the points were like Walmart credit cards and payroll often made mistakes, and not to the employee's favor.

What a mess...

[Sour Lemon]

To make a long story short, we are extremely short staffed. Full time staff are being required to work at least one extra shift, although I'm not sure how (or if) that's being enforced. I am often the only nurse on my acute care unit and have all total cares. There's no other nurse, no CNA, no clerk, etc. It's JUST me.

As per diem, I am immune from the mandates, but I have picked up a few extra shifts voluntarily because I feel bad for the other nurses, not to mention the patients. The last shift I worked, they actually forgot I was coming and were super happy when I showed up. When I got my pay, I was surprised to find that there were a bunch of codes tacked on that increased it significantly ...and I mean at least 30ish dollars an hour higher than what I normally make.

"We're in a pandemic" is the reason I am given for anything I ask, as well. It's been rough, but I feel like our supervisors are trying, so I just do the best I can with what I have to work with.

I'm in med/surg/tele/psych, though. I think ICU or ER would be extraordinarily stressful in comparison.

[JBMmom, MSN, NP]

Thanks for the responses. I'm in the middle of a six night stretch so I think I was just feeling a little overwhelmed, I'm sure we're not dealing with anything others aren't going through as well. I want to do what's best for patients, so if it means mandating staff I think it's the right thing to do, the problem is the constant "do more with less" message coming from management. But I do realize they are also limited by the lack of available staff. 

[speedynurse, ADN, BSN, RN, EMT-P]

Only “mandates” for my facility are for regular hours and on call. Now....I admit sometimes we are cajoled into more hours but not mandated. I will always help my team but not to the point that I don’t feel like a safe nurse anymore....

[OUxPhys, BSN, RN]

I work for the VA. They do mandate but it's rare. It's only supposed to be used in emergencies but of course it is implemented when a lot of call offs happen. 

[TheMoonisMyLantern, ADN, LPN, RN]

I work for a state facility that mandates up to 16 hours, typically we have a mandate day three times per week. Tonight's my 7th night in a row. ?

[Tweety, BSN, RN]

Thankfully there are no mandates here but we are dreadfully short staffed every day.  When we are well staffed they will pull to another unit (often the covid unit) to cover so we are all equally short staffed.  They are even sending mother-baby RNs to be "helper RNs" on the floor and do tech work because we are also short of techs.

We supposedly had some contract nurses hired on Monday.  They are also offering financial incentives to pick up extra shifts and an even bigger incentive if you pick up an extra shift weekly for a month or six weeks.  

We've yet to experience our 2nd wave of covid admissions and sick staff but it's just now starting as our percent of positivity is double digits in the county I work here in Florida.

Good luck.  

[HiddencatBSN, BSN]

My hospital mandates and whenever they do they are fined by the state....but we're a state run facility so IDK how that all works out. They try to make deals (stay 4 hours and I'll take you off 4-8 on another day) but the deals end up compounding staffing issues on other days. They've been working to hire more nurses and tech and with COVID we have a labor pool where non-clinical staff gets reassigned as help nurses or runners to try to make things run more smoothly.

My experience is that mandating is the last option and they really try to make other solutions work, both immediate term and longer term.

 

[NICU Guy, BSN, RN]

Our unit is at a record low census (half avg. normal census). There has been a low number of births since Covid started. The rest of the hospital has been slow due to Flu and RSV being eliminated due to masks and home schooling. Our PRN nurses have been working our COVID call center since April/May. We have 4 Adult hospitals and 1 children's hospital. We may be pulled to the adult hospitals to be sitters for adult patients. We can also volunteer to work extra shifts as a bedside nurse in the adult hospitals for an extra $20/hr.

[AceOfHearts<3]

No mandates, but the messages from staffing constantly looking for help is tiring. They keep increasing the pick-up bonus, but eventually that doesn’t help since people are so tired. I work in a very large ICU, so while it’s definitely hard we at least tend to have a lot of extra ears available and our Covid rooms have the pumps outside the rooms. Now, whether or not someone who is sitting around actually checks a beeping pump is another (frustrating) story. We’ve also had nurses tripled at times. We keep being told “it’s a pandemic so we just have to make do” ?