Does the size of the work unit matter?

[adventure_rn, MSN, NP]

Hi fellow AN folks! I've been thinking about unit sizes, and I'd be curious to hear your feedback.

I've spent time on units ranging from a 6 bed CVICU to a 60 bed Neonatal ICU. Neonatal ICUs, my specialty, tend to be enormous; the largest I've heard of is a 120 bed unit in Alabama.

Here are some pros I've come up with:

Benefits of a small unit:

-Manager is very accessible

-Nurses become a tight-knit group

Benefits of a huge unit:

-If you can't stand your manager or certain coworkers, you can more easily avoid them

-With a pool of literally hundreds of nurses, you can usually find coverage for high census, holiday, switches, etc.

So, AN, I'd be curious to hear about your thoughts and experiences. What is the unit size 'sweet spot'?

[Pangea Reunited, ASN, RN]

I love working on my small unit. Although we have 19 beds, we usually stick to 10 patients, 2 nurses and one CNA unless the hospital is super-busy. We also have a unit clerk. My unit is tight-knit and not as chaotic as the larger units. As for switching, we are allowed to switch with other units, so we still have a descent sized pool.

[Dogen]

I like big units.

I work on a unit that has the best of both worlds. We're actually three small units (10-19 beds) combined into one 43-bed unit. The staff are all shared between the three units, but on any given day you'll only work on one of them. Each unit has regular staff that float to the other two units as census dictates, and we PRN staff float between all three without a "home." The benefit to me is that I like everyone, so I float around and get to see them. I also find some of them annoying if I work with them for long periods, so floating around helps. Coverage for days off is rarely a problem. Each unit has its own flavor and the staff work effectively as a team, and the nurse manager rounds on all the units regularly, so I get benefits of small units, too.

Prior to this I worked on a 29-bed unit and it was a good size. I felt like there were enough staff to get coverage, and so you weren't always working with the exact same people, but small enough that you still got to know everyone pretty well.

[calivianya, BSN, RN]

Honestly, finding people to switch/do vacations/etc isn't necessarily any easier or more difficult based on unit size - it's more about how much management cares about making their staff happy. I work a 30 bed MICU and we have a ton of staff, probably well over 70-80 people. The policies are so restrictive that it's almost impossible to get vacation time off when you want. Not to mention everyone is assigned a team for holiday staffing, so you actually have to find someone to work a holiday for you.

At my first job, which was a smaller ICU, we could rank our holidays and our managers would try to work with us. I usually got the days I wanted off without too much hassle.

You might have more coworkers to switch with in a larger place, but it seems like management is a lot less likely to work with you because they have too much staff to bother with caring about what each individual person wants.

[BumbleBuddy]

I was mislead by the title of this post....

But anyways. I like a midsize unit. Ours is 30 beds. There's enough staff to cover days you need off. There's also enough people here to rotate around and prevent that annoyance you get working with people every single day, but also not too many so our staff members aren't practically strangers.

[Farawyn]

I was mislead by the title of this post...

Me too.

[melizerd, ASN, RN]

I'm on an 18 bed unit. Day shift we have 5 nurses and 3 aides. From 19-23 we have 4 nurses, still 3 aides. Nights have 3 nurses and 1-2 aides. We work every third weekend.

I feel like we are a pretty tight knit group. We don't usually have an issue switching holidays.

[Horseshoe, BSN, RN]

In reading the first several responses, I was amazed that no one interjected any levity, given the title of the thread. And then...

I worked in a fairly small unit. We self scheduled. Our manager told us if we couldn't get a schedule filled fairly and properly, she would take it over, and we might not necessarily be pleased with the results. If you needed to switch, people would try very hard to accommodate you, since we all knew we'd need that favor as well eventually. So we made it work. And it was nice to be treated like grown ups who could understand and implement fairness without managerial intervention. Our unit manager was so awesome.

[adventure_rn, MSN, NP]

Me too.

Oh dear, censored again.