Evidence-based Justification for <40hr/week & Per Diem Scheduling?

[mountainandsurf]

Greetings,

I am hoping that someone out there can assist me in locating an evidence-based foundation supporting flexible scheduling for acute-care RN employment. In addition, I would like to hear how your hospital utilizes per-diem nurses to assist the workflow.

In what I feel is a short-sighted and ill-conceived move, my hospital is only posting new openings at a 80-hour/2 week ("1.0" schedule), whereas previously a 56-hour/2 week ("0.7") and 64-hour/2 week ("0.8") schedule were considered full-time for benefit purposes (full coverage / no partial pay). Where I worked previously, the switch to 1.0 schedules for new hires translated to burnout, turnover, increased training costs and lower morale. My hospital is also going towards a self-scheduling model, which is effectively cutting per-diem staff from scheduled shifts (the PD commitment is 2x 8hr shifts/2 weeks, and previously could be scheduled and/or available for short-notice needs). With our new model, there are not enough open slots for existing PD staff to meet their commitment (some of these RNs have many years of experience in this department, but are now considering employment change). And yes, there is new management in place...

Some of my peers work a 1.0 schedule for personal reasons to cover their expenses, etc. and I've heard plenty of old-time stories of working "28 hours a day, uphill both ways, in the snow, etc." I believe a 1.0 is fine if you are standing behind a cash register or churning out spreadsheets from a cubicle, but I personally am very invested in my patient care, and am often emotionally, mentally, and physically spent from a tough shift. I have worked the full spectrum of shifts from days to NOCs, and schedules from 1.0 to per diem, and I know I am a better nurse when I work less than 40 hours per week. I also feel like it is vital that our per-diem staff remain familiar with the workflow and shouldn't be relegated to merely stand-by/as-needed scheduling.

I welcome any thoughts and feedback, and would specifically appreciate any research/academic thoughts on the subject.

Thank you, a PACU RN, MBA

[Altra, BSN, RN]

It sounds like your hospital had implemented a desperation measure during the nursing shortage of the 2000s and provided full-time benefits for part-time employees. And now they're saying, that's enough of that.

I can't really get on board with getting too upset about not providing full-time benefits to those who work as little as 28 hours/week. Across all industries, 37.5 - 40 hours/week is considered to be the full-time norm. Nursing has it pretty good to get full-time status at 36 hours/week.

I've known many nurses who were just as dismayed as you are now when their positions went from 1.0 to 0.9, as it meant a 10% pay cut.

A schedule full of part-timers and per diem workers can get to be a scheduling nightmare, and presents numerous challenges in maintaining communication, commitment to the unit, and ongoing training/competency testing/continuing ed.

Do a search for self-scheduling and nurse satisfaction and you will find numerous references. Forgoing this important aspect of job satisfaction for full-time employees just to satisfy part-time and per diem nurses doesn't make much sense.

[BlueDevil,DNP, DNP, RN]

I don't think there is anything wring with wanting to work less than 1.0FTE. I think one is looking through rose colored glasses if they are expecting full time benefits for part-time work. I am not aware of many opportunities of this nature in present day nursing.

I don't work in a hospital setting anymore. The last 10 years or so that I did, the only way we used per diem nurses was to fill in for vacations and last minute call-ins. Per diem was a "no benefit" position. As in zero, none, nil, naught, zip, nada, zlich. I can see that offering the opportunity to work less than FT and still earn FT benefits would be appealing and boost morale and help decrease turnonver, especially since it is a goo bet no one else in town is offering that, lol. It is also hella expensive, since benefits are the most expensive part of compensation. These days FT employees are lucky to get any benefits!

Hospitals are hemorrhaging money. I'd be pretty shocked to see PT employees see benefits such as you describe again in this lifetime.

[HouTx, BSN, MSN, EdD]

PPs are absolutely correct. The days of 'bonus' benefits (e.g, 36 hours with full time benefits) are extinct. Hospitals are scrambling to reduce costs in a way that does not decrease bedside staffing... the biggest opportunities are those benefits that used to be needed to attract and maintain staff.

BTW, OP is misinformed. Training costs are the same for FT, PT, PD because competency & performance expectations are not pro-rated by number of hours worked. Therefore, training is much more expensive, in terms of ROI (return on investment) for people who work less than full time.

[emtb2rn, BSN, RN, EMT-B]

PPs are absolutely correct. The days of 'bonus' benefits (e.g, 36 hours with full time benefits) are extinct. .

36 hours still equals full time in NJ. At least it does in central/north. 3 12's per week is FT.

[LTCNS, LPN]

The hospital I am employed under considers 30 hours per week as full-time while providing full benefits. I myself work 36 hours per week, but would eventually like to go to 32 hours per week. I am in MS.

[llg, PhD, RN]

The hospital I work for gives "full time" benefits to nursing working 3 12-hour shifts (36 hours) ... but some of the benefits are calculated based on the number of hours actually worked. For example, the 36 hour folks get the same health insurance coverage for the same amount deducted from their paychecks as the 40-hour people. However, vacation time earned and retirement plan contribution are calculated on the number of hours actually worked.

Less than 36 hours per week is considered "part time" and gets a diminished benefit package.

[mountainandsurf]

Thanks for the responses so far and sharing your perspectives. A few points of clarification:

1. I live & work in the San Francisco Bay Area, and I am well aware that many conditions here are unique compared with elsewhere in the nation (supply & demand, unions, cost of living, ratio's, etc.)
   
2. Per diems are not benefitted (by definition)
   
3. I meant training costs increased because turnover increased - with poor retention, training costs are greater & productivity is negatively affected as experienced staff orient new-hires, etc.
   

Please keep your ideas coming!

[jadelpn, LPN, EMT-B]

Because of the influx of new graduates or nurses who are looking for a change, there are many hospitals who are doing away with PD staff all together in favor of "float pools" for sudden staffing needs. Or changing the rules for per diem to reflect "as needed or PRN" which essentially means that once the self schedule is completed, per diems can take what is left--or not.

One of the interesting things about self scheduling is that it depends where you are on the picking list. Someone who has always worked nights, for instance, can find themselves with the only choice being days once it is their turn to pick. Or visa-versa.

Unfortunetely, the days of anything other than 40 hours being full time is over for a number of nurses. Others find that the rules change as far as 36 hours "may" be considered a full time employee, but the benefits are pro-rated or you have to make a higher contribution to your benefits, so it is a huge money loss. I have never heard of 28 hours being considered full time. In my facility that is a part time employee, and everything is prorated as such.

Going to 2 8's and 2 12's or 5 8's is not an easy thing, however, you may feel less burn out if you just work the 8 hour shifts. When one is used to 12 hour shifts, it is amazing the difference a few hours can make.

When you are talking about a time where there is so many changes to the way healthcare is delivered, and management seemingly wanting to "groom their own" at whatever cost necessary to established staff, they will get there by whatever means they can--because unfortunetely, for your job there's 15 other nurses who would take it in a heartbeat--even if it were a 40 hour position. But they would keep you on to make sure you precept them first......

[kabfighter]

I am offered benefits at my hospital despite only working 40 hours biweekly (0.5 FTE). The only difference is that I have to pay about $75 more per month for health insurance. If you are 0.8 FTE you are considered 'full-time' and get the cheaper insurance, and 0.9 FTE gets the maximum amount of tuition reimbursement.