Filling in staffing holes?

[martymoose, BSN, RN]

I'm interested in hearing what other acute care hospitals do when they have have holes in staffing, such as same day call ins, or shortages of staff that don't allow for proper scheduling? 

Where do you get staff from? What does California do when they don't have staff? Where do they get them from? Are there same day agencies? What Kind of lead time do they need? Can it be done with 2 hour notice? 

I know some hospitals have "in house supplemental staffing" but my place ended that program. So if some one calls out, tough crap.

Are there a lot of mandatory overtimes in acute care? Do people quit because of that then, as how are you supposed to care for children and pets if you are at work and have no other means(no neighbors, etc.) 

Just some questions in trying to make sense of the lack of staffing. which is one of the most common threads I'm seeing ,

[TheMoonisMyLantern, ADN, LPN, RN]

A float pool or resource pool is very common in hospitals to help fill in staffing holes. In addition the person doing staffing for the shift will look at the census and staffing for each unit in the hospital and reallocate staff as needed if a unit has a surplus of staff and another has a shortage. Certain areas may be "closed" units and cover their own staffing, usually highly specialized units like mother/baby, nicu, peds, etc. it's not uncommon for closed units to have a scheduled "on call"" or mandatory overtime schedule to cover staffing holes. In larger areas agencies can send nurses to help with coverage, it's easier to get staff the more notice you give them. For chronic shortages travelers are utilized. Then of course there's the daily begging for permanent staff to pick up shifts. Oh and hiring PRN or Per diem staff to help fill in holes is common as well. 

Small hospitals seem to utilize mandatory overtime quite a bit because the census can be pretty turbulent. 

[RNperdiem, RN]

My large teaching hospital has a flex team of literally hundreds of nurses capable of filling most holes. The flex nurses are generally very good. The charge nurse looks at staffing for the next shift, the census and acuity of patients and puts in staffing requests. The staffing department will fill those holes with flex staff or float staff. Usually we get what we need. For the COVID surge, the unit hired some travel nurses to boost staffing. 

If staffing can't send us enough people, then we put out an email or text letting staff know that we are short and would welcome extra help. This is not mandatory staffing, just putting the word out. If possible then the charge nurse might pick up an assignment instead of being free charge.

If all else doesn't work, the manager or assistant nurse managers come in to staff. This happened a lot during the COVID surge. Staffing hole happened at midnight, and the manager came in to take a patient assignment.

[JBMmom, MSN, NP]

5 minutes ago, RNperdiem said:

If all else doesn't work, the manager or assistant nurse managers come in to staff. This happened a lot during the COVID surge. Staffing hole happened at midnight, and the manager came in to take a patient assignment.

Oh my goodness that sounds like a dream. Management that actually cares, and does something, about the staffing of the unit?! Our hospital utilizes mandatory overtime so staff in the unit are "mandated" to stay up to 16 hours to cover holes. We do have a small float pool, but during the COVID surge every floor needed coverage so there weren't enough. Our manager told us that if staff "cared enough about their co-workers, they would come in and help". Many staff were so burnt out they weren't willing to take on extra time, and none of us blamed our coworkers. We've been okay for the past couple weeks, hoping that this is the end of the COVID crisis in our area, and for everyone.

[TheMoonisMyLantern, ADN, LPN, RN]

48 minutes ago, RNperdiem said:

My large teaching hospital has a flex team of literally hundreds of nurses capable of filling most holes. The flex nurses are generally very good. The charge nurse looks at staffing for the next shift, the census and acuity of patients and puts in staffing requests. The staffing department will fill those holes with flex staff or float staff. Usually we get what we need. For the COVID surge, the unit hired some travel nurses to boost staffing. 

If staffing can't send us enough people, then we put out an email or text letting staff know that we are short and would welcome extra help. This is not mandatory staffing, just putting the word out. If possible then the charge nurse might pick up an assignment instead of being free charge.

If all else doesn't work, the manager or assistant nurse managers come in to staff. This happened a lot during the COVID surge. Staffing hole happened at midnight, and the manager came in to take a patient assignment.

Wow, acuity is considered in addition to the census? Hundreds of flex nurses? Management that is able and willing to provide patient care? Ya'll hiring? 

[Sour Lemon]

4 hours ago, martymoose said:

I'm interested in hearing what other acute care hospitals do when they have have holes in staffing, such as same day call ins, or shortages of staff that don't allow for proper scheduling? 

Where do you get staff from? What does California do when they don't have staff? where do they get them from? are there same day agencies? what Kind of lead time do they need? Can it be done with 2 hour notice? 

I know some hospitals have "in house supplemental staffing" but my place ended that program. So if some one calls out, tough crap.

Are there a lot of mandatory overtimes in acute care? Do people quit because of that then, as how are you supposed to care for children and pets if you are at work and have no other means(no neighbors, etc.) 

Just some questions in trying to make sense of the lack of staffing. which is one of the most common threads I'm seeing ,

I rarely see agency at my hospital. In fact, I never have. There were some agency nurses training on the computer system when I started, though. We do have a few staff who float. I am one of them. We also have mandatory overtime for full time staff, but that's recent and expected to be short lived.

The biggest success in creating adequate staffing has been to throw a bunch of money at people who volunteer. I don't recall the exact amounts, but they're way above what anyone would expect. There are constant confirmations, as people believe it's too good to be true. An extra day gets you paid well beyond overtime. An extra day and working in the covid unit gets you mega-compensated.

I got talked into working an extra day by a supervisor I'm fond of. I was very confused when I got my paycheck, because it was so much more than I was expecting.

[JadedCPN, BSN, RN]

It blows my mind when hospitals, especially larger ones, get rid of the float pool department to save money.

My hospital uses float pool for most of the daily needs although there can often be more needs than float staff - in that case they will send an email/text out to people saying there are X amount of needs on this day if anyone is willing to pick up. If nobody picks up, then management comes into staffing to charge and the charge that was scheduled takes an assignment.

Post-COVID, several units have hired travel nurses as well since there isn't enough float pool staff to go around. Our float pool has also hired additional staff to help with the increased needs. Pre-COVID, certain units could offer a bonus pay for shifts that are deemed "critical" which would be an extra $10/hr.

[martymoose, BSN, RN]

6 hours ago, RNperdiem said:

My large teaching hospital has a flex team of literally hundreds of nurses capable of filling most holes. The flex nurses are generally very good.

we used to have this. Once Covid started hitting, they ended it. Not sure if it was coincidence or not. It was great when they had it; we had some regulars that were wonderful. Now they are all assigned permanently to floors ( and not mine ; they got to pick, if that tells you anything , LOL. 

[martymoose, BSN, RN]

On 3/1/2021 at 10:20 AM, Sour Lemon said:

The biggest success in creating adequate staffing has been to throw a bunch of money at people who volunteer. I don't recall the exact amounts, but they're way above what anyone would expect. There are constant confirmations, as people believe it's too good to be true. An extra day gets you paid well beyond overtime.

Nope , we even tried this- like 40 bucks an hour more. Even that doesn't help. Everyone is exhausted. And burnt. And kind of hard to do when you're working all 3 shifts in one week.

[JBMmom, MSN, NP]

4 hours ago, martymoose said:

Nope , we even tried this- like 40 bucks an hour more. Even that doesn't help. Everyone is exhausted. And burnt. And kind of hard to do when you're working all 3 shifts in one week.

There are so many places with critical staffing shortages across the country. We frequently have travelers, especially on my night shift. Lately it's been difficult to staff our unit with travelers because we didn't qualify for COVID crisis pay- those travelers were getting up to $6-8K per week! We finally got a few new travelers in the past two weeks. Sad that the hospital is willing to pay them twice what they pay us, but I guess they justify it with the whole "not paying benefits" argument. It doesn't always help morale, though. 

I know your unit/hospital has been very difficult lately, I hope you're over the crisis point soon and there's an improvement in your working conditions. 

[martymoose, BSN, RN]

On 3/1/2021 at 7:47 PM, JBMmom said:

I know your unit/hospital has been very difficult lately, I hope you're over the crisis point soon and there's an improvement in your working conditions. 

Thank you JBMmom.I hope there is improvement.

 I am going in tonight- 11-7 tends to be floated ( even if were short, they have all these overflow floors running) and I actually hope I do get floated. At least Ill have 10  med/surg pts and not PCU pts.