Forced to Flex Off

[Nurse Beth, MSN]

Dear Nurse Beth,

My hospital, that I have worked at for the past 23 years, has started a new "Flexing down for low Census" policy.

Our new CEO's newsletters remind us repeatedly that staffing is their biggest expense. I work in a pediatric hospital and the census fluctuates greatly. Point in case, on Thursday our 21 bed ICU was almost full. Today, Sunday, we have 8 patients.

As I have read on-line, flexing down is not a new phenomenon. The flexing down has been a huge issue. We first were being called off by reverse seniority and in 4 hour blocks. That was horrible. Some people were playing the 4hr off only game, forcing the next person in line to be sent home resulting in some patients having up to 7

RN

's in a 24hr period. We can choose to take time off with pay (using our vacation time) or time off without pay. Neither option is good.

One gives us money but no time for a real vacation. The other gives you a smaller paycheck making it more difficult to make ends meet. At the onset of the policy the pediatric hospital was having a strangely low census forcing many of us off, sometimes more than once in a pay period. It caused a panic and a ruckus among all of children's hospital.

We had a staff meeting that I had never seen so many people attend, ever. The powers that be talked, not with staff, but with leadership of our concerns and negative impact this was having all the way around. Staff satisfaction, patient satisfaction, patient outcomes, things getting lost in the multiple reports that were being given.

They decided to give us a cap of forced off time -16hrs in a 4 week block. The cap is not the answer. Getting called off translates to a loss of some sort for us hourly paid staff. Due to our variable census and lack of pay, from the start of this policy in November last year to current June, we have lost 11

RN

's.

We stand to lose more as this continues. There are only so many places we can float. We do not float to the adult hospital and we don't expect the adult

RN

's to float to peds. The adult hospital is rarely impacted by this.

My dream question is how can we stop this? Make this policy go away? We were much more willing to take time off when it was a choice. Now that we are forced, we are afraid to use our time by choice.

Morale is horrible, everyone is looking at the job board. This hospital won an award once upon a time as the best place to work. Now, no. Many of us don't want to leave. We enjoy what we do, we are proud of what we do. But not making a full time paycheck when you have a full time job is not sustainable.

And, I don't understand where retention has gone. Hospitals spend upwards of $100,000 for each new

RN

that they orient. Where is the cost effectiveness in that? Our jobs are creating a lot of anxiety in us. We have become afraid of the phone. The dreaded phone call.

And, we are afraid to speak up, speak out for fear of being fired.

Upper management is not affected, they don't lose money or time off. What can we do?

Any words of wisdom or channels to try to fix this misery?

Dear Forced to Flex,

More often you hear about nurses who are happy to go home due to low census, but trust me, once it goes on too long, it causes morale problems. It can quickly become dog eat dog with everyone trying to protect their PTO and worrying about getting a full paycheck.

Nurses with more seniority feel nurses with less seniority should be sent home.

Full time staff feel travelers and part-time staff should be sent home.

Travelers with contractual guaranteed number of days feel regular staff should be sent home.

Once I worked in a facility where I was sent home because I had the most accrued PTO.

Matching staffing to census is a tough balancing act when census

varies. Managers are held to productivity standards that are based on a ratio of nursing care hours to patient care hours. Facilities that do not have a clear process for mandatory time off create uncertainty and confusion for their staff. The fact that your facility is capping your forced time off at 16 hrs per 4 week block is more than what most do.

Some nurses fall back on part-time jobs during low census months. Some nurses use up all of their PTO and give up any plans for vacation later in the year.

Unfortunately, flexing to census is the nature of the business although as professionals it's not in line with most other professions. As you say, there is a cost to sacrificing the long-term goals of retention in order to meet this month's short-term budget. In an ideal world, nurses would not be called off but would be given the option of other work, which would at least give them some control.

There is very little nurses can do in your situation except to vote with their feet, I am sorry to say. There are those who can afford to ride it out until winter or higher census, while others need a steady income.

Best wishes to you,

Nurse Beth

Author, "

Your Last Nursing Class: How to Land Your First Nursing Job

"...and your next!

[llg, PhD, RN]

I have yet to find a "perfect" solution to this problem that will please everyone. No hospital can afford to pay the number of nurses needed to adequately care for 21 patients if there are really only 8 patients in the unit that day. Often, the best we can hope for is that system of deciding who needs to stay home is fair -- and that the financial hardship is distributed among the staff in a way that most people think is reasonable.

My own work hours have been reduced this year due to lowering census and budget constraints -- and I am experiencing that type of financial hardship myself. I know from experience it can be stressful -- but my only choice is to accept it or leave. I have chosen to stay and try to reduce a few of my expenses. I am also picking up some work hours elsewhere to supplement my income. I don't want to "start over" somewhere else at this point in my life.

[Nurse SMS, MSN, RN]

The only part of this I have a huge problem with is the four hour increments nonsense. Either call me off or let me work. None of this "we'll call you in four hours if we need you" crap, and with no on-call pay either.

Sounds like the nurses need to unionize.

[beekee]

Can you cross train to the adult side? Then, maybe, you could float there instead of being flexed off.

[Orca, ADN, ASN, RN]

The only part of this I have a huge problem with is the four hour increments nonsense. Either call me off or let me work. None of this "we'll call you in four hours if we need you" crap, and with no on-call pay either.

I worked per diem on a hospital geropsych unit years ago. The hospital called me off for low census (which was their policy - per diems are called off first). Two hours later, they started getting hit with admissions and they wanted me to come in. I explained that I was not on call for them, and that they had already told me that I was not working (my shifts were scheduled in advance).

As it turned out, I won more in the casino that night than I would have gotten had I worked, and it was below the threshold to have to fill out a tax form, so tax free income.

[Elaken]

Being called off due to low census is just the nature of the business. I know it is rough when you can't float to other units so maybe PRN elsewhere is what is needed.

The seniority thing is ridiculous though. My hospital keeps track of low workload dates and if no one volunteers to go then they look at dates which is the only fair thing, in my opinion. If sent home then you are done for the day. If called off before your shift starts they either tell you for the full day or they can still call you in for the last 6 hrs of the shift but they have to tell you they need you two hours before. If they don't call by 11 then you are good. If they want you to come in within an hour notice than they pay on call pay but it is paltry.

I think this this is a relatively decent system

I think my system has done is hire a lot of PRN people and seasonal since our census always drops in summer (and PRN staff are always first cancelled). Maybe your hospital needs to look into that.

[CMCbabyRN]

You are lucky that this is a relatively new scenario for your hospital. I have been an RN for 30 years and have dealt with this in my last 2 jobs. It is a source of contention and strife in our unit. Maternity is another area that is crazy busy or dead quiet. Never any happy medium.. Last year I saw over 100 hours of downtime....... equivalent to about 3 weeks of pay!!!! We have asked for a max/pay period with no success.

On our unit, we keep a monthly log. It is decided first by per diems and then volunteers, then the staff member that hasn't been down in the longest period of time.

We get a few dollars of call pay because we have to have the full compliment if labor patients come in.

It "counts" as a X if you are down for at least 4 hours.

Since most of the nurses on our unit works 12 hours, you can't be forced to be down for more than 6 hours, although if you are on for an 8 hour day, you are going to be down for the full 8. 4's don't work with 12 hour shifts. Not going home at 11 and coming back at 3.

Some of our day nurses have been going and helping out in outpatient settings. There is more strife there because not everyone does that and so there are a few that sit up on our unit and hang out while the rest of us willing to go, go. Although that is going to be changing.

We can choose to use earned time to balance our time, but again, who wants to eat away at their vacation time and have none to take down the road just to make ends meet at home......although sometimes we have no choice!!!

Our unit also takes surgical overflow patients but they aren't always enough to keep our full compliment of 3-4 nurses on duty.

Ironically, we too have had several retire/resign and now are so short staffed that we have bonuses being offered but with major stipulations to earn them. Our bonus shifts are the first to be cancelled. Gotta love when you have a bonus shift in the first week and downtime in the second week. Yes, we are breaking even, but at the cost of giving yet another day of work and another day of sitting at home by the phone!

[ripsky4501]

Are there any nursing specialties/units in the hospital where this flexing is less common?

[Nunya, BSN]

A big city NICU. I was always asked if I wanted to be called off, because with lots of staff someone always wants to go home. My last job had a voluntary "call off list" so they went by that if they needed to call someone off. Almost every day had at least one person on the list. I suspect this would also work for any unit with a lot of staff.

[Froggybelly]

Most of our unit's staff work 4-5 days per week on 8s and 10s, though we do have people on 12s as well. We utilize a Go Home Early list that people can sign up for. If they leave due to low census, they still receive accrual toward PTO, but no pay unless they use their earned PTO. People who are off earlier have first choice to leave, as it allows us to staff for the afternoon should we need it. I like the system.

[caliotter3]

I work in extended care home health where the policy is no work, no pay. My current client cuts my hours short two out of five days a week and sometimes entire shifts on a regular basis. I was being assigned to fill-in work that never seemed to pan out, so when I got tired of the short paychecks and being jerked around, I went to a different agency and took a regular assignment. I can count on that second paycheck and the first agency simply does not have me to jerk around any longer. If the situation is becoming too much to bear, then decide whether another job, or a new job, might provide that dependable paycheck that you need.