Only one nurse scheduled overnight - What is your facilty backup plan?

[pjsmom]

Hello wonderful and wise nurses,

I am the nurse manager at a facility that only has one nurse in the building overnight. While we are generally very lucky to have great staff, we occasionally run into situations where the overnight nurse has an emergency or calls in sick. What is your facilities back-up plan for when the only nurse calls out on the overnight shift?

We are a small company so having everyone take an "on-call" shift isn't a popular idea since there would likely be about 4 on-call shifts per month required to fill all the shifts. It also is expensive to pay to have an on-call backup 365 nights a year when we don't have that many call offs.

I am trying to brainstorm possible options that are fair to staff and to help alleviate the 24/7 on-call this situation puts me in.

Thanks a million!

[Bekknjd]

How can the previous shift leave with out a replacement? This would be considered abandonment. As the evening RNS I can't leave until night shift has been staffed(3 nurses and 1 must be an RN). Fortunately for me the DNS comes in to cover as I have babies that can't be left alone but there have been nights like this past Tuesday when I've had to stay. Plus it is required that the 3 Mon-Fri RNs(me, the day shift supe and the DNS rotate weekend call q3wks) and we don't get call pay. It is a requirement not optional. Our DNS is oncall 24/7 and is amazing at her job and this is why I've worked for her in several different buildings.

[Here.I.Stand, BSN, RN]

I find it horrifying that some managers require the off-going nurse to find a replacement or have to stay for double shifts. I'd be quitting asap.[/Quote]

Right?? I don't work anywhere that considers mandatory OT an acceptable staffing practice. (except in true emergencies. I did work one 16 hr shift, which at 14 hrs in looked like it might be 24 -- with the other nurse and I taking turns napping in those last 8 hrs. We had a blizzard, and the staff that TRIED to come in, ALL got stuck in the snow; fortunately by 2200, the roads were plowed well enough that the noc staff could come in. That I understood -- although I did advise management that given the hours I had worked that day, I wouldn't be in the following day.)

OP, are you the only nursing manager? I worked as a CNA at a small facility back in the late 90s. We had around 60 LTC beds and 8 or 10 hospital beds, plus an OR for relatively routine surgeries. At that place we had an ADON, a DON, and a VP of Nursing Services (like a CNO.) The ADON got the brunt of the mandatory nursing shifts, BUT all of them were RNs with active licenses.

If you're the only manager who can/will fill in staffing holes, and you are being prevented by upper management to staff appropriately, honestly I would leave. It's NOT good for you to be on call 24/7/365. It's also not good to mandate a nurse to stay, who has already worked 8-12 hours and who may have a long drive home, or may need to go home to care for kids or an elderly parent, or who is too tired to safely care for the pts/residents, or who plain and simple doesn't want more hours than s/he has agreed to work.

[lindseylpn]

I work at a group home with one nurse staffed in the home for 15 hours a day, split between a long nightshift and a few hour shift during the day. We rarely have call ins but, when we do the scheduling manager will basically call every nurse on staff and if no one will come in then either the Don or company president have to come in to pull the shift. They rotate weeks as "back up on-call" which includes all emergency calls throughout the agency (most of our homes aren't medical) as well as covering for nurse call ins. Usually the don comes in regardless of which one is actually the "back up on-call". I have no clue if they get on-call or overtime pay, or anything like that though.

We had an in office nurse for a short time that assisted the don with her work and she was made to cover for all call ins. That position didn't last long, she said she was basically on call 24/7 and quit.

[pjsmom]

It is the managers responsibility because they are the ones that have control over staffing. You even said earlier that it's too expensive to have more staff to cover the open shifts. That's a decision mgmt makes. The effects of that decision should be felt by mgmt and not passed along to the staff nurses. Do you even occasionally work those shifts? (My previous manager could not even do the job or cover a shift safely, which is terrible... he was not even willing to learn). Paying premium pay is ideal for all involved, but if it is abused by managers even that won't work very long. I find it horrifying that some managers require the off-going nurse to find a replacement or have to stay for double shifts. I'd be quitting asap. I'm glad you are looking for backup plan ideas that would be good for your staff. Money talks!!

I think you misunderstand what kind of control managers (or at least I) have on staffing. The department has a predetermined number of FTE's that are approved or budgeted for. I can not schedule more than the number of FTE's that my department has budgeted. I do work shifts; In fact until very recently I spent 20 hrs a week on the floor working as a nurse along with my managerial duties. I am not a manager that just takes my promotion to sit on my duff and enjoy the perks. With as many "perks" as a management job may have, it also has at least that many negatives. It wasn't long ago that we didn't have overnight differentials which is ludicrous. I had to prove my point time and time again, submit market research and finally was able to get differentials approved. Those 20 hours I was working a few months ago, I was able to turn into a full-time position and hire a FT nurse which we needed. This is just the next piece of the pie that I am trying to work on. Your right, money talks! I think a few people have made suggestions that I think I can actually use. (double pay & increasing bonuses). I have actually looked into an online & app based scheduling system where people can "sign-up" for extra shifts. It will probably be too expensive for a small department like ours, but I am open to learning more.

[NurseDimples]

I am a night nurse that works alone overnight. I like my job. I'm good at it. After months of being promised additional staff w/o result, I'm quitting. Quitting for a job that pays less money. WHY? Because you don't have any control over your life. If something comes up, you can't participate because you don't have coverage. I blame management for being short sighted. I'm exhausted from trying to explain the rational. When they have to fill in the nights I'm not there, maybe then they will understand. You can't own my whole life for my salary. I'm not for sale, for rent yes, but not for sale.

[blondy2061h, MSN, RN]

You could have a call calendar with on call pay to cover in case of a problem with the scheduled RN.

[Crush]

I find it unsafe to have only 1 RN on overnight. I understand a small facility, medically cleared and all. However, when working youth and psych, what happens during a code? What if there is an allergic reaction to a medication?

What about a list of nurses who would be willing to cover in event of a call out? Or a sign-up sheet? Can you call your ADON to work it and then give them the next day off? Offering comp time maybe ( nurse works the night shift to cover but gets their next scheduled shift off )?