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

  1. 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!
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    About pjsmom

    Joined: Aug '09; Posts: 25; Likes: 3

    30 Comments

  3. by   Sour Lemon
    If the nurse manager staffs with a skeleton crew, then the nurse manager should probably come in to cover when the only scheduled employee gets sick.
  4. by   JKL33
    Quote from Sour Lemon
    If the nurse manager staffs with a skeleton crew, then the nurse manager should probably come in to cover when the only scheduled employee gets sick.
    That is all.
  5. by   pjsmom
    I guess that is what I am trying to find a solution for. This is the way the schedule has always been written since before I came on as the nurse manager and I am trying to find creative ways to make things better. I am not the bad guy here - it's about all of us as employees and I am willing to pitch in for the team. Just saying it is the nurse managers job to be on-call 365 nights a year isn't a solution. What happens when I am out of town or on PTO? There surely has to be another facility out there with a plan.
  6. by   MJB2010
    How many patients? If there is only one nurse, how many other staff members are present? If someone is being coded, what happens to ALL the other patients? Seems very unsafe unless we are talking a tiny facility. Sounds like more PRN staff are needed to be on call. Just because that is the way it has always been done, doesn't mean it has to continue. Glad you are looking into better staffing and a more reasonable plan.
  7. by   pjsmom
    It is a crisis / psych facility for youth. The staff to client ratio is 6/1 not including the nurse and the therapist in the building. The nurse mostly does intakes at night and is the point person for emergencies. The clients must be medically cleared from an ED to be transferred to our facility and have no known medical issues.

    The only issue with adding more PRN staff is that there just isn't very many call-offs and then I don't have shifts for the PRN's.
  8. by   Orca
    Quote from pjsmom
    Just saying it is the nurse managers job to be on-call 365 nights a year isn't a solution. What happens when I am out of town or on PTO?
    Ultimately I have to come in and cover if no other solution can be found to a staffing issue. On the occasions when I am on leave, that falls to my second in command. That is part of the responsibility of upper management. The only alternative that I know of is to staff well enough that one call-in is not catastrophic to staffing.
  9. by   roser13
    Quote from pjsmom
    It is a crisis / psych facility for youth. The staff to client ratio is 6/1 not including the nurse and the therapist in the building. The nurse mostly does intakes at night and is the point person for emergencies. The clients must be medically cleared from an ED to be transferred to our facility and have no known medical issues.

    The only issue with adding more PRN staff is that there just isn't very many call-offs and then I don't have shifts for the PRN's.
    Medical issues certainly aren't the only type of emergencies. Personally I would not be willing to staff a facility overnight as the only RN. That seems very unsafe. Our facility's policy is never to staff less than 2 RN's overnight.
  10. by   MilliePieRN
    My suggestion would be to offer double pay to anyone willing to cover the shift. Have those interested sign up for a group text alert when someone calls in. This won't work if it happens very often, but I'd go in for double pay occasionally if mgmt was not abusing the nurses.
  11. by   OrganizedChaos
    I worked for a small, private company similar to this. They also only had 1 main, night nurse but it was to many more children/residents. I believe what they did was had another night nurse to help out & relieve the main one. How is it possible that 1 person works nights constantly?

    The place I worked was cheap, I mean they cut corners wherever they could. I'm amazed they got away with things & aren't shut down! So if they have 2 night nurses maybe you should hire another one.
  12. by   retiredmednurse
    Some nurses want to work extra. Allow them to sign up for whatever shift they wish to work. If the night nurse does not call in sick up to the time of 4 hours before her shift is to start, than who signed up is called, and told "thanks, but no thanks. You are not needed tonight." This does requre that the nurse call in no later than the 4 hours before her shift starts.This can also be used to a degree in the annual work evaluation as being a team player. Also, if she is the only nurse, than she should be paid OT for her lunch break. As the only nurse, she officially can't leave the floor/unit as she is working.
  13. by   retiredmednurse
    I forgot to mention that the called-off nurse gets no financial benefit for this. But she would be the one called, if the nurse did call and say she couldn't make it.
  14. by   RNGummy40
    The solution to your problem is that you need to change the policy. You need to have two nurses, otherwise you are going to have to be the one to pick up the shifts. I am curious as to which type of emergency situation you have experienced at your facility and the frequency of them. If you are having an increase in emergent events, or the severity of those events are high, then that should be enough evidence to change the policy. Even without such evidence, one nurse by herself is asking for trouble. Also, you mentioned who would cover the shift if the nurse did call out and you were out of town. How have you been scheduling for those situations?
    The description you gave for your facility was a "crisis / psych facility for youth," does light up some warning flags. Just the term crisis and psych, indicate triaging patients and when I worked in an inpatient acute psychiatric hospital and there were many times adolescent patients acted impulsively and or aggressively /violent. How does your facility handle those situations? How does the one nurse manage those situations? There were many times figuratively, a match would be lit, and when one adolescent acted out, that negative behavior spread like wildfire. Codes were called not usually for just one patient, but two, three, a couple of times 6 patients. When the unit was staffed with one nurse, it was so unsafe. 20 patients and 1 nurse, with multiple codes. What is your patient load? Just providing feedback to your post. I hope you can form a safe solution.

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