GNA staffing, retention and burn-out

[pinkiepieRN]

The issue at hand is short staffing. I don't know if some of the GNAs changed their schedules or availability around but the staffing coordinator has been leaving the building at 4 or 5 pm with holes in the schedule, highlighted to be filled either by myself on 11-7 or by the 3-11 supervisor. The 3-11 supervisor is way too busy to sit down and call for additional staff for the next day; if anything, she will probably get a call out or two. If I've already got two spots to fill left by the staffing coordinator and get a call out on top of it, I'm now down by 3 GNAs for day shift. I've been leaving the building with a guilty conscience because I called 9 GNAs but no one picked up the phone or returned my messages.

For the 4th day in a row, each of our units (we have 4) has had 2 GNAs on 7-3 shift. One of our units has 33 LTC residents right now, some of them bariatric, a lot of them total care and 12 of them are feeders. We have a rehab unit with 33 residents, another rehab unit with 25 and another LTC unit with 22. The staffing is the same on days for all units: 2 nurses, and there should be 3 GNAs. This week it's been 2 GNAs/unit and it's been really tough. They're calling out because they're so exhausted and of course if it's their day off and they've experienced hell this week, they're not going to willingly put themselves through that again, even for OT.

Here's the kicker: we no longer hire PRN GNAs. I don't understand the rationale but I don't see this situation getting better and staying good without such a safety net! We've got one GNA on light duty right now and no-one to take her place, so someone either gets pulled from their home unit or the staffing coordinator gets someone to come in from 3-11 or 11-7, often leaving that shift short instead. I feel for our GNAs, I really do. Any ideas as to why a facility wouldn't have GNAs hired as PRN staff?

Aside from hiring more staff, any ideas for incentives I might be able to suggest to get people to come in on their off time? I know I can't (unfortunately) make the staffing better by myself. I can't make people come in. I can't make the jobs of the GNAs less taxing and stressful. And I can't prevent people from calling out.

I'm posting this even though I hope my ADNS is brainstorming simultaneously.

[CrunchRN, ADN, RN]

Well shoot. You need management to find some solution or let you hire PRN's. What staffing model is madness.

[amoLucia]

Is your house nursing staff meeting "the numbers' for staffing requirements by the DOH?? Might you be deficient?

However, having done "the numbers" before, I know that being top-heavy with nsg management positions, can plump up those numbers with staff who are NOT working the floor. So you're still left with overworked staff.

But if your numbers are really deficient, then perhaps a phone call to the State might be in order. Just be sure to give them specific dates to help them investigate.

In the meantime, try to thank or reward the staff you do have for what they do.

[pinkiepieRN]

Is your house nursing staff meeting "the numbers' for staffing requirements by the DOH?? Might you be deficient?

However, having done "the numbers" before, I know that being top-heavy with nsg management positions, can plump up those numbers with staff who are NOT working the floor. So you're still left with overworked staff.

But if your numbers are really deficient, then perhaps a phone call to the State might be in order. Just be sure to give them specific dates to help them investigate.

In the meantime, try to thank or reward the staff you do have for what they do.

Hmm...this is a good question to ask. I feel like we likely do "meet the numbers", but something is wrong with how we schedule people, especially part-timers and extra shifts. There are about as many GNAs who work 3-11 and 7-3 but there's way less of a staffing issue there. I think 3-11 GNAs genuinely enjoy their jobs and call out way less often. The researcher in me wants to do a root cause analysis or something. I think the ADNS and the PTB are so concerned about patient outcomes, complaints, issues, etc. that these staffing issues are being overlooked, simply because we're "making do", even if it's not good for patient outcomes. Chicken and egg stuff.

[pinkiepieRN]

Well shoot. You need management to find some solution or let you hire PRN's. What staffing model is madness.

Thanks. No, seriously! I think I've been looking for rationalization for my concern. I think unit managers are working with what they have, because they don't actually hire their own staff (that's HR and the ADNS), but that's clearly not working. The system is broken and I can't fix it; but I can help put things in place to get things fixed.

I hear you about the PRNs. None of my nurses can make hind nor hair of it as to why the policy of no more PRN GNAs are hired. The 2 PRN ones we have can almost *never* come in but have "worked" for us since the 80's or 90's.

[pinkiepieRN]

Ugh, according to COMAR (state regulations),

The ratio of nursing service personnel on duty to patients may not at any time be less than one to 25, of fraction thereof.

With the staffing ratios we have right now, we're actually exceeding the minimums of that regulation. Our usual ratio (with 2 GNAs/floor) is 1:16 or 1:18 on days, but I still think like that's way too high and too much work to be done, given other issues such a resident acuity, dependency etc.

The ratio drops down to 1:8 or 1:11 on evenings and I think there's something lopsided about that! I wonder what of staffing template the staffing coordinator works off of when she makes the schedule?