Low Census

[allstressedout1]

How is low census handled around the country? A little low census is nice on occasion but when you need your income and low census is excessive what do most units do. Like for 8-10 week stretches you are maybe 2 to 3 days a paycheck short. Because a third of the staff are team leaders who are not required to take low census (or call, or holidays, or weekends) the remaining staff get more than they want of the low census. If you want to be paid you have to use vacation because you are not able to pick up extra work because you are still tied to unit by being kept on call while you are low census. Of course then if you are sick or had vacation planned your time is all gone.

[Meriwhen, ASN, BSN, MSN, RN]

We have the opposite problem: too many patients, sometimes not enough nurses :/

For the times we do have a low census, the cancellation policy is as follows: any OT staff is always cancelled first. Then staff who volunteer for cancellation. Then registry staff. Then per-diems. Last to be cancelled the regular staff, and that's on a rotating basis--we keep track of who has been cancelled so everyone has an equal chance of getting the chop. If you get cancelled, you have the option of using PTO to cover the hours or taking it unpaid.

Usually, it never gets as far as forced cancellation of regular staff. After the OT (if any) is cancelled, there's at least one or two staff who request to be cancelled if not needed.

OP: if you find yourself being cancelled a little too often, you'd be wise to pick up a PRN or registry position at another facility, so you can make up any cut hours.

We are not let off though. Always kept on call In case needed in our unit, so can't go to just any unit to work because have to be available for ours.

I would hope that they are compensating you for being on-call then. Otherwise they are royally screwing you over, IMO.

[blondy2061h, MSN, RN]

You need to go to HR or your manager with your concerns and leave if they can't come up with an acceptable solution.

My hospital just really doesn't have a low census problem. Hospital wide we're almost always at 90%+. We have generous personal and vacation time so people are always looking to get extra days off if by chance the census does drop. The second it looks like the census may drop we have lists a mile long of people trying to get a day off.

It's funny when we get new nurses who worked elsewhere before and they're saying they'd like to volunteer to be called off tomorrow. "Yeah, with your low seniority you're like 8th on the list. You'll be coming in."

[Lunah, MSN, RN]

We are not let off though. Always kept on call In case needed in our unit, so can't go to just any unit to work because have to be available for ours. Also most of us don't know enough about adults to float on adult floors and can't really float to "dirty" or areas in case we are needed back on ours.

On call every day? You have to have some days off.

[caliotter3]

Unless you work somewhere that has a defined and consistent census, the expectation of low census needs to be something that you expect to happen and your budget should be based on how much you're likely to actually work , not how much you could theoretically make if there wasn't any low census.

I'm not really getting how half your staff is assigned to charge nurse on any given shift.

I get sent home on an irregularly regular basis, if that makes sense. I do not count a full schedule period, but just use the lowest average of hours, because sometimes it is X number of hours while other times it is X hours, Y minutes that I miss. What really hurt though was being told there was no work during the holiday season. The two weeks forced vacation, much less no holiday pay, was not welcomed at all.

[JKL33]

A situation where you're called off but must stay on call is a raw deal (read: unethical employer practice). These are good things for nurses to know about when evaluating prospective positions.

[Davey Do]

One of the advantages of working at a place like Wrongway Regional Medical Center is that they can't keep Nurses so there's very little low census.

And I've noticed from working here for nearly 15 years, the more WRMC's reputation gets out there, the less number of Patients are admitted.

[eashton72]

We have a list of everyone on our unit, including charge nurses and if you get called off then you get put to the bottom of the list and it goes to the next person. Have you looked into floating to other units? I know in our hospital at least one of the ICUs will always take a nurse, so if you can float then ask to be used on a different unit.

[JerseyTomatoMDCrab, BSN]

At every hospital job I've had, low census was handled like this:

PRN nurses were called off and sent home first (they cost the most)

After PRNs, the unit kept a cancellation log and we took turns.

My unit closed for low census many times but if you wanted, you could volunteer to float to another unit if they were short instead of being cancelled. That was good because you didn't have to use any time off and it made me very comfortable working in a variety of settings.

[klone, MSN, RN]

How many nurses are staffed, and how many are put on call on a typical shift?

[NurseStorm, BSN, RN]

This used to happen semi regularly about 4-5 years ago on our unit, but the last 1-2 years (especially this past year) it has been rare to practically non existent. We are more often short staffed with completely full census most of the time.

When we do have low census, (has happened maybe 2-3 times since september..) there is a list of when everyone has last stayed home. We look at the list for each person scheduled to work the next shift and write out the order from who stayed home most to least recently. Then we call in that order offering them the chance to stay home (usually home on call) if they want. This will come out of their stat/time in lieu/vacation. If they say no we proceed down the list. We are under no obligation to stay home, it's actually more of a privilege. If you don't want to, you don't have to- but since we are getting denied so many days off and shifts are so busy crazy and hectic, it's usually people clamoring to stay home!

If everyone says no, we just all come to work, we cannot be forced to stay home once scheduled for a shift. Often the supervisor will make us float to other areas and help with tasks we can do (simple things such as vitals etc). Sometimes the clinical leader or manager will have little projects they've been wanting us to work on and get us to do that (reading manuals, checking carts, transport bags, organizing side rooms and cupboards, etc etc).

[allstressedout1]

Right. But one of the perks of being one of the charge numbers is no low census. If more than one is scheduled that day only one is designated charge each shift but they don't have to take LC. They might be just taking an assignment that day but aren't required to take LC.

[allstressedout1]

No if it is your scheduled day you get LC but are most often required to stay on call. I might say be scheduled 3 12hour shift and 1 call day of 12 hours. If census is down I might be LCOC 1st day, work next 12 hour shift, LCOC 3rd scheduled day and spend 4th day sitting home on call for 12 hours. So 4 days tied up and work 1 of them.