Low census--what do you do?

MikeyT-c-IV · Sep 12, 2016

I have my FT job in a department that only utilizes two of us. We have our scheduled days to work. I love this fact but some days I miss the times when I would get called off work. Back when I was on the floor and if I got called off we had the option to use PTO. I like to keep a couple PRN jobs on the side so if the opportunity presents itself I have a little extra work.

My wife works L&D and she sometimes gets called off and she'll use her PTO. They rotate through a list. They also have a great team that will work together if one person wants off the other will cover. I'm impressed with their teamwork.

brillohead, ADN, RN · Sep 12, 2016

First, they float someone to another department if there is a need on another unit.

Then, they check to see if anyone volunteered to be called off (we have a list where you can request to be the first person called off for a specific shift).

If they still need to mandate someone off, there is a list of dates when each person was last mandated off for low census, and the person who is "due" next gets mandated off (and put on-call in the event that census changes significantly during the night).

RainMom · Sep 12, 2016

First, they float someone to another department if there is a need on another unit.
Then, they check to see if anyone volunteered to be called off (we have a list where you can request to be the first person called off for a specific shift).
If they still need to mandate someone off, there is a list of dates when each person was last mandated off for low census, and the person who is "due" next gets mandated off (and put on-call in the event that census changes significantly during the night).

This is exactly how my facility does it too. Most people love to get the occasional low census day. It becomes a problem for some though when census goes down & stays down. In my hospital, TPTB often decide to close one floor. Then staff is combined for 2 floors with nearly half being forced off. We had a period about three yes ago when this happened with a floor closed for about 6 weeks. By the end of that time when census finally starting to stay up, quite a few people left for other jobs. It was particularly hard on anybody that was part-time; one nurse literally did not get a check one pay period because every time she had a shift scheduled, her name was up again to be forced off! Of course after that, we went thru periods of very high census, & were short on staff, finally resorting to travelers.

NurseMerlin · Sep 17, 2016

As a former admissions director, I can tell you the problem arises when the admissions department is slacking, along with the marketing and outreach departments in terms of keeping beds filled.

When I handled admissions, we would stay at about 95% or higher census, many times even 100%. The facility made money, US nurses made money, the nursing assistants made money, and the patients had great, continuous, steady care.

When your facility can't even keep the beds filled, that's a problem. Nurses should not be the ones taking a hit for poor management.

armyicurn · Sep 17, 2016

I go home with pay. I am a salary employee. Other times, I catch up on the tons of mandatory training required or other government related politics.

dec2007 · Sep 17, 2016

I know nothing of this so called low census.
My hospital is almost always OVER census! It is the norm for us to go 1 to 2 pts over our census. We usually have 10 - 15 people admitted who are stuck in ER waiting for a bed.

This is our situation also. For quite awhile we were working mandatory overtime. Now we have "incentive shifts" for people to sign up for. It's working pretty well from the standpoint of staff members. I'm not sure how our leadership team feels. I hope it is working for them as well. If it looks like there might be a low census situation coming up there are usually a ling line of us trying to sign up.

armyicurn · Sep 17, 2016

This is our situation also. For quite awhile we were working mandatory overtime. Now we have "incentive shifts" for people to sign up for. It's working pretty well from the standpoint of staff members. I'm not sure how our leadership team feels. I hope it is working for them as well. If it looks like there might be a low census situation coming up there are usually a ling line of us trying to sign up.

Where are these hospitals? I need to go there!

LotusPetals82, ADN, CNA, RN · Sep 17, 2016

As a PCA, we also get called off for low census. We take turns being floated, or being sitters, and if we can't do that, we get called off. As a nursing student working two days per week, and practically starving (OK, a little melodramatic), being called off definitely affects me financially in a negative way. It leaves me short on money. I think it's unfair.

Harveyslake · Sep 17, 2016

I work in an ICU. If we have low census, we get floated to Tele or Med/Surg. Or, we get put on call. Never called off because we are ICU. The floor nurses get completely called off. It's never a "snow day" for us. We have the option of using PTO or going unpaid. We have a rotating list but we all still get put on call multiple times per month. It eats our vacation time or drops our income by 10-15% per month. In a word,....it sucks. Administration LOVES it however. Licensed Healthcare Workers are not day labor. We should not be treated as such. If they want to have nurses available when census is high, they need to maintain them when census is low. Many have left because of this and others have taken second jobs to make ends meet. That makes them unavailable to work extra shifts when census is high, so we end up short staffed. Administration continues to fiddle while Rome burns. Time to look for a new job,...not that it's any better anywhere else, these days.

I've gone in to work and been floated to Med/Surg because one of their nurses was put on call. Half way through my shift, I have to re float because they put a Tele nurse on call. I'm late for that floor because I have to give report on my patients. An hour into that shift a code goes to the ICU and I have to quickly give report on my patients, some of which I haven't even seen yet resulting in overloaded assignments for the other nurses and run to the ICU. It's absolute madness all in the name of the hospital saving a few bucks. Calling it a circus is in insult to all circuses.

Scroll89 · Sep 17, 2016

I work in a smaller ICU and when we do not have patients we simply take over telemetry and stay at the hospital. We are considered "essential personnel" so we never get called off, but the poor telemetry technicians do. We respond to all rapid responses obviously, but we also respond to all codes and to major trauma activations. Have to have at least 1 ICU nurse in the unit at all times, so have to have nurses.

Elaken · Sep 17, 2016

It sounds like my hospital is the exception because low workloads happen. Part of the problem is I live in AZ and snowbirds cause a huge influx of people in winter. This last winter was crazy busy. Our 28 bed overflow unit was open at one point along with putting 8 adult patients in pediatric rooms and having a never used overflow PACU open and some patients were still waiting 5-10 hours in the ED for a bed. Even though we use tons of travelers we still need enough staff which means come summer it can get bad because we have too many. This summer I have been low work loaded almost every week for a month - the two previous summers weren't bad.

Everyone floats when needed but we but we do have a float pool, which I am part of. They look at low work load dates so sometimes someone from a unit is sent home so I can go there if I was canceled sooner than them. It can get rough but come winter you can do 1-2 extra shifts every week for months if you want so you can get yourself a financial buffer.

What I hate is they don't pay on call pay. So instead we are "low work loaded" in four hour increments but they can then essentially require you to come on at either 1100 or 1500 if needed.

cleback · Sep 17, 2016

I am actually hoping to get called off this afternoon. Fingers crossed!

People in my department sign up. If there are more shifts to cut than people signed up, they start calling people to stay home voluntarily. Theoretically, the house Supervisor can mandate the call off, but honestly, that never happens. Someone us always willing to take the time off voluntarily.