Low census--what do you do?

SilleLu · Sep 17, 2016

Union hospital

Overtime and per diem cancelled first

Nurses can sign up to request to be cancelled for a particular shift, that list goes by seniority

Then mandatory cancellation by lowest senior order, with NO ROTATION!!

and float pool is included, so they can cancel low senior unit nurses to allow a float pool nurse to work our unit

So, the lowest senior nurse has been lucky to work one day a week recently. Some days we have up to 6 cancels for our unit, usually a combination of requested cancels and mandatory.

I don't care for our system at all.

And some days have been due to low census, but others are purely due to over staffing. It's seasonal of course, other times we have plenty of mandatory overtime.

SharePRN · Sep 17, 2016

This is a common occurrence on L&D, as the census fluctuates on a constant basis, even during one shift. When I worked charge on 12 hour nights, it was a definite skill to have the shift's staffing "just right" while also prepared for the proverbial bus of laboring women to pull up. Luckily, we often had a list of people who wanted to be called off or sent home early, if possible. We had to remain on call and was paid time and a half if called back in. We disliked floating to PP, etc. because we knew no one could ever float to us in our time of need. I rarely found it difficult to find someone to go home at 3 a.m. It often balanced out with the number of times we were begged at 3 a.m. to come in because that bus pulled up!

chunkalunk, ADN, RN · Sep 17, 2016

I'm nursing student too (like another previous poster) but I work as a CNA in the mean time.

Beginning of this year, my per diem hospice job started having a low census. I was put on call or canceled a lot. I had a feeling that would continue during the summer time. So I started looking for another per diem job because I wanted to make as much as I could during summertime. I ended up with a part time home health gig. It's a good thing I did that because I worked less than 10 shifts at my hospice job this whole summer. I also ended up picking up another per diem job at a long term acute care facility. They just canceled me the other week due to a low census. I'm always canceled or put on call first since I'm per diem.

I get paid (very little) to be on call with my hospice job. I had one paycheck that consisted of all on call days. It was enough to buy some groceries. I enjoyed getting paid to stay home. Of course that paycheck didn't compare to if I actually worked.

It does sucks when I get canceled but I don't mind using that time as rest or study days. It sucks even more when I was depending on that money to pay for bills or food. Then again, that's why I like keeping multiple jobs as back up plans. Luckily, my home health job is a steady gig.

PANYNP · 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%.
My comment is respectful, not at all antagonistic: How does one person guarantee filled beds?
A couple thoughts -
It seems that the type of hospital and the type of unit specialty might have an effect on census at any given time. If it's a critical access hospital with only 15 beds, and the patients decompensate and need to be transferred to an academic medical center three hours away, low census may occur.
If five of ten patients in an ICU that doesn't have an onsite cardiac surgery service suddenly develop cardiogenic shock, low census may occur, because these patients need to be transferred on IV NTG and Dobutamine that function as a physiologic balloon pump until an actual IABP can be inserted.
Presumably nurses who work in pediatrics units in smaller regional hospitals need to be cross-trained or be agreeable to being sent home when patients are few.
Even the 800-bed academic medical center where I work has seasonal lulls with low census at times. I'm not sure that marketing and outreach can fill beds if folks just don't need them.
While I agree that nurses should not be regarded as day laborers, the comments in this thread about floating, using PTO, being subjected to callback, and unfortunately having to tighten purse strings seem to demonstrate that times of low census occur in varied settings.

JayHanig · Sep 17, 2016

We had a low census frequently because my hospital's reputation sucked. We went by who got called off last going to the bottom of the list but I was *always* happy to take it if nobody else wanted to be off. Every shift away from that hellhole was another day I wasn't written up.

dbybee · Sep 17, 2016

Hospitals have a budget and cannot staff empty beds. I appreciated the union folks joining the conversation as seniority rules and the low man can potentially take all the low work. I hate to work short but also hate a lot of low work. It is hard to anticipate admissions.

Upgrading_Status, BSN, MSN, RN, NP · Sep 17, 2016

If no one is offered the night off we're told to do online mandatories.

MelpyRN2B · Sep 17, 2016

Our hospital does a rotating/volunteer low census. If we're put on standby, the "joy" is that we get time and a half if we're called in. Otherwise there is a very nominal $/hr that we're paid while on standby. Often they make it up, unless you tell them otherwise, with PTO.

michael2479 · Sep 17, 2016

Money is always a limiting factor for any public good, service, or business. The problem is that we can always do more if only we had more money or more time. Cutting hours is not about being fair or unfair. It's about how do people and businesses allocate resources given that everything is in finite quantities.

Kysam · Sep 17, 2016

If you get regularly called, you can apply for unemployment to bring your salary up.

A.Robins · Sep 17, 2016

NHS. They often cancel any bank nurses booked in if numbers are low, but the regular staff just stay, even if it means only having 1 or 2 patients each. Some charge nurses try to let someone go home early if they can, but not often the case. I do have coworkers who used to work in private hospitals, and they did have the problem of being cancelled as regular staff if they didn't have enough patients.

FlyMurse, BSN, RN · 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...

Yep! I'm in the north valley and we hardly slowed down for the summer. Flu/PNA/RSV season hit us hard last year. Holding admissions in ED almost daily. We need a bigger hospital! My first job as a new grad was in Payson and I had to quit because of such a low census in winter of 2013. Moved back down to the valley and have been busy ever since!