NPC hot topic for our unit***

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Hello, I am writing this for some in sight as to how other units handle the influx of babies that come and go, particularly in the summer in a Community Hospital. I work at a hospital that handles 70-90 births a month. Our staffing is all done together for Labor/Mother Baby/Special Care nursery. We sometimes get transfer backs and feeder growers from high acuity hospitals. Routinely we pick up call as needed, every six weeks to fill in for vacations and FMLA coverages. This brings us up to our "par" which is usually 5 on nights and weekends and 6-7 on days. It is nice that we all work together and can swing our staffing around a bit, but, as you all know at 3 pm on a Saturday in July...it is busy.

It seems as of late we can not get extra help for those times when we send out our "SOS calls". It has not been in issue to get extra help when we need it during the week. Some ideas that have been brought up are:

If someone calls off on a weekend, they pick up call the next weekend. Our unit really doesn't have a problem with call offs so this isn't really necessary.

Another option is putting out an additional call schedule and asking everyone to pick up 1 twelve hour weekend shift. Fri night, Sat night/day, Sun night/day in addition to our regular call. These would be bringing us above "our par". So, essentially we will have two call lists...one of the complaints was that someone could get stuck doing a lot of weekends depending when it was their turn to sign up, so it was suggested to keep the two lists seperate...we rotate our regular call time sign up and pick up in 4 hours slots which is nice because you don't have to give away your whole day if you don't want to.

Any Ideas how to solve this problem? Having a traveler is not an option. Our next NPC meeting is coming up soon :yes:

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Specializes in Critical Care.

I think the first problem is that your unit is by design short staffed for the weekends, if you need 6-7 on weekdays then there's no reason you wouldn't also need 6-7 on weekend days. I would guess your only elective admissions are for planned C-sections which are more likely to be planned on weekdays, but really I doubt that reduces your staffing needs on weekends by two nurses. I'm not sure what you mean by "having a traveler is not an option" since it is always an option. If your manager is simply refusing to staff properly then your problem is that you have a negligently incompetent manager and that should be pointed out to them.

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Specializes in SICU, trauma, neuro.

Why are travelers not an option? The difficulty with your suggestions is, it's really not the staff's job to cover the floor by picking up extra hours. Working their agreed upon FTE is.

Call-in/pickup bonuses could help, since it would then benefit the employee to work extra.

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Having a traveler/or having a weekender position has been brought up for 2 years and has not gotten approved for budget reasons....our census varies so much....and as a closed unit it is hard to justify having them.

This is mainly just a problem in the summer...so hiring additional people per weekend isn't really an answer either because we would end up needing to give low census'. We do have a high induction rate (a whole different issue with the MDs) and do scheduled C-sections only during the week. Our C-section rate is great though :)

For our call time and if we get an "SOS call" we get time and a half. I am going to suggest "sweeting" the deal a bit I've read about some different "incentives $" that are given out on the boards...Do any of you have experience with that? Does it motivate people? What are your incentives offered? Extra PTO? Extra dollars per hour? How much?

Either way this would be cheaper than a traveler and cheaper than a weekender...And I agree it this shouldn't be our responsibility...but we are mutually trying to come up with a solution...

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Does your hospital have a float pool? This seems to help our staffing work

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Yes, but the birthing center is a "closed unit" and only float to nsy, mb, and labor. Sometimes surgical gyn case overflow that are non-contaminated.

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Specializes in ICU.

You're going to have to increase your staffing on the weekends. It's one or the other, seems like - you're either going to have to overstaff and send people home for low census, or you're going to have to deal with weekend days that are really short. It seems like your current staff are not motivated by extra money.

We have a lot of staff like that on my unit. Won't come in for anything, no matter what incentive is offered, because they value their time off more than extra money. We currently are offering time and a half + $5/hr + $190 flat per shift... so it's almost $21/hr extra to come in for overtime, on top of time and a half, and people still don't do it.

You could try raising your incentives but it may not help. I suspect you're just going to need to hire more FTEs in general and start sending people home for low census.

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Specializes in NICU.

What about hiring a few PRN people. That way the hospital saves money by not paying FT staff time and a half for working extra. Have them work 1 day/ Pay period and then more often during summer when you are busy. We offer incentive when we are unexpectedly short staffed (several call-ins or bunch of admissions/ incoming transports). We pay $10/hr incentive, but have paid $20/hr when we were at capacity with several 1:1s. We are a large NICU (100+ beds and 300 RNs) so there is always someone willing to come in.

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Management is never going to approve the budget for extra weekend staff or travelers if your current staff keep making it work. I would say the last thing you need is an extra on call list or to force people to pick up call if they call out. Let the staffing be short and force management to address the issue.

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Specializes in Pediatric Critical Care.

For our call time and if we get an "SOS call" we get time and a half. I am going to suggest "sweeting" the deal a bit I've read about some different "incentives $" that are given out on the boards...Do any of you have experience with that? Does it motivate people? What are your incentives offered? Extra PTO? Extra dollars per hour? How much?

As a specialty unit (cardiac ICU), our staff got $500-1000 bonuses for working extra shifts, on top of time and a half pay. It was effective...but as soon as they stopped giving the bonus, nobody was willing to come in for no bonus anymore.

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Specializes in OB.

Agree with the others---it is NOT your responsibility to cover staffing shortages, and the longer you continue to do so, the longer there will be "no room in the budget" for extra staff, be it travelers, per diems, etc. Why would they when their existing staff is bowing down to their demands so nicely? It's one thing if people WANT overtime, it's another thing entirely for it to be part of the workplace culture that it's your responsibility to do it.

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I totally understand your desire to "make it work" because when your unit is short staffed, the people who suffer are the patients and the other nurses/aides. The problem with this "work more and harder" mentality is that management has no incentive to appropriately staff your unit.

It doesn't even have to cost much. Family Birth is a closed unit in my hospital. The nurses there really only float between L&D, maternity, and NICU. BUT we have float pool nurses who have oriented to maternity and go there when necessary. An experienced nurse should be able to pick up the uncomplicated mother-neonate dyads without too much investment in orientation. Your floats are your generalists, and I'm sure they've had experience with post-op patients - which is basically what a c-section mama is. Yes, they'll need some additional support getting up to speed with neonates, but it shouldn't be that difficult. No one's suggesting you randomly float someone to the NICU or even train a float for such a specialty position, but postpartum isn't THAT much of a stretch for an experienced float.

You need to toss the problem back to management rather than force your colleagues to interrupt their family time for additional call and shifts.

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