First of all I don't understand, "we have called a number of regional facilities and found that most all have some sort of protocol for a closing time or PACU takes over discharge after a certain time, etc. "
The two facilities I have worked in PACU is where patients are discharged from? One facility recovered major surgeries in level I PACU, then the patient's were admitted to the hospital, or came to level II PACU and were discharged home. Minor surgeries came straight to level II PACU. So the level II PACU was where all same day patients were discharged from.
But anyway I don't think my confusion is an issue.
I was never in charge of staffing but we had a lot of per diem nurses. The staffing nurse always knew a day or two before what the surgery schedule would be for that day. She would plot out by hour to hour how many patients would be in PACU per each hour. She would plot out how late the cases would run. Of course she, and we, knew surgeries don't run like clock work! She knew, learned, which doctors, cases, always ran over their allotted time, etc. but at least we could get a ball park idea idea how the day should go.
As I said we had a lot of extra help, per diem, and had a handful of nurses specifically hired, told, they would be the late shift. When it was obvious cases would be getting out at 5 or 6 pm these nurses would be told to come into work at 4, 5, or 6, pm. The per diem staff would be staggered to come in anywhere between 11 am to 2 pm to cover busy times.
I don't know why the charge nurse is coming in at 4:30?????? The 5:30 opening staff should be quite capable to open the unit and getting ready for the day. The charge nurse should be coming in at 8, 9,or 10, if she knows it's going to be a late, hectic day.
Some per diem were okay with odd hours, staying late, sometimes only working only 20 hours a week. Some needed, wanted, to get more permanent regular hours and would eventually get better, more regular hours. Some couldn't handle getting less hours and pay, staying past midnight and quit.
I guess the bottom line is hire a lot of per diem staff. Of course there were some per diem who when called, asked if they could work the next day, would say no, that was their option when hired. Eventually they'd be off the call list and replacements would be looked for.
i don't know the details but there was some policy that if you were called in, showed up to work, but not needed, you still got a mandatory number of hours of pay. I don't know if you were told the day before to come in at 2 pm and called 1 hour before your shift that they didn't need you, how all that got worked out? Certainly with crazy OR schedules these things did happen.