Dear Nurse Beth,
My hospital, that I have worked at for the past 23 years, has started a new "Flexing down for low Census" policy.
Our new CEO's newsletters remind us repeatedly that staffing is their biggest expense. I work in a pediatric hospital and the census fluctuates greatly. Point in case, on Thursday our 21 bed ICU was almost full. Today, Sunday, we have 8 patients.
As I have read on-line, flexing down is not a new phenomenon. The flexing down has been a huge issue. We first were being called off by reverse seniority and in 4 hour blocks. That was horrible. Some people were playing the 4hr off only game, forcing the next person in line to be sent home resulting in some patients having up to 7 RN's in a 24hr period. We can choose to take time off with pay (using our vacation time) or time off without pay. Neither option is good.
One gives us money but no time for a real vacation. The other gives you a smaller paycheck making it more difficult to make ends meet. At the onset of the policy the pediatric hospital was having a strangely low census forcing many of us off, sometimes more than once in a pay period. It caused a panic and a ruckus among all of children's hospital.
We had a staff meeting that I had never seen so many people attend, ever. The powers that be talked, not with staff, but with leadership of our concerns and negative impact this was having all the way around. Staff satisfaction, patient satisfaction, patient outcomes, things getting lost in the multiple reports that were being given.
They decided to give us a cap of forced off time -16hrs in a 4 week block. The cap is not the answer. Getting called off translates to a loss of some sort for us hourly paid staff. Due to our variable census and lack of pay, from the start of this policy in November last year to current June, we have lost 11 RN's.
We stand to lose more as this continues. There are only so many places we can float. We do not float to the adult hospital and we don't expect the adult RN's to float to peds. The adult hospital is rarely impacted by this.
My dream question is how can we stop this? Make this policy go away? We were much more willing to take time off when it was a choice. Now that we are forced, we are afraid to use our time by choice.
Morale is horrible, everyone is looking at the job board. This hospital won an award once upon a time as the best place to work. Now, no. Many of us don't want to leave. We enjoy what we do, we are proud of what we do. But not making a full time paycheck when you have a full time job is not sustainable.
And, I don't understand where retention has gone. Hospitals spend upwards of $100,000 for each new RN that they orient. Where is the cost effectiveness in that? Our jobs are creating a lot of anxiety in us. We have become afraid of the phone. The dreaded phone call.
And, we are afraid to speak up, speak out for fear of being fired.
Upper management is not affected, they don't lose money or time off. What can we do?
Any words of wisdom or channels to try to fix this misery?
Dear Forced to Flex,
More often you hear about nurses who are happy to go home due to low census, but trust me, once it goes on too long, it causes morale problems. It can quickly become dog eat dog with everyone trying to protect their PTO and worrying about getting a full paycheck.
Nurses with more seniority feel nurses with less seniority should be sent home.
Full time staff feel travelers and part-time staff should be sent home.
Travelers with contractual guaranteed number of days feel regular staff should be sent home.
Once I worked in a facility where I was sent home because I had the most accrued PTO.
Matching staffing to census is a tough balancing act when census
varies. Managers are held to productivity standards that are based on a ratio of nursing care hours to patient care hours. Facilities that do not have a clear process for mandatory time off create uncertainty and confusion for their staff. The fact that your facility is capping your forced time off at 16 hrs per 4 week block is more than what most do.
Some nurses fall back on part-time jobs during low census months. Some nurses use up all of their PTO and give up any plans for vacation later in the year.
Unfortunately, flexing to census is the nature of the business although as professionals it's not in line with most other professions. As you say, there is a cost to sacrificing the long-term goals of retention in order to meet this month's short-term budget. In an ideal world, nurses would not be called off but would be given the option of other work, which would at least give them some control.
There is very little nurses can do in your situation except to vote with their feet, I am sorry to say. There are those who can afford to ride it out until winter or higher census, while others need a steady income.
Best wishes to you,
Author, "Your Last Nursing Class: How to Land Your First Nursing Job"...and your next!