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Only one nurse scheduled overnight - What is your facilty backup plan?

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The solution to your problem is that you need to change the policy. You need to have two nurses, otherwise you are going to have to be the one to pick up the shifts. I am curious as to which type of emergency situation you have experienced at your facility and the frequency of them. If you are having an increase in emergent events, or the severity of those events are high, then that should be enough evidence to change the policy. Even without such evidence, one nurse by herself is asking for trouble. Also, you mentioned who would cover the shift if the nurse did call out and you were out of town. How have you been scheduling for those situations?

The description you gave for your facility was a "crisis / psych facility for youth," does light up some warning flags. Just the term crisis and psych, indicate triaging patients and when I worked in an inpatient acute psychiatric hospital and there were many times adolescent patients acted impulsively and or aggressively /violent. How does your facility handle those situations? How does the one nurse manage those situations? There were many times figuratively, a match would be lit, and when one adolescent acted out, that negative behavior spread like wildfire. Codes were called not usually for just one patient, but two, three, a couple of times 6 patients. When the unit was staffed with one nurse, it was so unsafe. 20 patients and 1 nurse, with multiple codes. What is your patient load? Just providing feedback to your post. I hope you can form a safe solution.

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Hello wonderful and wise nurses,

I am the nurse manager at a facility that only has one nurse in the building overnight. While we are generally very lucky to have great staff, we occasionally run into situations where the overnight nurse has an emergency or calls in sick. What is your facilities back-up plan for when the only nurse calls out on the overnight shift?

We are a small company so having everyone take an "on-call" shift isn't a popular idea since there would likely be about 4 on-call shifts per month required to fill all the shifts. It also is expensive to pay to have an on-call backup 365 nights a year when we don't have that many call offs.

I am trying to brainstorm possible options that are fair to staff and to help alleviate the 24/7 on-call this situation puts me in.

Thanks a million!

When I worked at that type of facility if there was no one designated on call the Nurse Manager or DON had to come in to cover the shift. I used to cover such situations from time to time but I got triple time to do it.

Hppy

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Is it at all possible for you all to hire 2 staff members. how about an LPN and an RN?

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I do like the idea of signing up for voluntary on-call shifts and then offering double pay if you do get called in. Something I hadn't thought of. I appreciate the allnurse community that I can bounce ideas off of.

I know some of you have asked about patient load and safety and while it does not really address the problem I am looking to solve, many of you are curious. I have worked as a floor nurse at this facility in every shift (days, swings, nights) before I took the management position and have always felt safe. There is a 2nd nurse until 9pm which is after med pass and when the residents go to bed. 90% of the time, the residents are in bed by then, of course emergencies can happen at any time but we have never had anything that couldn't be handled by the staff we have on duty.

Because the facility I work at is not a hospital with a large float pool, coverage has always been the hardest part of the job. One plus is that we never "down staff" or "low census" our nurses and send them home.

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My suggestion would be to offer double pay to anyone willing to cover the shift. Have those interested sign up for a group text alert when someone calls in. This won't work if it happens very often, but I'd go in for double pay occasionally if mgmt was not abusing the nurses.

Similarly, you could text staff and offer a bonus that increases until someone finally agrees to it, kind of like the airlines do to get people off of overbooked flights.

I worked at a facility where they started with a $100 bonus for 'desperation shifts' and went up above $500 (in addition to OT for > 40 hours per week). You'll finally reach a point where somebody is willing to come in, even if it's inconvenient for them. It's expensive, but still probably less expensive than 365 days per year of call pay.

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Good luck finding a solution. I was the "24/7" manager for my former facility for nearly 3 years and with no end in sight, I left it behind me! Even now, discussing the scheduling situation in the past, gives me palpitations and lots of anxiety. It's only been a couple of months since I left that job and while the stress relief is tremendous, the memories are almost like PTSD. Never again!

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Thanks adventure_RN; offering increasing bonuses to pick up a shift are intriguing as well!!! Would that make me the auctioneer? LOL

Mamabear, I am surprised at how many have chimed in to say that their facilities did not have a backup plan and it is the managers responsibility. How can one person have a life if they are always on call? It IS stressful! The scheduling piece is definitely is a nightmare! I hope you have found peace in your new job :)

I wish I could have agency nurses here! It would literally save my life! Unfortunately due to the fact that we work with kids our facility licensing requirements are too stringent (background checks, finger prints, trainings, etc.) to have an agency staff on-call.

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I'll go you one better. Our facility has only one nurse on and if a nurse calls in on evenings, nights or weekends the nurse on duty must find a replacement for the one calling off or pull a double. Our nurse manager wouldn't think of coming in. For a time, the nurse being called in could bargain for overtime but then the NM announced the "leadership" didn't like paying so much overtime. And yes, it's illegal in this state for a nurse to self-mandate. But that's what's done.

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We run one Charge RN at night for a sub acute facility of 45 kids. If the Charge calls out sick and no one is available to cover, the RN Case Managers (which includes myself) are usually called to cover. We usually split the shift to ease the burden.

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I'll go you one better. Our facility has only one nurse on and if a nurse calls in on evenings, nights or weekends the nurse on duty must find a replacement for the one calling off or pull a double. Our nurse manager wouldn't think of coming in. For a time, the nurse being called in could bargain for overtime but then the NM announced the "leadership" didn't like paying so much overtime. And yes, it's illegal in this state for a nurse to self-mandate. But that's what's done.

That sounds horrible. I worked at a facility with mandation and the morale was super low (other issues besides staffing but yeah).

I read the post titile thinking this would be about patient emergency situations with one nurse. I'm kind of surprised it's not a problem... that is what I would be more worried about as a nurse manager.

Anyway, I vote for double or triple pay. And if no one volunteers, then the nurse manager has to come in. I mean, if it doesn't happen enough to need extra staff, then it really shouldn't be a big burden for the nurse manager to cover.

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Mamabear, I am surprised at how many have chimed in to say that their facilities did not have a backup plan and it is the managers responsibility. How can one person have a life if they are always on call? It IS stressful! The scheduling piece is definitely is a nightmare! I hope you have found peace in your new job :)

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It is the managers responsibility because they are the ones that have control over staffing. You even said earlier that it's too expensive to have more staff to cover the open shifts. That's a decision mgmt makes. The effects of that decision should be felt by mgmt and not passed along to the staff nurses. Do you even occasionally work those shifts? (My previous manager could not even do the job or cover a shift safely, which is terrible... he was not even willing to learn). Paying premium pay is ideal for all involved, but if it is abused by managers even that won't work very long. I find it horrifying that some managers require the off-going nurse to find a replacement or have to stay for double shifts. I'd be quitting asap. I'm glad you are looking for backup plan ideas that would be good for your staff. Money talks!!

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