Our census is very low, canceled right and left

[inthesouthrn]

Hello everyone! I just joined the forum and wanted to pose some questions.

Here's my situation. I live in southeastern North Carolina, and I've been working at a local hospital, a usually busy one located near an interstate, for the past 2 and a half years. In that time up until this May or so, I have been enjoying 40 to 48 hours with lots of overtime and a REALLY nice paycheck. Then around May, our census started plummeting. We get our shifts canceled all the time. My vacation time, along with everyone else's has reduced to not much of anything...some people have none left due to this canceling. I have been canceled for the second time this week.

I thought there was a nursing shortage! Where are the patients? Along with that, I feel our floor has hired too many RNs and now I only get 36 hours a week, IF I'm NOT canceled, which is rare now.

I'm really starting to worry. I have never seen such a thing. I was considering becoming a travel nurse, but I'm not sure if even THEY can find as much work as they would like during this time.

How are things in your neck of the woods? I work on a medical floor, but this has affected our entire hospital. I thought I'd NEVER have to worry about a job being a nurse. I've been an RN for 15 years.

I know the economy is bad, but people STILL get sick. Tell me how things are in your area? Should I be worried?

Thank you.

[luv2yoga]

This is going on at my hospital too, and I'm in a completely different part of the country than you. It's voluntary to take it, but if you don't, you may be floated. I almost always took it this summer, but now I am working part time and don't want to take it any more. I just don't answer the phone - I know what time that call comes.

[FroggyMama]

We've got it bad here now too. The last 2 months most of us have lost at least one shift a week. They start voluntary, then go by who's turn it is. As someone else said, it seems your turn comes up awfully quickly again. But I don't dare look for a second job, because flu season is coming, then we'll be working overtime every week. Can't win.

[MaryAnn_RN]

A couple of weeks ago we had ONE patient in our ICU. Was I bored or what, would loved to have gone home.

We have had low census here for weeks now, usually have a couple of empty beds, and holding on to level 2 patients as well that we would normally step down quickly.

We have been told that if we are not needed and don't wish to take annual leave for the day then that is fine. The downside is then we have to go and work on the wards :eek::eek::eek::eek: ...I haven't worked on a ward for years and don't want to. So I will be the first one with my coat on if offered the chance to go home.

The only thing is I usually get overtime at least once a week and have only had 20 hours since August, bills going up all the time and Christmas coming...just hope things pick up quickly.

[mskate]

low over here in southern california too!

i'm a float traveler - so when census is low, staff nurses get 1st pick, then unit travelers - then staff floats - THEN me. i'm getting canceled all the time! i got agency to pick up extra - but its not much better!

[barefootlady, ADN, RN]

People are so worried about the economy until the ulcers kick in they do not dwell on being sick. Afraid of the bill and what insurance will stick them with.

Everyone is worried. I remember someone saying it took a flu epidemic and a war to get people to use the hospitals. Now it looks like a depression(did I say that?) will keep them home when they are really sick.

[TheCommuter, BSN, RN]

A chronically low census is a sign of the times, people. We are experiencing an all-out economic recession, whether anyone wishes to believe it or not.

When the nation is in the middle of an economic recession, people refrain from undergoing elective surgeries because they feel the need to keep on working without interruption. These people who need elective surgical procedures are leery of taking all the time off work that is needed for full recovery, which leads to low hospital census. Of course, low census results in less nurses that are needed to keep the floor going.

Therefore, the middle-aged man avoids having that total knee replacement surgery with the hope that he can put it off for a few more years. The woman who lives in misery with large fibroid cysts avoids having an elective myomectomy or hysterectomy, hoping she can deal with the symptoms for a little longer. The toddler doesn't undergo a much-needed surgery to correct a birth defect because his parents cannot afford the $1,500 deductible for the hospital stay.

An innumerable number of people are becoming unemployed during these times and, as a result, lose their healthcare benefits. Uninsured and underinsured people are not inclined to seek healthcare unless it is an absolute emergency. In addition, medical bills incurred by uninsured patients tend to go unpaid, which means less money for healthcare facilities.

[cupcake25]

My hospital has been very slow the past few weeks and nurses were put on call. This is the first week where the census has increased. My hospital has a hiring freeze on for new nurses and other ancillary help. I just hope they don't take away my overtime.

[pagandeva2000, LPN]

Is this a non-union hospital? Sounds like it. If you are working for a hospital that has unions for employees, you have to be guarenteed whatever hours are in the contract. Per diem or agency employees are to be cancelled out before the union nurses. It may be because with the new medicaid billing (which I think started this month), there are less admissions, because medicaid will not pay. In fact, it would not surprize me that the shift goes more to ambulatory care and community health moreso.

Our nurses aren't cancelled out, but there are considerablely less admissions from what I understand than what it was even at one month ago.

[Ms.RN]

can someone explain this new medicaid billing?

[TheCommuter, BSN, RN]

can someone explain this new medicaid billing?

in a nutshell, it involves significantly lower reimbursements combined with significantly lengthy time frames for the hospital and doctor to get reimbursed. i know of primary care doctors who are dropping their medicaid patients because they are only being reimbursed at an average of $35 per visit. also, medicaid is taking 60 to 90 days to reimburse doctors and hospitals for the services rendered.

[madwife2002, BSN, RN]

Our hospital normally quiet in the summer and then busy all winter due to the influx of 'snow birds' this year I dont think they went home but stayed through the summer because we have been steady all summer long.

[pagandeva2000, LPN]

In addition, medicaid will not pay for nosocomial infections or injuries, bedsores, surgical mistakes, etc...done in the hospital. The hospital will have to foot the bill for the treatment of the patient and not be reimbursed by medicaid, and I am sure that private insurance will follow shortly afterwards. Bottom line is that it is falling on nursing. With the shortage of staff, more patients and paperwork, it will be difficult to be able to make proper assessments, closely monitor and turn patients to prevent skin breakdown. The nurse will have to do a head to toe assessment and maticulous documentation of findings must be done, or the hot ball will land on the receiving facility. I can see this getting to the point where the admission nurse may take the fall if she misses too many things.

Our floor nurses are so bombarded with the new on line system, flow sheets and other repetitive documentation that they have no time for patient care, they are telling me that they have not laid eyes on their patients for hours, if at all. It is a scary thing these days, for sure!