Over staffed

[megmon31]

I work on a med/surg pediatric unit that has a revolving door. We have 38 beds and some days we are full and other days we have a very low census. We are always staffed for 38 patients and can only float to 3 other units, so most days a nurse or two (sometimes 4) are asked to take the day off without pay or using PTO (we call this furlough). Because of this we have a calender book where the staff can put their name in certain days they would like to be off. When they get the day off their hours of time off are logged in a book. If the census permits, the charge nurse looks at the book to see if anyone has requested that day off and calls them 2 hours prior to the shift and gives them off (but on call). Some days there are more than 1 person in the book for that day, when this happens the charge nurse will look in the book to see who has less hours of "furlough" and that person gets the day off.

I was wondering if anyone else has a system similar to this? And what rules they go by with their furlough book. Our rule for the furlough book is you can only request 2 days per month and if you don't get that day, you can not pick another day (no erasing). If no one requests, it goes by hours previously furloughed and each person is called until someone takes it. If no one takes it, the person with the least hours is mandated to take off.

If you have a similar system that works good please share! Or if you have ideas please share!

[meanmaryjean, DNP, RN]

Ours goes by request first (this is unlimited- you can ask for every day off if you like) and then by who got what we call VTO (voluntary time off) last. If everyone declines- then the the person who got VTO the longest time ago gets mandatoried.

The only wrench in this is if our acuity prohibits certain, more experienced nurses from being off - for example if we have ECMO running. Some of our nurses have voluntarily cross-trained to NICU and if NICU needs help- they automatically float and skip the VTO list.

[TheCommuter, BSN, RN]

Any floor nurses who are overtime (or would cross over into overtime pay if they worked) will have their shifts canceled first. If no one is in overtime, whomever requests a cancellation will be canceled.

If no one has requested a cancellation, we cancel the shifts in the following order, according to employment status:

1. PRN/per diem nurses are canceled first

2. Part-time nurses are canceled second

3. As a last resort, we cancel the shifts of full-time staff

At my workplace there are no limits to the number of times an employee can request to have his/her shifts canceled.

[nurse4ever08]

Ours is OT then pen staff then by a rotation list

[psu_213, BSN, RN]

People on OT are sent first, followed by casual staff, followed by part time staff, followed by full time time staff. Full time staff is supposed to be sent home based on who was last sent home. However, some people do no want to be sent home (for instance, someone low on PTO); others will always take the extra time off. In other words, the issue becomes a bit more complicated that just "what RN was sent home most recently."

As for "calling off" staff before one's shift…given the relative unpredictability of ER census, we very rarely call off an RN before they are even scheduled to be there.

Oh, and one more thing--weekend option staff, working on a weekend basically can never be down staffed. By contract, they are required to work 24 hrs each weekend, so they cannot be sent home on a weekend.

[icuRNmaggie, BSN, RN]

Full time employees do not have to take on call.

You can say no thank you, I am scheduled to work today.

They can always reassign you to another unit.

If they send you home, you are eligible to file for unemployment benefits for that day.

What other profession has to use their vacation time in order to pay their bills?

What other profession would put up with being treated so poorly in order for a corporation to make a profit?

[Here.I.Stand, BSN, RN]

Our system is like meanmaryjean's.

[blondy2061h, MSN, RN]

We very rarely have low census. We have tons of paid time off and very rare opportunities to use it. If we ever have excessive staff, people fight over who can have off. You are never mandated off on your regular shifts. My unit's staff can go anywhere in the hospital to work. They'll send us anywhere, even if it's just to be a one to one sitter. I had one shift where I worked and they really didn't have an assignment for me. I did IV starts, dressing changes, hung blood products, did tele strips, stocked supplies, did vital signs, glucose checks, answered call lights, turned and positioned people, answered phones, worked on mandatory inservices. I was busy the whole day

[~PedsRN~, BSN, RN]

We have a date book. One for call offs and one for floats. So if we are overstuffed, we wait for word from divisional. If there is a need in the hospital, we look at the last float dates in the book and the earliest date floats. So your float order (and call offs) will depend on who else is working with you that day. ?

Calls offs work the same way, kind of. If there is no need in the hospital, then the charge RN calls earliest to latest dates to see if they want the day off. You can choose to take PTO or take the day unpaid. If no one wants the day off, the earliest date will be forced to take it.

Overtime and partial shifts (4 and 8 hours) and PRN are always called off first.

[HouTx, BSN, MSN, EdD]

Based on OP's description, the staffing plan is wonky. Staffing should be based on the median census (most frequent).. Not the Average Daily Census - ADC is only useful for financial projections, not patient care because it can easily be skewed by outliers. I have never encountered any organization that permitted departments to be staffed for 'maximum possible' census... it doesn't even make sense. It is also common practice for 80% of core staffing needs to be filled with Full Time staff, and the other 20% with part-time and PRN because this builds in some flexibility to accommodate census changes without jeopardizing income for the full timers.

PP comments about 'call offs' reflect best practices. Full time staff should always be treated as the most valuable because they are the ones that demonstrate the most commitment to the organization - they should be allowed to volunteer for call off prior to mandating call offs for other types of staff. Part Timers should be given next priority, followed by PRN. There should be a systematic method (e.g., rotations) so that call offs are distributed equally. Those are just basic principles of staffing that can also be applied to requests for time off.

Unfortunately, many nurses are pushed (leap?) into management roles without adequate training or preparation -- and naturally they end up making staffing mistakes.