Gardengal

Ever since I took my first "blood bath" at work I have kept a full set of scrubs as spare at work. It has nothing to do with the weather, although when the weather gets rough-it's not uncommon for me to bring in an additional set and extra underwear and socks. I've been stuck at work before, and if I have my own stuff it's not too bad.

It's been 7 years since I was there, but there are 3 key hospitals in Lexington. Central Baptist Hospital, University of Ky, and St Joes. I worked at Central Baptist and liked it. The worst hospital at that time was Humana and wasn't really thought well of by nurses-it was changed to Columbia and I don't know what happened at that point. As I said-it's old info.

This thread concerns me from a legal and safety standpoint. Propofol is only indicated for intubated patients as an infusion. Bolus dosing may only be given with anesthesia. I do not as a nurse want to risk loss of respirations and an airway because I gave propofol to a non intubated patient-and will not do so despite pressure from some physicians who want to do a procedure. They'll say so and so- does it all the time and why can't i be like that nurse? My response is always -because I only work under my nurse practice act and do not choose to violate that-I then offer to call anesthesia to see when we can get the procedure scheduled appropriately. MDs back down. I then follow up with anyone the MD named and make sure that they understand the safety and legal ramifications of actions if what the MD is saying is true. Intubated patients having a procedure typically are not considered concious sedation since they have a protected airway. In these patient I still do not bolus with propofo because these are anesthesia doses and not covered under my licensure and nurse practice act. Be careful.

I don't know that there is a standard answer to your question. There are many areas in nursing where the frequency of exposure to gross stuff is less, but typically ou have to get some experience first. In general I would say that as a staff nurse there are some days that are grosser than others. Although I know that the bloodborne diseases require caution, I always felt better dealing with blood that vomit or feces because the smell didn't make me gag. I learned to keep Halls mentholyptis cough drops in my pocket. I could overcome any smell and gag response with the strong menthol smell-although several of my coworkers would ask if I was ever going to get over my cold. It kind of depends on the support of nursing assistants as to how many excrements you deal with. I spent many days on med surg and telemetry when my patients were all continent and just required assistance to the BR. I also have worked with many nursing assistants who have cleaned up my incontinent patients unaided. In ICU as a staff nurse I deal with something gross a few times a day. Even now, as a manager I still deal with it every few days. If I see something happening I'm there to help out so...it could be gross. My husband questioned if he could deal with the gross stuff when he started nursing school and clinical. The first day he said he didn't think he could handle it. Then, the dog got sick at home and he cleaned diarrhea stool several times. He told me about it when I got home and said it was really gross, but he felt bad because the dog looked so sick and ashamed. He said he focused more on worry about the dog and less about the task and realized that nursing couldn't be worse. A year later he tells me-the gross stuff isn't so bad after all and it really isn't constant all day. Maybe a cuple times a day or not at all on some days. If you are thinking of PA don't go to nursing school. I would only do that for nurse practitioner. By the way-when I was in nursing school I got sick every day at my part time job-working at McDonalds. The stale smell of old grease when we sloped the floor at closing and cleaning the milkshake machine was gross. I'd rather be a nurse.

We maintain a full census all year in our ICU except for maybe 1-2 weeks/year. We're usually looking for more staff instead of hoping not to be called off. Most of the staff would love an additional surprize day off. Years ago I worked staff in a facility where we had a big drop in summer census. When people started to get sick of being downstaffed, I volunteered to be farmed out elsewher for weeks at a time and we all won out. I gained a few new skills, learned more flexibiity, saved my vacation time. The other departments got the help they needed and my peers protectedtheir benefit time and paid hours. It was fun.

Like glassam, as a manager I deal with tardiness when it is an issue. I did terminate a nurse because of chronic tardiness, and it was upheld in grievance and when she fought it through unemployment. She was chronically late, and did not respond to questions regarding reasons, and efforts to assist her if needed. She would say, I just can't seem to get here on time....There was a 7 minute window to start times, so tardy didn't even count until after that time. I honestly didn't note her tardiness until If felt the rumbles in the unit and followed up. I learned at that point that instead of just accepting the total of 8 hours or 12 hours noted on the time sheet I needed to actually look at every minute. This nurse improved for about 1-2 weeks after I spoke with her then reverted right back to her disrespectful late ways. After almost a year of talking, counselling, trying to rearrange shifts, verbal warnings, written discipline, final written, suspension.. I had no choice but to go to termination. The funny thing about it was that she too was a really good nurse when she was there, but her late behavior caused a poor working environment and anger within her peer group. Her peers were not exactly happy to see her gone, because we all liked her, but everyone was relieved when we all respected each other's time. She would always say," but I have to get my children to school. " My response was typically that I understood that, but since several others in her area, in the same school district with the same time constraints could do it then I didn't see why she was any different. As we went further through our process I actually would tell ehr about other job opportunities which started 1/2 hour later...she'd say but I need to get home earlier than that, I can't get home late. I tried offering her 4 hour shifts, that wasn't aceptable either because she needed less work days. When we finally got to the end of the discipline trail she knew what was coming, but still thought that her priorities took precedence over her peers and those of the organization. After this learning experience I look at every minute on time sheets. When I begin to notice the beginnings of a problem I bring it up. My staff know that I do this and accept this. They also know that I will never tell them if I am disciplining someone, and would never tell anyonethat they are being disciplined. So...if I have someone who appears to be having an issue of any sort and they are angry about it they know that I am dealing with it, but they will never know the details.

Xtreme1, Your screen name says it all...this sure is an extreme one. You are absolutely right. She is obviously wrong.Obviously administration is viewing the severity of the situation to call her in. I do question their confidentiality however by you knowing that she refused to come in. For her confidentiality as an employee-they should not have revealed that and should instead have said that they are "arranging for her to come in and discuss it" The other real issue here though is the hostile and threatening environment that is resulting. There are whistleblower laws which should protect you, and if there is any witness to the call that in itself should be grounds for dismissal. Obviously what she did was also wrong and also grounds for dismissal and a board reportable offense. You did the correct thing, and I'm sure it is an enormously painful process. I recall the initial fallout I received from an accused individual and coworkers when I brought to light false narcotic documentation several years back. It led to an investigation and the nurse, choosing not to admit a problem , lost her job. I felt guilty for a while until I remembered that although the discharged nurse was gone because of my observations and complaint, she was the one who did wrong....to patients and the organization. Try to feel good about what you did, correctly in the protection of your patients. We are patient advocates and need to act in this way. Stick to your guns and try to ride it out. If it gets increasingly messy, insist on time off with pay while th eorganiztion deals with the issue. I would also recommend an unlisted phone number so you don't have to deal with harassing phone calls if you get any calls at home. I admire your integrity.Hang in there!

Have you ever been to the NTI? Did you enjoy it? I loved this past week at the NTI. I just had to share my enthusiasm for our profession, (and I think my husband is tired of the topic now that I've been home for a few hours). I just got back from the AACN (American Association of Critical Care Nurses) NTI (National Teaching Institute) annual critical care convention and can't contain my renewed energy and excitement for our profession. This year's conference had 6000 nurses attending and it was an awesome experience. The conference was in San Antonio Texas. The conference was great and the city was incredible. Anyone with any doubts about customer service programs should go to San Antonio. Every person I encountered was welcoming and warm and makes me want to return there. The conference as a whole was really good. Many vendors with info and freebies, many professional nurses with ideas to share, and a lot of fun. The conference is an almost week long annual event. It will be in Orlando FL next May. I hope to see many of you there. This was my 5th NTI. I think the best thing about the conference is the fun and friendship. It is such a joy to be able to talk to so many others who love nursing and go to this conference to get information and furtherpromote nursing. I am re-energized from my experience.

Night Owl: I agree with you with the exception of the JCAHO surprise visit. I sure wouldn't want the fall out institutionally for that. I'd deal with it internally and if inefective quit this unsafe situation...then report to the state after telling them I was doing so. I quit a management job because of my inability to make a discipline stick for sleeping on the job and poor care by an employee. (Not supported by human resources because how could I prove that the nurse was sleeping at the nurses station?-I had a written complaint of a coworker,(but only 1 of 5-no one else would document for fear of repercussions) vitals documented in the medical record which did not correlate with the bedside monitor in the ICU for the time frame , the employee when confronted who said that 'might have dozed off for a minute', and a patient who had a femoral IV line discovered by another nurse lying in the bed, blood dripping to the floor and the site already clotted. The other nurse entered the room because an IV pump was beeping. I couldn't see a question. The patient died a few hours later. I can't say it was directly related to the event, but it sure was contributory-exanguination is never really healthy. The RN in question had returned from a sleep break of at least 1 hour less than an hour previously according to the coworker. NO ONE should sleep while on the job. Lives depend on it. I do agree though that when on break anyone can nap(out of sight in the break room), as long as they wake themselves up and report back to work on time. It should not be a coworker's responsibility to come find you if you oversleep. That is taking them out of care giving while getting you. If you work with a staff who routinely naps on break everyone can quickly get acclimated to needing to wake up the previous co-worker. This is only OK if someone else is getting report from you as you leave to go on break, and a different person is giving report to the person coming back from break-otherwise you can have too many people gone at the same time and emergencies always happen when least expected. Having lived thorugh this, as an unsupported manager I agree with you wholeheartedly. Employee handbook says no sleeping or immediate dismissal. I have found that this is difficult because of permissive human resource practices which don't match policy and takes successive occurrences and much documentation to enforce. There is always a fear by an institution that things will be overturned because everyone is not following the same rule the same way. Vicious circle.

I would ask the coordinator of your trip. A physician at our hospital takes our expired stuff every year to India to clinics in poor areas when he goes home to visit. We give him all sorts of stuff. When I asked him about things do to expire soon he told me that as long as packages are intact so that we would not question sterility-he'd love to take it. When I questioned him about expiration dates he said "when I look at no supplies or supplies that are just not guaranteed perfect anymore, I'll take the not guaranteed. He looked at it as supplies that he could use there, which he would not have otherwise. NSS should not degrade so i wouldn't think it would be a problem of stability.

I think the tube system is a real timesaver. At my current place of employment it's a little limited though because it couldn't go into some areas without a lot of reconstuction so they chose not to include some areas. In a new hospital though it should be pretty straightforward. The tube system at my hospital was installed after I started there in th epast few years and has really improved our deliveries. If you can't sell the idea on decreased labor costs because of transport of items, maybe you can convince them with increased speed and efficacy of treatment: Lab tests run quicker because specimen goes straight to the lab instead of traveling in a basket while a phlebotomist draws more blood before returning to the lab. Blood transfusions can be given quicker because you don't have run for the blood. Documentation is more accurate because you get your addressograph plate sooner-so your chart has better identification. Forgotten meds with transfers can be tubed-so doses don't get missed. Pharmacy copies of orders can be tubed to pharmacy-speeding up order verification and then delivery. Old charts from medical records come sooner-better care and MD satisfaction Better transport times for patients to get to tests because escorts, and aides don't have to do the other trips. Remind them that salary costs are perpetual, and they would speed up delivery and decrease labor costs so the sytem would eventually pay for itself if your hospital is large enough.

zuchRN I love that idea. It sounds like fun and rewarding. How are the funds obtained though. Is there a budget for it? Are donations sought?

I look forward to learning from the publications cited by Edward, IL. It's a topic of great interest to me, but it looks like it will be a while until I can get it all read and digested.

Deespoohbear- I see you did what I did today, assessed what you did and thought about what could be billed. Ifind myself thinking that I belittle the nursing profession though by trying to state the tasks. For example, taken from your list: Started 2 IVs and discontinued an IV. I believe that your task was more than a task. You probably either had bad IVs or needed additional lines based on your knowledge of incompatability of meds and need for further. You started a new IV-I bet you probably taught the patient about what you were doing, allayed anxiety, gathered supplies, performed the procedure, assessed tolerance of the procedure and then used the new line for whatever reason you started it for - and then assessed tolerance for that. You then had to document this. The 3 prns you gave-You assessed your patients, decided they needed the meds, administered the meds, documented them, assessed efficacy and then documented more. For each of your interventions I see that we would underestimate our worth, if we can't spell it all out. I agree that it doesn't seem right to bill to the lower acuity patient the same as another which requires more care. Should we try to bill based on tasks though? Or more for the level of care which most hospitals seem to average out by billing for a type of bed and assigning a cost. ie regular nursing floor, telemetry, step down or ICU. I see why you would have been tired after your 12 hour shift, but I see it because I am attributing each task with an assumption about your patients needs.......it sounds like telemetry since you put a telemetry pack on one....... I don't know. I agree that we should be able to bill for nursing, but until we as a profession in general can assign an average cost to a standardized acuity level it sounds like just more work added to our plates. .......too many questions for my tired old mind today....

I think that one of the reasons charges are higher for some of the items we use when we do bill for them is because it costs to use them-ie foley charges, ng, etc. -cost to hospital is way different than to the patient. I can't think how we could bill for the critical thinking which is what differentiates nurses from techs. One of our biggest frustrations is that we spin our wheels coordinating all sorts of activities all at the same time. Kind of tough to bill that to one individual. Easier to group it as a charge in toto. Perhaps we could differentiate nursing charges based on where a patient fits into an acuity scale, but I still see a data entry work increase...is it worth it? a couple of other points-I don't think it's a male female thing. Our pharmacy, pt and xray departments are led by women. Also, I recall reading a book years ago about paternalism with hospitals and vaguely recall this topic (probably the same book referred to by Edward)-I believe our health care environment has changed quite a bit since the publishing date of 1975. Afterall DRGs came out in the mid 80s-and finances have gone down since then.

I agree that it might seem insulting to be included in the room charge, but I sure don't want to be the nurse who has to jot down all my supplies and time and effort used at the bedside so that I can bill for it later...what a nightmare! Can you imagine the time and energy expenditure? Here's an example: Patient admitted to ICU in septic shock, hypotensive, intubated in ER, on multiple pressors, lots of anxious family, combative requiring sedation in order to treat. So..lets see what we would do: 1 Get report 2 Get patient into bed 3 Attach to noninvasive BP, monitor and pulse ox 4 Call resp therapy to attach and set up vent 5 Page MD that pt has arrived 6 check vs on monitor- decide if they're Ok or not 7 Quick physical assessment for abc 8 Get ER linens out 9 Cycle BP for another set vs if they were relatively ok before if not you already rechecked them and dirty linens are still there....Call MD again so you can get orders to titrate pressor meds up, or get original order. 10 draw labs 11 enter labs in computer and send labs 12 Get specimen collection containers and get sputum and urine cultures, send them. 13. titrate pressors becaus of BP change 14. Get ABG results back-call mD 15. call respratory and make vent changes. 16. set up for line insertion 17 talk to family while assisting with line insertion so you can get more detail and get advance directive info. 18. Do the assessment on paper after doing full physical assessment afetr line done 19. I forgot preparing transducers and hooking up cables, zero, etc, 20. sterile central line dressing 21. cxr-call to have done, assist with film position 22. call md to tell him film is done and needs viewed 23. reposition endo tube and retape because in to far. (no wonder we needed so much sedation (forgot to mention titrating that too) 24. ask nursing assistant to restock line insertion cart 25 etc, etc, etc I personally don't want to keep track of all this so I can later bill for it-especially since we get a flat rate fee for at least half of our patients, and not item or fee charge reimbursement. I'd rather acknowledge that the fee charged for a bed in my area includes the services of nursing, housekeeping, electricity, plumbing, depreciation, case management, dietary, general supplies....etc. I also am glad that I do not save all those stickers off of items by wearing them until I can place them on a charge board so they can be charged...that was a pain. I would love to think that we could quantify our costs, but the time and energy involved in the nursing department, in addition to th efinance department doesn't seem worth it fo rmy ego's sake. I'd rather look at it as the daily charge is for the care and services, and you just happen to get billed for it as a room rate because that's where it happened. Sorry for the disjointed entry-got called to the phone half way through so didn't finish this lengthy(and some would say painful) post immediately and somehow sent it off before finishing.

How did I miss this thread in the first fray of replies? What a lot of emotional responses are here. It's obvious from the responses that many of us see the 'entitlement' issue as being true. (I personally see this as a generational trend as opposed to a nursing student trend) It's also pretty evident that some believe that we eat our own young.....I still feel that I'm pretty much intact, and heard about how nursing eats their young back when I started over 20 years ago.(I have been chewed up a few times, but eaten?????) The original poster was voicing frustration at the situation, and as others mentioned I think the frustration should be directed at the clinical assignment, not the traveler. A new travel nurse should not have been assigned a student-for both their sakes. I can only assume that there was no other choice, because it was a routine student day and time, and it was a shift short of routine staff. Not a good situation but i can see how it could happen. I too would discuss the situation with the nursing instructor, and voice my concerns. If the assignments are frequently like this then perhaps the school should be reconsidering its clinical sites. If this was a freak assignment then I say that there was still something to learn from the situation, even though it was not ideal. This shift probably showed how a new travel nurse, although not really comfortable at a new hospital yet is able to take care of patients......It says a lot for the portability of our profession. The student was able to see what not to do with students or orientees when the reverse situation occurs. In regards to the tasks being addressed as tech work-I think that is an oversimplification of the situation. If we look at it-just learning the tasks described of starting IVs, doing dressings or inserting NGs and foleys is just looking at the technical tasks of nursing and not the overall role. Sometimes learning delegation is one of the toughest things. This student was exposed to what it feels like to be delegated an undesirable task while wanting to do something else. This experience should help her in her own future delegation. I believe that all nurses have some responsibility to be preceptors. I personally enjoy it and find it energizing. Assisting with the orientation of others is included in our RN job description. After all, to truly be a profession and not just a job we need to be able to assist the profession with growth and change.

Like fab4fan I used folded tissue pinned to my head with 2 bobby pins. The tissue I used though was facial or toilet tissue. Cheaper and more easily replaced every day. Then we used a bobby pin threaded thru the front label and attached this to the foled tissue stuck to our heads. 2 pins at the back of the cap(usually white, but sometimes any old pin becasue that's what you had) completed the ensemble. I remember many headaches that originated under that crisscrossed bobbypin pad which kept the cap from falling off of my head! I could still feel the sore spot from hair pulling several hours after I removed the cap. Once I removed my cap after graduation I only ever put it back on once, for a Halloween costume. I kept one clean cap, just in case I ever needed one-although i can't imagine ever putting one on. I turned down a great job offer 10 years ago because the nursing staff wore caps. When I moved a few years ago I came across my old cap in that round plastic cap holder. The cap had yellowed over the years, but the white bobby pins in the container were still bright white.

Maxter, My questions before pursuing this position are....what would be the position of the previous nurse manager who also applied for this position...and what is the feeling of the staff for that manager. It sounds like upper administration is behind you and that is in your favor, but the other manager could cause you some discomfort as well. You obviously have a good reputation and have earned the respect of others, so you will go far regardless of what your decision. It sounds like you will have the support you need to develop in your role. Like ACNORN and you I have had those feelings of doubt, but i prefer to call them excited trepidation. go for the new position if your family is behind you on this, and you are clear on the flexibility of hours and the time expectation needed for thisjob. Good Luck.

No- my salary is not moving up when the staff's is. As an inpatient nursing manager I'm getting increasingly frustrated, as are my peers. I am one of the lucky ones on the higher level of pay for departmental managers (22 yr RN, MSN 14 yrs and 12 yrs management experience) I'm a little further ahead in wage than many of my peers, but the staff is really creeping close, and when they go home at the end of the day they aren't on call 24/ 7. I know that several of my peers are making less than some of their more senior staff-and most of us do when you calculate the hours we put in. It has been at least a year since we have been talking with senior management to adjust our wages. The staff nurses have had wage adjustments 3 times in this period. I received a merit increase with my performance eval in July, but no general adjustment for all. I'm getting pretty tired of waiting, as I assist many of the new managers in their role transition. They don't say much because they are looking at this position as a stepping stone. Having done education, staff, and administration-both unit and divisional and recognizing that I prefer to be closer to the patients I choose to stay in middle management. I am however again reevaluating my decision based on the lack of monetary recognition for my efforts. If money doesn't get a bit better soon I believe that I will work agency on a prn basis, but I hate to do that because I like what I do - I just am sick of the situation.

I find it interesting that your hospital encourages nurses to become CCRN certified after the first year. That's a pretty high goal, but certainly not impossible. I agree that Robin Dennison's review is thorough and Laura Gasparis Vonfrolio's pearls (and her videos) are memorable. i think your best bet though is learning at this point, as opposed to just studying for the test. The AACN has a core curriculum which you can purchase (see AACN.ORG) and there are many CCRN review classes offered by AACN local chapters and hospitals. Remember the CCRN review classes only tell you what to study. You will still need to study on your own. Perhaps the intent of your hospital is to have you increase your knowledge base through study. I took my CCRN after 1 year in CCU (prior 5 years in telemetry). I reviewed the core curriculum as preparation, also some review questions. Passed without problems, but I have always been really solid in A&P and I think you really need that as a basis to do the CCRN. I learned a lot in my studying and have always been grateful that i made the effort to learn more. It gave me a far greater understanding of why I do what I do. Good luck in your studies. Even if you don't take the test it won't be a waste of time.

We have time and a half for working holidays and get another 8 hours off

When I was an off shift house supervisor for a 500+ bed hospital I worked with a partner and we split the hospital. The supervisor covering trauma kept a list of the trauma patients and security levels to deal with media calls, otherwise we didn't carry any census information other than the everchanging census numbers per nursing unit....no particular patientes except for trouble areas. We carried a few sheets which had preprinted the departments and room for staffing,census numbers and a few comments. The supervisor who covered the house issues took notes on the back or another sheet. All fit easily in a pocket. We always wrote census and staffing info in pencil because it always changed. Policy manuals and references are on all of the nursing units and our office.

I just encountered this thread and read it with great interest because I too struggle with weekend coverage at times with call offs. We too have bonus for extra shifts, travelers, local agency nurses, posted extra shift availability lists and I truly try to be an understanding manager. Sometimes though I get so tired I could cry when I get that call from the weekend offshift supervisor that there were call offs. (I've figured out that sometimes it's better to just plan to work a tough to staff weekend shift and take a day off mid week than hope not to get called on a known difficult weekend, it's those call offs that are tough) My staff is absolutely wonderful overall, though and more often than not when I call and see what's going on in the unit they say they'll call me back...they're trying to figure it out as to how to cover that call off. They don't want me to have to come in. i think that's because they know I will if I need to and that I try to respect their time too. There have been times that merely discussing with them a change in pairing of patients, sharing cardiac arrest responsibility with other ICUs or triaging beds and potentially blocking a bed if possible after transferring a patient will avert a crisis. Some shifts have been pretty tight, and I'll just go in at lunch time to cover assignments to make sure everyone gets a break. It's kind of funny though, because everytime I do that it's kind of like a gab fest because I usually try to bring in some kind of edible treat and we all end up going in and out of the break room eating together. Sure, I have some people who have obvious trends in call offs.I try to deal with those on an individual basis. [ People who have patterns of call offs (especially around holidays )days they've tried to trade and then call off, excuses to others that they can't do schedule switches to help others, persons who make more requests on the schedule than they are allotted on a routine basis]......those people do have to do an additional weekend at the scheduling committee's and my discretion when they call off. I think that's only fair. Like many others I have been living with the nursing shortage. I took my present job with a nursing vacancy rate of 40% in my department, and many nurses fearing mandation. Within my first month in my job the vacancy progressed to 50% and stabilized. I closed 2 ICU beds in my unit and actively recruited travelers. I knew that our local area would not be able to get me enough recruits quick enough to fix the problem. It took me almost 3 months to get my traveler contracts in place so that they would all start close to the same time, and I reopened the 2 beds. It would have just increased cost and not open any more beds if I acted too quickly and just brought in one at a time. I explained to the staff my rationale, and asked for everyone to tell me what their most important times were and asked how much extra they could give or wanted to give. I discovered that many nurses wanted the extra time and money, but only on certain days and circumstances. we worked really hard to take advantage of all of the available opportunities of time from everyone. Frequently at the end of a 4 week schedule you couldn't recognize what the original schedule was, because we did so many switches.(I do not believe in mandating nurses, however I do think that it is something that has happened and will happen forever to a minimal degree. We just didn't call it mandation 20 years ago. I think that there will always be that rare occurrence when someone just has to stay another shift or portion of a shift because of a late call off or a sudden rise in acuity and we can't cover the patients, despite all efforts. My staff knows that the potential is so low that they accept those rare occurrences. At least I think that's the case. They tell me they understand, it's only happened twice in the 15 months I've been in this position) I think one of the biggest positives in my unit is the team spirit that we have. Our rules are clearly spelled out and everyone knows that the rules are followed-within my discretion. I do schedule everyone to every other weekend. The hospital policy is 1/2 of the weekends/yr and my staff prefers the predictability of every other as opposed to 4 weekend shifts out of 8 which was also discussed. My scheduling committee balances all of the schedule requests. When there is conflict I mediate and make the ugly decisions, but usually it's based on trends tracked by my scheduling group. My staff knows that if they call off on a weekend that hospital policy states that they may have to work another weekend at the managers discretion, but it doesn't really happen too much. The attendance policy also says that you may have to switch with someone to coordinate your weekend. An approved week of vacation by policy includes the weekend off before and after, but the weekend which you should work might need to be switched with someone else. In my department we have chosen to not switch that weekend, but rather to utilize other people's availability on that weekend. We asked who wanted to work extra weekends and use them. We also call our casual staff and supplement there. It is also understood that in order to honor nice vacations for all we will shoot for core minimum staffing on weekends sometimes although we would like ideal staffing (ideal includes a charge nurse without a patient assignment which allows us to respond to ICU patient acuity changes more easily) With the efforts that we make to make sure that the big requests are honored, it is understood if you call off on weekends you may be placed on an additional weekend later when needed. A called off weekend may be made up anytime in the next year. If that weekend shift does not need to be made up in the year it will be erased as being due. Typically I have seen that those who have called off on a weekend tell the scheduling committee that they are available for an extra weekend on a particular wekend and we can use that time. I usually will allow the decision for the need for a make up to be made by the committee, who trends weekend call offs. Persons who give me notice of a particular need with enough notice typically can get that day off. If I am not able to just grant the day because of tight staffing, I frequently can tell them which person is most likely to be able to switch. If it's a really important request to a staff member and I am able, if no one is able to switch I will sometimes take a weekday off and come in for the weekend as my schedule allows. My staff knows that if you want people to be flexible with you, you need to be flexible back. I am happy to say that finally after a tough year of balancing day by day,life started to improve. We finally were able to recruit a few nurses to build more stability. We now only have a 35% vacancy and are undergoing my phase out plan for travelers. I continue to have several local agency people who we use routinely to supplement my core staff. A few of these nurses have asked me to warn them for the time I have enough staff that I won't have as much routine time. I believe that they will come on board as regular staff. I guess in retrospect I'm lucky. I have panic moments when I look at particular weekends, but somehow we always get it figured out. I give credit to my staff who trusted me to pick qualified travelers and agency nurses to supplement them and work around their schedules. It's been a tough ride, but next week I take 2 nurses off of orientation and will again be able to run at 95% occupancy. In the past year we have maintained 89% and the docs are happy with getting their patients in most of the time. My biggest pleasure is that I am now taking extra days off. I am taking Friday off with my weekend and have signed off my pager for a 3 day weekend! I am a happy woman!

I never really thought too much about the exact words until I called the unit one evening to ask a question and heard : "Am I" when I called the unit. I work in an MICU and frequently we refer to the unit as 'MI'. It never occured to me until I was on the other end of the phone how that sounds....It sounded to me like the person answering was saying "am I" I immediately responded with "Are you what?" My coworker was dumbfounded and said "What???" I repeated "Are you what?" I explained to my coworker how it sounded and we all try now to clearly at least say MICU and identify ourselves by name.