short staffed

shygirl · Oct 3, 2002

Hire more people

llg, PhD, RN · Oct 3, 2002

This is the age-old problems. The patients don't go home when the shift ends ... and there are not enough nursese coming in for the new shift.

I think you have to have a system worked out in advance and not wait until the last minute to scramble. There are no easy answers, but the most successful plans I have worked with involve more than one "back up plan" and not just one. For example, (1) having a "float pool" available to draw upon, (2) having incentives available for people who would be willing to switch shifts or work extra, (3) having staff cross-trained between 2 or 3 units to increase the pool of possibilities, (4) having a plan to close to new admissions and/or transfer patients if necessary, etc.

The standard, "hire more people" response is great -- assuming your community has qualified people who want the job. However, even a unit that is generally well-staffed will occasionally run into trouble if census and/or acutiy rises to an unusual level or in the event that a large portion of the staff becomes ill. At those times, you need your back-up plans that you put into place long ago.

If you regularly staff your unit for the peak, busiest scenarios, then you are stuck with the opposite problem during those times when it is not so busy and/or no one really wants vacation right now and not many people are sick. You have too many staff and some must get "cancelled" -- and then they get angry at you for that. My unit once went from 55 patients (35 on ventilators) in August to 29 patients (about 15 ventilators) in February. We needed almost twice as many nurses in the summer than in the winter that year. There are no quick, easy answers for situations like that. Sometimes, it just takes everyone being flexible to work through a bad situation that is really nobody's fault.

Welcome to the joys of management. I'll be interested to read whether or not people's replies actually work through the complexities of the situation and suggest really workable solutions or whether you just get "smart-a***" replies.

llg

ACNORN · Oct 4, 2002

Hi Alkat,

Staffing...............The age old problem...........

First of all, I totally agree with all the comments of llg.

I have recently had more of a problem with last minute staffing problems and had to get some things in place so that we had options when they occur. As it was, my nurse manager and I were all too frequently having to work as staff (for free) when call-ins happened and we decided that we were not going to be the 2 person voluntary staffing agency. It is much better now that we fixed some things. Here's what we did, hope some of these will help you out:

1. First we analyzed the staffing schedule and looked for imbalances in the number and skill mix of staff. We found major imbalances with fewer staff scheduled on Fridays, Saturdays, and Sundays (imagine that). So we corrected that first.

2. We took the PRNs who had not worked for us in a long time off our PRN roster and hired some new PRNs who could give us some hours.

3. We reviewed the attendance policy with our HR folks to make sure it was what we needed it to be. As it turned out, we did not need to change the policy but simply enforce it TO THE LETTER. There were several staff who were absent more often than not and we had to deal with them to get their attendance improved and to quit demoralizing those who had good attendance.

4. When we were in a situation were we had many open RN positions, we offered an incentive program whereby we paid the staff extra money for coming in and working shifts with critical shortages. RNs got an extra $100 for 12 hours, LPNs got $75 for 12 hours, and techs got $50 for 12 hours. If they called in during the same week, they forfeited the incentive pay (so they could not game the system). Of course if they qualified for OT then they got that too plus any shift diff. they would normally get. We would only approve incentive shifts on a posted list about a day or two ahead of time when we had already tried to cover it and had no luck.

5. Of course, we continued our recruiting efforts and implemented a $5,000 recruiting incentive for our staff who recruited a FT RN for us. This was extremely successful and did not cost more than the money we were spending on newspaper ads already.

6. Lastly, I'm just now implementing a weekend incentive position so that I have nurses who work only weekends (kinda similar to Baylor positions).

Something else you might want to consider is having nurses write your newspaper ads. We used to have our HR folks doing it and we never got any response. No offense to them, they're great, but they don't think like nurses. I wrote the ads with bullet points in them outlining what we have to offer a nurse that is better than the competition. We consistently get responses now.

You may want to consider an on-call program too.

Hope some of these ideas help.

frankie · Oct 4, 2002

Cover your unit - Pay nurses more - Pay for retention of nurses - Treat staff as people - Treat staff as professionals - Stop paying hiring bonus - Do not burn your nurses out, especially until they call in sick - Do not make your nurses feel guilty, sometimes nurses get sick - I have been on both sides of management, from staff RN to Director of Cardiac Services - Treat the nurses as you would be treated.

Orca, ADN, ASN, RN · Oct 10, 2002

ACNORN hit on a point I believe is key: enforce attendance policies. Too many units tolerate employees with poor timekeeping habits because they believe they cannot replace them - although they frequently have to, and on short notice. Unfortunately, if this kind of behavior goes unchecked and unpunished, it kills the morale of the staff who are more conscientious. I have seen staff develop the attitude that management doesn't seem to care about timekeeping, "so I will call in whenever I want to." While this may seem a negativisitic way to improve staffing, call-ins (or worse, no-call/no-show) are often a root cause of shortages.

A deeper problem is the fact that most hospitals can terminate at will. Employees are expected to be loyal to the employer, but it often isn't a two-way street. That issue would take a lot more work.

psychman · Oct 2, 2003

it seems there are two issues. the immedicate and pressing issue is staffing. the above responses are great. the other issue is "why" are the staff calling off? we can be gullible and beleive they are all sick.....or we can see if there is a burnout, morale, personality, etc issue going on. i average only two call offs per day and weekends are higher. my staff is burned out and i have litte recourse in the short term but to ask the "same ole" folk to pick up. therebye accelerating their burnout. vicious cycle occurs. we are even using most of the above things to help with staff- pools, incentives, trades. what is better when the staff who will not pick up scream the loudest when they work short....

renerian, BSN, RN · Oct 3, 2003

The unit I worked on used to say if you called off since you all have a copy of the schedule before you call off, call another worker and see if you can trade a day. That helped tons.

Since I just started back on a hem/onc unit as a head nurse I shall see what they do. If they do not do this I am going to suggest it. I know when I was ill I hated to call off and I felt much better if I could call and say Mary is working for me today as I am sick and I am picking up her shift on Friday. Sometimes you cannot do anything other than pull, agency or working short or using your head nurse to help. Yes some of us do that LOL>

renerian

Orca, ADN, ASN, RN · Oct 11, 2003

A hospital I once worked for had a requirement that if an employee was tardy or absent three times within a 90-day period without justification, as a supervisor I had to verbally counsel them and submit documentation that became a part of their permanent personnel record. If this happened three times, it was grounds for termination. I had no latitude. The hospital's policy was clear. While it may seem rigid, expectations were clearly spelled out, and problems usually disappeared quickly once the first counseling was done.

Contrast that with a hospital where I work per diem now. A similar policy is in place, but it is not enforced. Some staff are legendary for their tardiness and absenteeism. One LPN is known not to arrive until 15-20 minutes after the time for her shift to start. She even jokes about it ("You know I'm always late.") I start report without her when she is on the relieving crew. A CNA on this unit habitually calls in every two weeks on Sunday after a payday on Friday. You can count on it. Unit management tolerates both situations because the people involved are "good workers". I don't question the competency or care of either employee, but I believe that being a "good worker" includes being where you are supposed to be when you are supposed to be there. It is part and parcel of professional behavior.

jeffb · Oct 16, 2003

I spend a lot of time each day taking care of staffing issues. It would be nice to staff an additional nurse each shift, each day, just so you can have peace of mind. But, that's not really practical. My advice:

1. Enforce your facility's attendance policy and look for trends with your employees. Intervening early will help.

2. If you cannot financially incent an employee to work, then making work deals is the next best thing. I will give someone a day off on a weekend if they can cover a last minute call-off during the week. That will generally take care of my crisis moment, then I have more time to fill the weekend shift.

Good Luck

BadBird, BSN, RN · Feb 7, 2004

Having a reliable agency with qualified n

RN's can be a lifesaver too.

nurseT · Feb 8, 2004

Has anyone ever considered contracting with 1 or more RN's for calloffs? This would not be a routine employee. With a contract, the employer saves money. The employer does not have to pay taxes or insurances on the contracted individual, nor does the employer owe the contracted person any hours. In light of these facts, the employer is able to pay a much higher rate for the contracted to be willing to come in at a moments notice. Say 40.00/hr. Much cheaper than useing Agency. Expect the contracted to supply and show proof of their own malpractice insurance, criminal check, drug screen, current license etc. This would work great for CNA's too. There are alot of older workers out there that this would be great for.:kiss