template? matrix? How do you staff your ER?

Specialties Emergency

Published

Our poor little ER is going through HUGE changes in staffing. We are needing to staff to expected pt census. Meaning less RN coverage in the morning hours and more in the evening hours.

The new manager tried a "self schedule" where we were all placed in groups (a,b,c,d) weekender's always choose first then it rotates through a,b,c,and d. If you are last to choose you are completely hosed.

They have made 4 different day shifts. 6-6, 7-5, 9-9 and 10-10. All dayshifters protest the 10-10. (in my opinion this is swing and we shouldn't have to work it) The self schedule option is not working. The staff wants to go to a template or a matrix where you know what you work till the end of time and if you leave your position the nurse that takes it agrees to work your matrix/template.

My question to you all that have a template/matrix system is HOW did it start? How did you fill in all the little holes and come up with a system tha works for BOTH the ER and YOU??? I would love to see anyone's staffing grid if you would be willing to email it to me.

I would LOVE to hear about any scheduling options that work.

ANY ideas would be welcome. Our staff is nearly ready to rip each other apart in order to A) work the days we need/want to work and B) do as few 9-9 and 10-10's as possible.

we are trying to staff for 90pt's per day. heeeelp...:cry:

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Specializes in LTC.

How many beds is your ER? When I worked in a small ER we saw about 90-100 pts in a day too. Our staffing was as follows:

7a-7p: 2 RNS (assigned to half of ER each)

9a-9p: 1 RN or EMT (float)

11a-11p: one RN or EMT for fastrack (our FT was only open 11-11 then these pts came back to the main ER)

3p-3a: another float RN or EMT

7p-7a: 2 RNS

THis worked really well. I often worked the 3-3 shift and I loved it. (But I didn't have kids at the time) We had staff staggered throughout the day and if something big came in or we were still busy the 9, 11, and 3 RNS would always stay to help.

Hope that helps you!

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Specializes in Emergency.

Its hard to say how to staff without knowing how many rooms you have. When the volume starts to pick up ie ours is around 10AM +- hr. When the volume drops off. Do you hold pts. What's the pt mix? Do you attempt to keep the ratio at 3 or 4 to 1?

My ED for example the volume picks up generally most days at around 10AM give or take. We staff 2- 12hr shifts, 7a and 7p, with a few 11a and 3p shifts thrown in. We staff our minor care from 10-10 as well. The 11A are our 2 flow coordinator nurses, who help the charge nurse who cant see the whole department. We typically start the day with 10RNs and peak is 13 RNs. We have 33 beds, plus halls. We see anywhere from 125-175/day on average.

Rj

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We have 21 beds. We also have 4 fast track beds. Our ER was poorly designed and it is like having 2 completely seperate ER's. Our fast track used to be seperate but we decided to have the PA's take pt's in the main ER (they "cherry pick" the fast track pt's) We found that when fast track was slow the nurse over there was knitting...or reading...or playing online when the rest of us were busting our butts.

We rarely have to hold pt's. Our ICU and med surg floors try to be very cooperative with the ER to prevent bottle neck's.

As both a floor nurse and a charge nurse I try really hard to staff with 3:1 ratio's. We have one tech per 7-8 rooms. When you say 2 nurses from 7-7 how many rooms do they each have? and do you have a designated triage nurse? How about a charge rn?

I'm really more interested in HOW you decide who works what shifts/days...Do you have a set schedule? Do you choose? Does someone else choose and you just work whatever you are told to work?

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How many beds is your ER? When I worked in a small ER we saw about 90-100 pts in a day too. Our staffing was as follows:

7a-7p: 2 RNS (assigned to half of ER each)

9a-9p: 1 RN or EMT (float)

11a-11p: one RN or EMT for fastrack (our FT was only open 11-11 then these pts came back to the main ER)

3p-3a: another float RN or EMT

7p-7a: 2 RNS

THis worked really well. I often worked the 3-3 shift and I loved it. (But I didn't have kids at the time) We had staff staggered throughout the day and if something big came in or we were still busy the 9, 11, and 3 RNS would always stay to help.

Hope that helps you!

What kind of pt to nurse ratio does this give you?

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Specializes in Emergency Department.

We staff our 36 bed trauma center with:

5 nurses at 7a

2 nurses at 9a

2 nurses at 11a

1 nurse at 1p

1 nurse at 3p

1 nurse at 5p

5 nurses at 7p

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Specializes in Emergency, outpatient.

It doesn't sound like self-scheduling is going to work for your ED. Someone needs to do it (at least for now,) and share the wealth of the 9's and 10's fairly across the board for dayshifters.

Would it help to offer a differential for the evening from 3-9 or 3-10? Some folks might snap that up and take it off the ones who really have to go home at 7p.

Another option might be to schedule in 4 hour time slots, giving seniority preference. That might give you more flexibility, with some night shifters picking up pieces of shifts after 7p. One ED I worked at did the 4-hr slots, and it seemed to work well. The giant board was up for at least 3 weeks for everyone to enter their time, reviewed and adjusted as needed by the manager, then posted. That way you had negotiating time. It was most important to get your "R" (request offs) listed on there so others could see when you needed to be off, and schedule around you.

The dayshift and nightshift each had an informal "specialist" who was really good at working the schedule and making calls to try to work out something if you had a problem and couldn't fix it on your own. We had very few callouts, and it seemed to work smoothly. But I think this ED had been doing this together for a lot of years.:twocents:

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Specializes in Emergency & Trauma/Adult ICU.

What are the HR scheduling policies at your hospital?

I ask because there is no "official" day position at either of the hospitals in which I've worked. At the first - EVERYONE was required to work some number of night shifts - the number was reduced according to seniority. At the other, "day" people are really day/evening - they are required to work some number of shifts that start at 10am or later each month.

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I was hired as a 12 hour DAY RN...I guess that really doesnt matter anymore to our new management. I can see why they need to move people around to staff to pt needs, but DANG it sucks!

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How do assignments work with people comming in at all hours. Does everyone just given up pt's when oncomming people come in or do the oncomming people float? Can anyone give me examples of their assignment sheets? I work in at 30 bed expanding to 70 bed ED. For once we have so much staff we are tripping over each other as we have already hired 10 new nurses to get ready for the first phase of expansion this summer. Our charge nurses have no clue as to how or where to assign people.

Thanks for any help you may have.

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Specializes in Emergency.
How do assignments work with people comming in at all hours. Does everyone just given up pt's when oncomming people come in or do the oncomming people float? Can anyone give me examples of their assignment sheets? I work in at 30 bed expanding to 70 bed ED. For once we have so much staff we are tripping over each other as we have already hired 10 new nurses to get ready for the first phase of expansion this summer. Our charge nurses have no clue as to how or where to assign people.

Thanks for any help you may have.

Well it varies. Some places keep parts of the ED closed off and open that area up as staff come in and then close them off again later as then census allows and staff leave. Other places staff is adequate to staff all the assignments and the oncoming people float, provide lunch/dinner/break/test/procedure coverage as needed or volume allows. Most depts I have worked staff off some type of grid or assignment sheet.

Rj

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We open beds according to staffing. we have zones. (red, green, yellow) green opens first and the nurses open beds there as the pt's roll in. When another nurse arrives at say 0900 they open red and start putting pt's in beds there. When the 1100 nurse comes in she opens the fast track rooms. When the 1200 nurse comes in they open more beds depending on the need or they start relieving the 0700 nurses for lunch. When the 1400 nurse comes on they go to the side that has the most open beds or they take triage or they float...

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