Staffing losses could quickly reach crisis proportions’
If your ED already is experiencing high vacancy rates for nursing staff, decreased morale, and increased patient volume, try this on for size: What if you suddenly lost several nurses, technicians, and physicians without notice for an undetermined period of time? This is the scenario many EDs may face in the coming months as a result of losing staff due to military call-ups.
"This is a huge issue, and it’s going to get even worse," says Robin Gilbert, RN, BSN, CEN, manager of the ED at Memorial Hospital in North Conway, NH. "For rural EDs, even having one nurse mobilized could have a tremendous impact." The ED’s medical director has just reported for active duty, she notes. "We are already struggling trying to fill open shifts," Gilbert says. "In the middle of a nursing shortage, the ability to rely on traveling or agency nurses is greatly diminished."
At Methodist Hospital in Indianapolis, two ED nurses have been activated full time and are not expected back for one year; three others are called in on a temporary basis for two to six weeks; and another nurse is awaiting orders, reports Kathy Hendershot, RN, MSN, CS, director of clinical operations for the emergency medicine and trauma center. "The nurses themselves are unsure as to how long they will be off our schedule," Hendershot says.
Generally, an ED could suffer the loss of up to 10% of their personnel and survive on volunteerism for the first month, but after that, it would quickly become problematic, says Michael L. Carius, MD, FACEP, chairman of Norwalk (CT) Hospital’s department of emergency medicine. "This could quickly reach crisis proportions," Carius says.
Use these survival strategies for military call-ups:
• Use flexible scheduling. Add short four-hour shifts to satisfy peak demands, Carius suggests. "The bottom line is to have sufficient personnel to handle the load during peak times, such as early evenings or midafternoons," he says. "These or other times may represent predictable surges."
• Create networks of part-time ED physicians. Develop a list of individuals willing to work additional shifts at your ED should the need arise, Carius suggests. Four physicians from local EDs work in Carius’ department occasionally, he reports. This provides a buffer for any potential staffing shortfalls, such as unexpected illnesses and injuries, and staff being called to active duty from the reserves, he explains. The per-diem physicians also cover the ED’s monthly staff meetings, which results in nearly 100% participation, and cover additional open shifts each month, says Carius. Each per-diem physician ends up working about one shift a month, says Carius. "The minimum number to have is probably two for a group the size of ours [12 full-time ED physicians], but four is much more comfortable and doable," he says.
• Address unique needs that occur when managers are called up. While having to replace nursing staff is a daunting challenge, it is even more difficult to cover managers should they be called up, says Denise King, RN, MSN, ED nurse manager at St. Joseph Hospital, Orange, CA, who is a reservist. If any managers are reservists, you should develop a contingency plan now, King says. "It would be unwise to wait until the call-up occurs," she says.
Maintaining smooth operation of the ED
The goal is to support the manager’s military service with minimal disruption to the ED, King says. "With a lack of leadership, things can get ugly very quickly," she says. If King is called up, the ED director and four clinical coordinators would take on more administrative responsibilities, she says. King recommends the following:
- holding a meeting to discuss ideas for a smooth transition;
- assigning a manager from another unit as a resource and backup;
- training a staff person to take on the role.
"This may entail having a charge nurse stepping up and filling in for the nurse manager, in which case, the manager should begin orienting and working with the identified replacement," King says.
• Discuss plans with administrators in advance. Discuss backup plans for staffing with administrators now, Carius advises. "We all manage these situations on a daily and weekly basis, but when they become prolonged, then we have some real problems," he says. "That is why early conversations are extremely important."
• Find out which staff may be called. After the Sept. 11, 2001, terrorist attacks, Hendershot found that her ED was suddenly short-staffed when several members of the Federal Emergency Management Agency’s (FEMA’s) search and rescue team were deployed to New York. "We were not ready for such sudden vacancies over such a long time," she says. "I looked for ways to mitigate the circumstances if it happened again. I could not afford any more holes in my staffing plan."
Here are some of the steps she took:
- conducted an informal survey to find out how many ED staff could possibly be activated;
- monitored patient census carefully to keep a close watch on staffing needs;
- communicated with staff about the need to ask for overtime or deny requests for vacations and educational time off.
"I explain the military leave policy and what it may mean to us, and review our mission to deliver great care," Hendershot says. "I am willing to look at anything they can come up with that will get the job done and minimize the hardships." For example, she says that the ED may change the length of shifts for a short time to accommodate the needs of older nursing staff.
Address reservists’ concerns
You also will need to address concerns of reservists about what will happen to their jobs, Hendershot says. The facility’s policy is that they return to a similar job within the institution at a comparable rate from the time they left, she explains. "It does not guarantee them the same position in my ED with the same shift," she says. "I personally will hold their position and promise a return to their previous status. I do not do this for any other leave of absence."
• Contact staffing agencies in advance. The biggest problem with military call-ups is the loss of staff with almost no notice, explains Camilla Jones, RN, BBA, director of emergency and transfer services at Lewis-Gale Medical Center in Salem, VA. "Our ED has had one person to date deployed to active military duty with only two days notice, and we have another employee who also may be deployed," she reports. Contact staffing agencies now to prepare for this possibility, Jones recommends. "You need to establish relationships and agreements in advance if a sudden loss of manpower is expected," she says.
• Use more per diems and part-timers. Broaden your pool of supplemental staff in advance, recommends Carius. "We have a ready supply, most of whom are more than willing to work additional hours," he says.
At Methodist’s ED, an incentive package was created to encourage nurses to take a temporary assignment with the ED, to avoid having to hire traveling nurses, Hendershot reports. Nurses who worked two shifts each week were offered a third shift at time and a half, she says. "If three part-timers agree to do that, you can fill in a full time slot," she explains. Other incentives include a $25 bonus for every additional four hours worked, Hendershot adds. "This [incentive package] can be helpful in quickly filling a vacant spot with very little orientation to environment or culture of your ED," she says. "If all else fails, our educators, managers, and I are expected to don the uniform and provide the care."
Sources
For more information about the impact of military call-ups on staffing in the ED, contact:
• Michael L. Carius, MD, FACEP, Norwalk Hospital, Maple Street, Norwalk, CT 06856. Telephone: (203) 852-2281. Fax: (203) 855-3705. E-mail: [email protected].
• Robin Gilbert, RN, BSN, CEN, Manager, Emergency Department, The Memorial Hospital, 3073 White Mountain Highway, North Conway, NH 03860. Tele-phone: (603) 356-5461. E-mail: [email protected].
• Kathy Hendershot, RN, MSN, CS, Director of Clinical Operations, Emergency Medicine and Trauma Center, Methodist Hospital, 1-65 at 21st Street, P.O. Box 1367, Indianapolis, IN 46206-1367. Telephone: (317) 962-8939. Fax: (317) 962-2306. E-mail: [email protected].
• Camilla L. Jones, RN, Director of Emergency and Transfer Services, Lewis-Gale Medical Center, 1900 Electric Road, Salem, VA 24153. Telephone: (540) 776-4850. Fax: (540) 776-4849. E-mail: [email protected].
• Denise King, RN, MSN, Nurse Manager, Emergency Department, St. Joseph Hospital, 1100 W. Stewart Drive, Orange, CA 92868. Telephone: (714) 771-8000, ext. 7983. Fax: (714) 744-8527. E-mail: [email protected].
If your ED already is experiencing high vacancy rates for nursing staff, decreased morale, and increased patient volume, try this on for size: What if you suddenly lost several nurses, technicians, and physicians without notice for an undetermined period of time? This is the scenario many EDs may face in the coming months as a result of losing staff due to military call-ups.
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