System averages $6,000 savings per RN supervisor
Staff satisfaction, productivity increase
Staffing solutions are always welcome if they help agencies cover their patient census while keeping staff happy. One private duty agency found that the RN supervisor positions provided the perfect opportunity to create flexibility in the workplace while providing total coverage for its patient census.
"Private duty agencies do not necessarily have many opportunities to be creative in job flexibility," says Sonia Logsdon, RN, BSN, manager of private sector for Commonwealth Health Care in Virginia Beach, VA. "We structured the position of RN supervisor into a more productive and cost-effective role for our agency."
Logsdon says that private duty agencies that implement a scheduling system similar to her new one for RN supervisors could save at least an average of $6,000 per supervisor per year. That’s an estimated savings of eight hours per week or 416 hours per year.
In addition to the average $6,000 savings per supervisor per year, the system will also result in savings associated with eliminating full-time salaries and benefits for multiple supervisors.
The scheduling system has, over nine years, become a cost-effective method for the agency to cover all its patients without hiring a 40-hour supervisor. "In this system, you have no waste," says Logsdon. "I don’t have to worry about how to provide total coverage. The supervisors have devised a way that vacations, days off, and sick days are automatically covered through the scheduling system."
Creative scheduling options
The agency schedules patients through zip codes. Nurses are responsible for patients located in certain zip codes, which can account for greater or fewer patients during any given week. When the patient census goes up, the supervisors’ hours increase to 32 hours or a maximum of 40. If a nurse wants to work fewer hours, her zip codes are shifted to another nurse who may want more hours. If the census decreases, nurses retain a minimum amount of hours they determine. The agency ends up paying the supervisors only for the hours they log no benefits and usually no overtime.
Commonwealth had two nursing supervisors on staff who worked an average of 32 hours per week. A third supervisor worked fewer hours and another worked only eight to fill in for supervisors who may be unavailable. One supervisor is always in the office and covers for the others’ patients, visiting homes if needed.
Logsdon says that she has been upfront with her employees from the start about the pros and cons of the flexibility. These supervisors do not qualify for benefits, such as medical insurance. They can, however, earn vacation time. Commonwealth is currently trying to shift the patient census around so nurses can qualify for medical benefits if they need them.
"You can’t spring this type of scheduling on staff," she emphasizes. "You really need their input so that the system works for everyone. The nurses realize that if they choose flexibility, they lose their benefits. But the option is very important to them."
Staff also must be flexible, notes Logsdon, which is what makes her agency’s scheduling successful. Some of the nurse supervisors who take part in the flexible system have been with Commonwealth for more than 17 years. In fact, Logsdon says that she has never lost a nurse due to dissatisfaction, only to retirement and moving out of state. The system has fostered loyalty as well as made nurses more productive.
Productivity increases
Supervisors are more productive, Logsdon says, because they only get paid to spend 1.2 hours per patient. (For more information, see related story, at left.) If the nurse spends three hours with a patient, she still only gets paid 1.2 hours; therefore, nurses’ scheduling and visiting of patients become more efficient. In addition, the more patients a supervisor sees, the more money she will ultimately make.
"Our nurses act as sales people for the company," says Logsdon. "They know that if they bring in more patients, their salaries will increase." Logsdon also encourages her supervisors to speak to hospital discharge planners and social workers so they can get referrals.
Any agency can benefit from providing flexible scheduling since these programs may entice new staff to sign on or retain current staff. "In today’s work force, we are seeing women who want to return to work but need more flexibility. Benefits are not always the top priority," notes Logsdon. "Our nurses like a four-day week, but we are willing to let nurses work from 10 a.m to 2 p.m. or see a patient in the evening, as long as they put in their hours and complete the required paperwork."
The first step Logsdon recommends agencies take: Look at patient population for fluctuations. "If you see changes in the census, this is the system for you," she says. "But remember that many employees need that 40-hour work week and benefits." Agencies should also assess the needs of staff through one-on-one conversations and by listening to employees. Asking employees what would give a position greater permanence and satisfaction will help management understand how staff view their work. This, Logsdon advises, is one of the more important steps in any kind of restructuring.
Employees who are content with their jobs, Logsdon says, benefit the entire company. The staff’s attitude and approach to management will trickle down to field employees, who, in turn, may be more productive because they have happy supervisors. Logsdon has noticed this reaction from her staff.
Opening other positions to flexibility
Commonwealth also lets the receptionist position share job responsibilities. The agency was having troubling filling the receptionist/switchboard operator position full time. Logsdon says that absenteeism was high. She decided to hire a person who fit the qualifications and was "really good at the position." However, the applicant could only work 20 hours a week because she was receiving social security benefits. Logsdon called the local chapter of the American Association of Retired Persons to see if they could recommend another person to share the job. "They sent some people over, and I hired one of them who also wanted to work 20 hours a week," says Logsdon.
"When I oriented [both employees] to the position, I explained that they were sharing one job and were responsible for total coverage of the telephones. They understand that they must fill that position during working hours." Logsdon says that absenteeism is not a problem now, and she knows that telephone calls are answered professionally and immediately.
If an agency is thinking about implementing a program like this, Logsdon suggests starting with the assessment process and getting the leadership of the company on board. A manager may want to estimate the impact of the program by conducting an analysis of potential cost savings , such as reductions in employee benefits, hours, and overtime pay.
Analyzing fluctuations in patient census can tell you if such a scheduling system will work for your agency. If last year’s monthly census varies widely, the system will be a better fit.
Agencies should then query employees about how receptive they may be to flexible scheduling and changes in their benefit status. This may be welcome news to some employees, but if the majority does not approve, then management may need to rethink its strategy.
"This is a dynamite system that may not work for every agency, but worked great for us," Logsdon says. "Agencies and even large corporations need to be open to this type of scheduling. It could make a difference in the morale of the company as well as benefit the bottom line."
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