Staffing should be more than just a holiday wish
Self-scheduling can work all year, says one expert
On Christmas morning, there isn’t a nurse manager in the country who doesn’t wake up wondering how many nurses showed up for work and whether there’s sufficient coverage to make the day a success, at least on the morning shift.
Try as you might to avoid such occurrences, there’s always one nurse or technician who will take an unplanned day off on a holiday. And while nurse registries and per diem personnel might offer solutions, experience shows that depending entirely on them at the last minute is a gamble.
But worrying over your eggnog on Christmas day isn’t the right way to show your concern. If you’ve worked with your nurses and other staff long enough and established expectations well in advance, you can minimize unforeseen incidents, says veteran nurse manager Nancy Molter, RN, now a clinical nurse educator at St. Luke’s Baptist Hospital in San Antonio.
Advance planning is the key element, says Molter, who as a manager preferred to allow her staff maximum flexibility in setting their own work schedules, especially around holidays. She plans for Christmas in early September.
It’s not that unplanned absences will ever become a thing of the past. But if you establish a consistent yet flexible scheduling policy that is acceptable to nurses, unplanned sick calls on holidays can be kept well under control or even made rare, Molter says, speaking from experience.
But it involves some work and management flair, she adds. Here’s a way to consider those all-important family holidays, according to Molter: The end of the year should be viewed by both you and your team as no different from any other time when it comes to proper staff coverage.
If you see holidays as exceptions, they’ll become exceptions for both good and bad reasons. People inevitably will find an excuse to take advantage of any special situation, Molter says.
There always will be occasions in which the unit will have to balance the needs of patients with the importance of giving your staff adequate time off to spend with their families. But requiring your nursing staff to assume greater responsibility for the unit’s staffing needs can make your work a lot easier, she says. Here’s how:
o Encourage staff to self-schedule holistically.
Self-scheduling is a common practice. But it is often done haphazardly, usually when managers are busy with other tasks or when they’re not paying sufficient attention. Getting the entire team involved in the process allows for smoother planning, Molter says.
The team should be encouraged to select a leader, sometimes called a moderator. The moderator should function much like a manager by leading the process and directing nurses to fill in their own individual schedules well ahead of the time the final schedule is written. Each nurse or technician should be specific and realistic about submitting his or her own time-off schedules.
In past assignments, she says, she watched from a distance as the moderator led the effort. "Don’t get involved in the process but monitor the moderator’s activities," she advises.
o Acknowledge a "chaos" theory.
New trends in critical care suggest that peaks and valleys in ICU activities, once daylong affairs, now are occurring in hourly intervals. "There’s a more chaotic pattern to events in the intensive care unit," Molter says. Managers need to account for these gyrations as physicians come and go from the ICU, changing orders and sending patients in and out almost on an hourly basis.
Getting your team to understand the value of clinical pathways will enable team members to anticipate sudden changes in the medical status of individual patients within the unit. Conse quently, they can plan schedules according to two primary factors: (1) the average patient census on any given day, especially if a long holiday or weekend is approaching, and (2) the particular diagnosis or condition of most patients.
Knowing the last point in conjunction with the department’s clinical pathways for those patients will provide nurses with a fair estimate of their latitude when self-scheduling time off. But it also give will managers a good view of what they are thinking about, she says.
o Set a minimum standard on baseline staffing for the day.
Most managers will schedule based on expected census. But often what they’re not sure about is the number of individuals who should make up a core-staffing group. Trends within the ICU, including the unit’s size and number of occupied beds, will help dictate the number.
Here again, Molter advises that managers allow the staff to determine what should be an adequate core number based on expected conditions on the day or weekend in question. The final number can be adjusted easily but not after the schedule is approved. Therefore, make certain the minimum staffing level for the day is reasonable.
o Ask your staff to be reasonable and intervene in individual problem cases.
Less experienced managers often fail to set limits. Giving staff time off should be viewed as a positive gesture intended to lift morale. It isn’t a time of wholesale generosity, Molter advises.
Allowing certain nurses to fly to Europe or Asia to be with their families is one thing. Granting their request for two weeks off to do so needs to be weighed against the effects an approval will have on others in the unit. Being overly flexible is often worse than denying all requests for time off. The key is to be consistent, Molter adds.
Working personally with individuals who have a history of unscheduled absences can pay off if your actions aren’t misconstrued as favoritism. Molter says she once worked with a young nurse who had a spotty work record. The nurse kept asking for days off that required a change in her overall schedule.
When Molter adjusted the schedule to meet the nurse’s needs, her work record improved. Managers can benefit from taking the same factors into consideration when granting holiday time off, Molter concludes.
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