I’m using the power of the blogo- and twitterspheres in hopes that nurses will come up with some good ideas or tried-and-true solutions.
The problem: We are have shift-retention issues on night shift. It’s not necessarily staff retention (I continue to maintain that my hospital is A Good Place to Work™). People just move to other shifts, with the result being that we on night shift have a few experienced nurses (the few, the proud) and a bunch of rapidly rotating new grads or new ER nurses who scatter as soon as another shift comes open. The staffing situation therefore ranges from a simple lack of enough bodies to having enough bodies but not enough experience to go around.
The factors: The one at hand involves scheduling and pay—this has to be a common issue for nurses everywhere and is the one I seek ideas for solving. Our shift differential sucks. It is in no way competitive with other area hospitals and completely removes any financial incentive to stay on night shift. I’m told that the budget is in a sad state because of all the callback pay for filling empty shifts and the huge costs for continually training new nurses (which costs result from people moving off the shift because of the lack of a decent differential, the lack of which causes MORE nurses to move off the shift, thus causing more costs to replace them and pay callback in the meanwhile, and so on), so the differential will not be changing.
Side note: IMHO, this is an infuriating but common example of false economy. If institutions would spend some money up front on nurse retention, it would pay off and everyone would be a lot happier. But this is why I’m not in management.
The solutions: I’m all full of problems and short on solutions. They can’t just pay us more, so we have to get creative. What have other hospitals done? Here are a few ideas I’ve come up with.
Incentivize seniority. Right now, there’s absolutely no reason to stay on this shift. Not even scheduling priority. In fact, those of us with experience have the opposite of an incentive because in order to spread around the experience we’re made to fit the schedules of the new people. We’re told we need to do this just for reasons of esprit de corps. Few people are that generous, not even me, if you can believe that, and with some other issues going on, there isn’t much esprit de corps anyway. I need more than “take one for the team,” and so does everyone else. The practical result is that the longer you stay, the LESS scheduling flexibility you have, and you spend all your time training and mentoring new nurses who immediately leave when they’re trained and able to go.
The last hospital where I worked provided the incentive of schedule priority to those who had been there longer, and if nurses were needed on shifts they didn’t want, they got paid more. And the shifts were all covered, and nobody was pissed off about the schedule. New nurses just walk in and start demanding a “fair” schedule here (meaning “exactly what they want”), which I don’t understand. When I was new, they gave me a schedule, and I moved my life around to fit it with the understanding that as I gained seniority I would have a better schedule. Guess what? I don’t. Giving schedule priority to those who stay would, I think, make existing staff happy and persuade newer ones to stay with the promise that by not leaving, they too could work toward the schedule they want.
- Cut deals with people. Most nurses seem to have some THING that they would like a break on. They don’t want to work on Tuesday nights, ever, because that’s when their husband is available for date night. They want to take a class that meets on Thursdays so they need a guarantee that they’ll be free EVERY Thursday night. They despise Monday nights because of the postweekend rush. They hate call. Whatever. Mine is I hate taking call. I don’t mind working weekends, whatever, but I HATE call. What if management cut deals with us? Such as:
- You will never have to work Tuesday nights if you agree to working every single Friday night.
- If you agree to work [some awful schedule no one else wants], you don’t have to take call.
- If you switch a scheduled night to fill in when they need experience, you get callback pay. (I become much more flexible when I’m paid for it, I find.)
- If a dayshifter flips to nights for a while, he or she will receive a thank-you bonus, and one that makes it worthwhile. These last two, although necessitating budgetary changes, would, I think, ultimately be MUCH cheaper than paying callback all the time on the spot because there’s a sudden shortage and, again, training new people all the time.
That’s pretty much all I’ve got. Who has other ideas? What has your hospital done? Please add a comment or send me an e-mail.