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Want to boost morale? Try creative scheduling
Flexibility helps recruitment, retention
Boosting morale. It sounds easy enough, but good solutions for this problem that plagues many EDs are tough to find. "With increasing numbers of patients seeking health care in the ED instead of their private physician, budget constraints, and the ever-increasing shortage of experienced ED nurses, indeed, morale can be a challenge," says Vernon Craig Meche, RN, BSN, CEN, ED nurse at Lafayette (LA) General Medical Center.
Creative scheduling is one effective way to improve both morale and retention of ED nurses, according to Meche. "Allowing staff to have some control over their practice and their lives has made a big difference in our ED," he reports.
Flexible schedules can even beat out money as a morale-boosting tool, according to Virginia Hebda, RN, CEN, nurse manager of the ED at F.F. Thompson Hospital, a 113-bed community hospital in Canandaigua, NY.
Three years ago, the ED began offering a separate pay differential of an additional $3 per hour for the 11 p.m.-7 a.m. shift, she says.
"This was a big incentive for night coverage and made them happier," says Hebda. "But I have also discovered that the extra money actually locks nurses into a shift that they cannot afford to leave, even if they want to — and that makes for burnout and worse."
A better solution might be a flexible schedule that gives more choices to nurses coping with child or elder care, transportation, educational, volunteering, or other conflicts, suggests Hebda. She credits flexible scheduling as a key contributing factor to her ED’s current 4% vacancy rates.
To use scheduling to improve morale of ED nursing staff, do the following:
• Give nurses the opportunity to schedule themselves.
At Thompson’s ED, nurses have done self-scheduling for several years. "There is a staff committee that reviews the schedule and ensures that all shifts are covered," says Hebda.
Similarly, ED nurses at Lafayette General Medical Center use a planner to mark down the days they want to work, and they schedule themselves four to six weeks in advance, says Meche. "The staff nurses are able to schedule themselves creatively by grouping several days together or spacing their shifts out over several days."
• Provide more flexibility for weekends and holidays.
A "weekend program" allows most ED nurses to work only every third weekend, says Meche. New ED nurses may have to work every other weekend and eventually will "graduate" to working every third weekend, he explains. "Being able to spend more time with one’s family and friends has kept retention at a higher level."
Likewise, at Thompson’s ED, new nurses are required to work every other weekend, but more experienced nurses work only every third weekend, says Hebda. As new staff are hired and pick up the weekends, older staff with more than 10 years of experience in the ED are given the option to decrease their weekends, she explains.
"Some choose to continue working every other weekend, as they like time off during the week," notes Hebda. "I currently have one long-term nurse who does one weekend out of eight, two nurses who do two out of eight, and the others do every other weekend or something in between."
Although per-diem nurses aren’t obligated to work weekends, some do choose to work those shifts and are used to cover for vacations and sick calls, says Hebda. In this case, nurses get paid an additional $5/hour, increasing to $10 extra per hour during summer months.
ED nurses are required to work only two holidays: one in the summer and one in the winter, and the per-diem obligation is one holiday per year, says Hebda. Christmas Eve and New Year’s Eve count for the holiday obligation, although nurses don’t get paid the holiday rate for those hours, she notes.
"This gives some leeway for staff to choose, as some celebrate Christmas on the 24th," says Hebda. "Or if nurses work evenings, they can still get the holiday time in and be home in the morning."
• Allow nurses to change shifts as needed.
Nurses are allowed to switch shifts with others, so long as the manager approves the schedule change and no overtime is generated, says Meche.
At Thompson, the ED’s schedule committee gives nurses time off as early as eight weeks in advance and has the summer vacation schedules available by late April, says Hebda. "This necessitates numerous phone calls and lots of shuffling and consideration for others from the staff," she says.
However, nurses are equally flexible when it comes to accommodating requests of co-workers, says Hebda. "As long as everyone is willing to give a little when it’s their turn, everyone usually gets the hours they need off," she says.
One individual is responsible for arranging all requests for time off, and two individuals handle filling holes in the schedule and covering any sick calls, Hebda explains.
• Give incentives to nurses who report when the ED is short-staffed.
Nurses who are called in because of high volume or acuity in the ED are paid time and a half, says Meche.
"We are a closed unit, meaning that no other floor nurses or critical care nurses are pulled to the ED," he adds. "We reward those nurses who come in to staff the unit in times of need."
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