Transition for Acute Care & Oncology Units Staffing Utilization Policy

1. Transition for Acute Care & Oncology UnitsStaffing Utilization Policy Trevan Biddulph, RN Acute Internal Medicine A

2. Staffing Guideline:New Policy for Staff Utilization A new staffing guideline has taken effect. This policy applies to all ICU, Acute care units at the main hospital and Huntsman Hospital. Employees are expected to float between units in their cluster if needed. Each unit may have seniority perks related to floating, but if junior staff are not available to float then senior staff will be required to float. All staff who are working over their FTE will be identified in Kronos by the following codes ES = Extra Shift. An employee on an extra shift is committed to the shift and is willing to float to another unit in the cluster or according to their skill set. ASC = Angel Shift Committed. An RN employee working an “Angel Shift” is committed to the shift but is only willing to work on their home unit. If there is not a need on their home unit, they will not work. Non committed staff are employees who state that they are available and you can call them if you have needs. They are not to be counted in the number reported to staffing since they have not committed to work. PRN staff are not required to work a specific number of hours per week and are paid a PRN wage. They are expected to float if needed. PRN staff can not be tagged as ES or AS unless they will go into overtime on the ES or AS shift.

3. Extra Staff:How to decided if I should Flex or put someone “On-Call” When an RN is not needed in their cluster for a scheduled shift they will either be put On-Call, flexed,or called off. Please be consistent in using the correct terminology with your staff. • On-Call: The staff member is available to come in within an hour and is near a phone so they are able to respond to a call from work within 15 minutes • Flexing: Adjusting a staff members shift start time. The staff member is required to report to work at the adjusted start time unless informed otherwise. • Called off: The staff member is release from their shift commitment to the hospital. They are not required to report to work or be near a phone. Staffing Grids should be adhered to. There is no staffing up for “What ifs.” With on call nurses there is a safety net for unplanned or sudden admissions. If a staff member is floated and the home unit becomes overwhelmed with admission, the charge nurse and hospital supervisor will decided which unit has the greater need. • Management of the fully staffed unit is not expected to cover the staffing gap. Try and be consistent with the use of this policy. The ICUs and the acute care units should be following the same guidelines. There are not two sets of rules.

4. Flexing:Guidelines for Flexed Staff Flexing should be done when there is a known need for staff later in the shift due to planned admissions. Flexing is usually driven by the home department as a way of preparing for surgical admissions and the home department decides what time to adjust the staff members start time. Do not automatically flex staff for a certain number of hours. Adjusted start times should be based on planned admission times and not tradition or old staffing policies. Again, the charge nurse of the flexed employees home unit should be deciding when to bring the employee in. Start times for regularly scheduled shifts may be adjusted once for up to 6 hours in ICU and 8 hours in acute care and oncology units. Employees do not receive on call pay and they are not expected to come in before their adjusted start time. If a flexed employee is not utilized at their adjusted start time, they are called off for the remainder of their shift or placed on call only if no one else in the cluster is on call. Staff that chose to come in prior to their adjusted start time will be paid call back pay until their adjusted start time. Staff who have been flexed are not required to near a phone. Their flexed off time is their own and they are not required to be available or on call. Flexed staff are available to their home unit first and if not needed, should float to another unit if there is a need elsewhere.

5. On Call:Guidelines for On Call Staff When an RN is placed “On Call” they need to stay within contact range and are required to report for their shift an hour after they are called in. On Call RNs will get paid $2.75 while they are on call for their regularly schedule shift, paid for by the unit that placed them on call. If the RN is “Called In” they will receive call by pay while they are working which is the same as the overtime rate (except PRN RNs). This is paid for by the unit that is utilizing the on call RN. If an RN is called in and floated to another unit and their home become overwhelmed with admissions, the charge RNs of the two units will consult with the hospital supervisor to determine if the RN will return to their home unit. Management of the unit that was fully staffed is not expected to cover the staffing gap. Staff that are called in prior to the start time of their regularly scheduled shift will not receive call back pay.

6. Call off:When to Call off an Employee If there is too many employees to be placed on call or flexed, they will be called off for the entire scheduled shift. The hospital supervisor and staffing coordinator will let you know if you should call off your RN for their entire shift. No more than 6 RNs will be placed on call for a shift for the ICU and acute care clusters. This may be adjusted based on usage data.

7. Call Off Order:Who is placed On Call, Flexed or Called off An employee in Overtime will be called off first. Second will be an employee who is any type of “extra shift.” Third is PRN employees. ICU Charge Nurses should bring to cluster the call off, flex or on call dates of their employees. Exceptions: PRN and extra shift staff may be utilized over regularly scheduled staff when there is a need for a specific skill set that only the PRN or extra shift staff can fulfill. The hospital supervisor must agree with the charge nurse.