By Rose O. Sherman, EdD, RN, NEA-BC, FAAN
Hospitals are 24/7 – right? We all know that when we apply to work in them. So how should leaders react when young nurses come to them right out of orientation (sometimes with doctor’s excuses for mental health and wellbeing) and say they can’t work nights? This phenomenon is happening right now all over the county.
What to do about nights is a complex issue, especially during a time when nurses are in the driver’s seat and know it. Leaders report to me when they try to point out that the nurse accepted their position with the understanding that night rotation would be part of it – nurses will counter that they will leave the position. Some frontline leaders tell me they are being held hostage with staffing and scheduling.
Nurse executives who read this might think – well, the rules are the rules, and you need to enforce them. But it is not that easy when you are a frontline manager who has just invested 12 weeks in a new graduate’s orientation. Your response will likely be nuanced if you spend 80% of your time staffing and scheduling trying to provide adequate RN coverage. Should I cave into this request and keep the new nurse or hold my ground and possibly find myself in the same place with my next new employee?
Nurse managers are slowly realizing that the nursing shortage is real and intractable. There will likely never be enough RNs to provide primary nursing in acute care units anytime soon, or maybe never.
Solving this wicked problem is very complicated, but here are strategies that are being deployed:
Strategies Being Deployed
- Partnering with academic institutions to give nursing students paid positions on a night tour to gain both clinical experience and exposure to the 24/7 hour work of hospitals.
- Developing new staff guides for Working the Night Tour , which provide research about when to sleep and when to eat when working these tours.
- Initiating programs like the Night Owls that Allegheny Health System uses to provide strong monetary and scheduling incentives for nurses to work permanent nights.
- Allowing parents to split the 12-hour night tour into two shifts to cover their childcare.
- Targeting international nurse recruitment efforts to provide coverage for night tours.
- Staffing the night shift with permanent charge nurses and educators incentivized to work nights.
- Initiating a weekend Baylor program – work two-twelve-hour night shifts on the weekend and get pay and benefits for 36 hours.
My advice to health systems is to make some small bets on programs to rebuild your night staff. Nurses who work shifts that no one wants to work deserve to be incentivized differently either through higher pay or much more flexible scheduling. An over-reliance on travel nurses to fill nightshift positions is both costly and less safe as these nurse are less familiar with hospital policies and procedures. If you wait for outcomes evidence that these programs work – you may miss a window of opportunity.
© emergingrnleader.com 2022
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