Flexible scheduling is one of the biggest attractors to hospital work for nurses. It's also a source of problems when people feel they are not getting the schedule they require for things like child care, school, and other personal factors. I'm handling the scheduling again. At The Old Place, it was the first responsibility I gleefully threw back at leadership when I disgustedly gave up my Team Leader position, but I must admit, I have excellent skills where scheduling is concerned, and so I always offer to do this task.
My scheduling process is unique. What I have done is placed everyone's name into Excel with the dates across the top. I print a blank schedule (names down the left side, dates across the top) and everyone just puts down an "N" for the days they wish to work. Every night that I work, I take these sheets and type that "N" into the computer, and I've programmed Excel to, for each day, count the total number of "Ns" in that column. So along the bottom of the sheet, I have a running total of the number of people that have signed up for the shift (each job description has its own sheet).
The trick to this is, as everyone comes in to work on a daily basis, they are supposed to examine this sheet, and as folks add themselves in (with me updating and re-printing the sheets several times a week), they shift their days around so that nurses on the over-staffed days voluntarily shift to one of the under-staffed days for the week.
This goes on continuously for 4 weeks, and I take the sheets up two weeks before the next schedule is to begin. Usually, there are not that many changes to be made, and I keep a list of who I move so that the same person is not moved every time. The final balancing act usually takes me about an hour (that's scheduling for two units, for nurses, nursing assistants, secretaries and monitor techs).
I know, some of you will balk at the idea of entering schedules on a daily basis. But really, it only takes about 5 minutes to put in the changes that get penciled in from one day to the next, and the constantly updated total at the bottom of the sheet really helps folks figure out when they have overstaffed. The constant message is always that it is better they move themselves (or arrange trades), because they all know that my final balancing will, without exception, have the same number of staff on duty each night.
It has worked out really well, but there are still some folks that just don't understand the consequences of their decision to go into nursing, instead of something like banking. I do have my "special children" every month, who get upset because I've moved them. But I always tell them they have had 4 weeks to move themselves, and chose not to do so. That usually settles them down.
The excel function, CountIf(range,value), is easy to use, if you are fluent in Excel.
John: Yes it's the same scheduling system, I just changed all of the names :-) I think The Old Place is going through a very tough period of transition. I've seen it before, where a lot of nurses quit, and then a new group of folks shows up and everything is fine. The period between can be grueling, because nurses these days are not willing to work in difficult situations unless there is some benefit ($$) to do so, so that means agency and traveler. Hopefully, things will turn to the better. For the patients, I hope so. None of what has transpired there has anything to do with the patients. It's all leadership, every damn bit.
Maria: They've already had to install 20-ft wide electric doors to get my swelled head in the building :-) And I can't tell you how many times I would have given my good knee to have a Psychiatrist there when a psychiatric patient is admitted to telemetry. My bag of tricks for these patients is awfully light, and these patients are admitted more and more it seems, and I'm not sure their needs are met effectively. Who knows, maybe I'll get over my weird reluctance to leave my apartment, and I'll do some travel nursing, and we'll walk into a code together (I just read your last blog post, and I'm still jealous, I'm still waiting for my post-code sexual encounter :-) --eric
Posted by: Eric | August 01, 2005 at 03:54 AM
The more you write, the more I wish we had the opportunity to work together. You sound like an awesome nurse. I'm not sure how a tele nurse and a psychiatry resident would work together, but I guess I wish you'd be around if any of my patients started to go into SVT or something. ;)
This whole idea of scheduling is also alien to me. I'm so used to just "following the grid"--choice? What's that?
Posted by: Maria | July 30, 2005 at 11:53 AM
Yeah, I remember the old scheduling program well...
The beauty of being a student, I tell them when I can work, and I work it. It never changes.. (not that they don't try).
It is the end of July at the old place, and you know what that means.. "Oh man, look at the registry budget and expenses". The powers that be budgeted $7500 for registry labor in 2005, and so far we've spent...$52000. Umm, that was close...
No more registry, charge nurses are having to take patients, and things are going along swimmingly (hear it in my voice... you'll get the sarcasm)
Posted by: DisappearingJohn | July 30, 2005 at 09:51 AM
Thanks for visiting. I entered your site into my del.icio.us list. The link is on the right side panel. It's in reverse chronological order so newest entries (yours) are on top. --eric
Posted by: Eric | July 29, 2005 at 12:25 PM
That is the best and fairest description of managing nursing self-scheduling that I have ever encountered.
I have added you to my blogroll, but if you do not wish your site to be associated with mine, I will promptly remove it, if you e-mail a request that I do so.
I came across your site via Disappearing John. I admire your writing and I hope you will continue to let me link you.
Posted by: shrimplate | July 29, 2005 at 09:36 AM