BCH Staffing Guidelines

*Refer to UCSF Medical Center Department of Nursing Administrative Policy regarding Staffing*

BCH UNIT CLUSTERS

  • ACUTE CARE
    • C5MSP; C5T; C6H; C6B, C1 CNSU, C2MSP South
  • CRITICAL CARE
    • PICU; CICU; ICN; CTCU
  • CTCU
    • Floating out = acute
    • Floating in = critical; if acute is floating in it is considered an out of cluster float

STAFFING GUIDELINES

Units charge nurses will enter acuity and staffing information to the Acuity Tool by 0330/1530 each shift.

BCH Nursing Supervisor will complete the needed information during 0400/1600 bed meeting, and email the condensed Report (am/pm) to the distribution list.

  • Do not float nurses from one unit at acuity to another unit unless it is to meet minimum.
  • Consider pulling resource, zone leader or POCRN(C6H) if resources are limited.
  • When a unit has to float a RN to another unit for a specific skill need, i.e. MIBG sedation or CRRT, the unit floating should report their staffing numbers reflective of what is specifically need for their unit, not subtracting the RN they have to float out.
  • Likewise a unit needing a specific skilled RN should report that need in their staffing numbers, ie. 8 RNs scheduled, need 9 which includes MIBG sedation RN.

FLOATING GUIDELINES

  • Resources will be assigned /floated within the Acute Care & Critical Care Division separately.
  • If cross-division floating is needed due to the need to meet minimum in one division/to an overage in one division the following guidelines apply:
    • Assess resources available in all units of the division required to float, including the Resource Team.
    • Float RNs in the following order:
      • Travelers
      • Per diems(by date)
      • Career RNs(by date)
  • If a specific skill is required, the Hospital Supervisor may override this order & assign an appropriate RN.
  • Minimum Guidelines
  • Guidelines for appropriate float assignments here.
  • Mid shift floating:
    • Traveler/per diem float out first.
    • Assess skill mix.
    • Do NOT float the RN who floated into the unit out to another unit, we do not double float contracted staff. The nurse should return to the home unit and the next nurse in line to float should float to the unit in need. A traveler may be floated to more than one unit in a shift.
  • Mid shift overage:
    • The RN who floated into the unit goes back to their home unit. That unit will decide how to down staff based on their unit guidelines.
  • Birth Center:
    • Do not give a float to put their RNs on call unless admissions are imminent or there are no needs elsewhere or no one wants day off.
  • ACRT & CCRT:
    • Some have specific competencies that allow them to perform a higher level of care/specialized skill.
    • Review the Competency Checklist for floating.
    • In cluster (no Float date) : C1 CNSU, C5 MSP, C5 TCUP, C6 Heme/ONC, C6 BMT, Well Baby (if trained), ED non boarders (if trained), ED Boarders (trained or not trained) and C2
    • Out of cluster (Float date) : CTCU. CICU, PICU, ICN, Any other pop off.
  • ICN & PICU:
    • Clarify with the units the acute care assignment & determine if appropriate or if it requires a higher level of care acute care nurse (ACRT, TCUP, CTCU).

DIBS OFF

  • Resource Team requests:
    • If there is an overage & a Resource Team RN has requested off, they are given dibs off first.
    • The overage must be in that cluster; i.e. if an ACRT wants off, but the overage is in critical care, the ACRT will not be given the dibs off. Likewise a critical care RN would not float to an acute care unit to give an ACRT off.
    • Do not give the same Resource RN the day off two days in a row unless no one else wants it.
    • Holiday Guidelines:
      • Resource Team requests off are considered with other RNs scheduled in the cluster requesting off on a seniority basis.
      • Units will maintain a dibs list for holidays organized by seniority. Allocate resource team members--charge nurses should call by seniority date (CNA date) to offer the day off based on who indicated they want dibs for overages after considering skill mix.
  • One way to allocate extra resources when multiple units have staff wanting a day off would be to choose the most senior RN requesting off within the cluster.

CANCELATIONS

  • Cancelation order is:      
    • Staff on an extra shift that may cause premium pay later in the week or on OT or on premium pay
      • Skill mix is always priority
      • Cancel per diem OT first, then career
      • If there are multiple career from a unit over on OT, cance by seniority date
    • Staff volunteering
    • Travelers
    • Per diem
    • Then force ELO.

ELO

CHALLENGES

  • Limited resources:
    • Considerations for allocation of resources:
      • PICU goes to RRT, Code Whites, & commonly gets admissions.
      • ICN has additional resources such as second triage, zone leaders, & commonly gets admissions.
      • C6H has a POCRN & usually an admit RN at 10:00 Monday-Friday.
  • No shows & late ill calls:
    • The unit experiencing this will have to adjust their staffing & escalate to their director.
    • Suggest staff stay over to cover need until a  solution is determined.
    • If the no show was a RN who was to float to another unit, the unit that was floating a RN is still expected to float a different RN.
    • If such unit has floated an RN to another unit, the expectation is that the RN will not automatically be pulled back to their home unit without the Hospital Supervisor having a conversation with both units.
    • The Hospital Supervisor will explore other unit’s ability to aid the situation.
  • Multiple unexpected admissions to one unit:
    • If the unit is now below minimum pull a RN from another unit that is staffed better.
  • C2 Med Surg South:

 

**These are guidelines only and are subject to Supervisor discretion.**