Crna schedule for your group

[anes121508]

Hey guys/gals....

Our group is looking into restructuring how the crnas are scheduled. We currently have a really basic system with a rotation and people just go home by the number.

Many folks though are really wanting shift work.

If you guys have a group where the crnas work shifts can you give a basic idea of how it works?

For example...

Different types of shifts? 4x10, 5x8, 3x12

What happens when you don’t need all the shift workers? Cut them and don’t pay their hours? Keep them busy? Send them home early and pay them anyways?

What happens when you need to run more rooms than anticipated and you need an early shift person to stay? How do you determine who needs to stay?

One challenge we face is that the OR schedule is fairly Horizontal. We start running 35 sites at 7am, but we are down to 20ish by 1pm. How do you guys staff efficiently to handle this? People that are .75fte and have shorter shifts 1-2 days a week?

Thanks!

Any input on solutions your group has to staff efficiently yet keep people happy with some
Predictability on their life would be much appreciated!

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[abolt18]

Hey guys/gals....

Our group is looking into restructuring how the crnas are scheduled. We currently have a really basic system with a rotation and people just go home by the number.

Many folks though are really wanting shift work.

If you guys have a group where the crnas work shifts can you give a basic idea of how it works?

For example...

Different types of shifts? 4x10, 5x8, 3x12

What happens when you don’t need all the shift workers? Cut them and don’t pay their hours? Keep them busy? Send them home early and pay them anyways?

What happens when you need to run more rooms than anticipated and you need an early shift person to stay? How do you determine who needs to stay?

One challenge we face is that the OR schedule is fairly Horizontal. We start running 35 sites at 7am, but we are down to 20ish by 1pm. How do you guys staff efficiently to handle this? People that are .75fte and have shorter shifts 1-2 days a week?

Thanks!

Any input on solutions your group has to staff efficiently yet keep people happy with some
Predictability on their life would be much appreciated!

The crnas at my hospital are shift work. They don't get sent home early and they don't stay late. On the regular you see 10-15 of them sitting in the break room for the last couple hours of their shifts. The only people that benefit from shift work is the nurses themselves. Lots of getting paid to do nothing and getting paid extra if they ever stay a minute over.

 

[dannyboy1]

The crnas at my hospital are shift work. They don't get sent home early and they don't stay late. On the regular you see 10-15 of them sitting in the break room for the last couple hours of their shifts. The only people that benefit from shift work is the nurses themselves. Lots of getting paid to do nothing and getting paid extra if they ever stay a minute over.

Pretty much the definition of what you are paid to do weather you are in the OR or not 😉. In all seriousness that is the definition of an employee, you work a shift that you are hired for. It’s not their fault if the hospital is inefficient and can’t schedule cases appropriately.

 

[Mman]

What you need to determine are what the hospital "demand" (for lack of a better word) schedule is for your operating rooms. How many do they want able to run at what hours. Once that is determined you can start mixing and matching shift durations to come up with a decent fit and then have call shifts on top of that to cover the occasional heavier usage.

 

[Arch Guillotti]

Hey guys/gals....

Our group is looking into restructuring how the crnas are scheduled. We currently have a really basic system with a rotation and people just go home by the number.

Many folks though are really wanting shift work.

If you guys have a group where the crnas work shifts can you give a basic idea of how it works?

For example...

Different types of shifts? 4x10, 5x8, 3x12

What happens when you don’t need all the shift workers? Cut them and don’t pay their hours? Keep them busy? Send them home early and pay them anyways?

What happens when you need to run more rooms than anticipated and you need an early shift person to stay? How do you determine who needs to stay?

One challenge we face is that the OR schedule is fairly Horizontal. We start running 35 sites at 7am, but we are down to 20ish by 1pm. How do you guys staff efficiently to handle this? People that are .75fte and have shorter shifts 1-2 days a week?

Thanks!

Any input on solutions your group has to staff efficiently yet keep people happy with some
Predictability on their life would be much appreciated!

Run as lean as you can until angry surgeons get the ear of administrators.

Then let the hospital employ them and worry about their hours and paying them!

 

[Consigliere]

Hey guys/gals....



Many folks though are really wanting shift work.

When I read this, I was so shocked I nearly fell off my chair.

 

[AdmiralChz]

Run as lean as you can until angry surgeons get the ear of administrators.

Then let the hospital employ them and worry about their hours and paying them!

The flip side with this approach is if you don’t employ them your control goes down an order of magnitude. The possibilities - increasing call outs, taking 45-60 minute lunches, disappearing at the end of shifts, increasing back talk/malignant behavior... the list goes on. If they aren’t your employees you have zero recourse to deal with it. If you are covering trauma/OB/emergencies overnight and receive a sizeable stipend (which is a virtual guarantee for the first 2 in today’s world), expect the hospital to pull all financial support for your group if they employ the nurses. Plus they will want a cut of the anesthesia fee... There are pluses and minuses for sure.

 

[Shimmy8]

We have a mix of shift and rotation. About half/half, and it’s mixed throughout year.

Some sites have shifts like 6-2, 7-3, 7-5, 7-7, 9-7 that effectively becomes a rotation but the shifts are staggered based on historical ORs running. Those “shifts” change every week/day though.

 

[Noyac]

Also, consider the hospitals OR staffing. It doesnt make sense to staff 10 CRNA’s past 3pm if the hospital only staffs for 8 OR‘S. This seems obvious but it isn’t always clear.

 

[AdmiralChz]

Also, consider the hospitals OR staffing. It doesnt make sense to staff 10 CRNA’s past 3pm if the hospital only staffs for 8 OR‘S. This seems obvious but it isn’t always clear.

For us, our responsibilities are explicitly dictated in our hospital contract - Full schedule at 730, X at 3 PM, Y at 5 PM and Z at 7 PM (barring emergencies ideally, and if that happens next case is bumped). We base our staffing off that.

We do a mix of 7-3, 7-5, 7-7 shifts (all chosen by anesthetists), 7-7ers have to do an extra 12 every 3 weeks or an 8 every 2 weeks to average out 40 hr/week. For breaks and possible out of OR stuff we add in a 9-5 shift, 11-7 and a 11-11 at our level 1 trauma center. We also have night time shifts. One or two do 7A-11P shifts, but they are grandfathered in and am not sure how that works. We also have call folks available - at our level 1 they get the next day off and extra pay after 11. Other hospitals go MD-only after then so the call person could work the next day.

 

[IlDestriero]

4 10s (7-5) or 3 12s (7-7)
We don’t have CRNAs on call overnight.
We run our rooms to 5 or 7 and run emergency only after that.
Places that might end earlier, ASC, GI, etc. are staffed solo MD.
If CRNAs end early, they break the late/call people for dinner, do preops, or go home a little early. If their shift ends we send them home and the late MDs can sit. Sometimes they stay an extra 15m, but sometimes they get out early, so it’s a wash. If they need to stay later because of some poor planning combined with emergencies, we ask for a volunteer and they are paid an hourly rate. It’s the call attending’s job to follow the rooms, anticipate needs, and get the CRNAs out on time. The OR nurses turn into turnips at the same times so the ORs have to contract at 5 and 7. That may mean delaying starts, etc. The surgeons aren’t happy, but they also sank their own ship by taking 4 hours for a knee scope or 6 hours for a 2 hour “tumor biopsy” turned resection. The computer assigns time for procedures, they schedule it wrong, try to game the system, etc. and they get to wait.
“When can I start? WTF?”
-You’re 2 hours behind and overbooked, you can go at maybe 9.
“This is BS! Call in another team!”
-They’re already here. If you want to use the trauma team we would have to go on trauma bypass, you’d have to discuss that with the ED and the senior administrator on call.
<crickets>
“We will have to add him on for tomorrow. I want to go first because I have xxxxxxx at 10am.”
There are already 6 add ons ahead of you. But we can move you to tomorrows add on list. No problem...
<crickets>
(Ok see ya around 9)

 

[pjl]

You need to decide how much control you have over the surgeons, and OR schedule. Convert to fewer, longer rooms if possible, since it is really hard to get a <8 hr shift out of someone. Otherwise you will have CRNAs sitting or leaving early.

Then eval total need at each time (3 pm, 5 pm, 7 pm, overnight). Match to schedule.
Daily we have 8 hour, 10 hr and 12 hour employees, matched to surgeon schedules.

Look at CRNAs and how desired your job is, if high desirability then send them unpaid when they leave early. If low, then pay 40 hr weekly whether they are there or not. Overtime over 40 hours is common, but if you can avoid, do it. If you need to pay for 40 hours when they leave early and overtime if past shifts, then do it.

Our CRNA shifts are 8x5, 10x4, 12x2+8x2, 12+10x2+8, 24+8x2.
Shift them to match the need. Once you get a defined need, then you can just drop in staff.

Overtime is fine in low amounts, and can be cheaper than creating new shifts, but you need to account/plan the point where you add staff ahead of time.

 

[AdmiralChz]

Sometimes they stay an extra 15m, but sometimes they get out early, so it’s a wash

if high desirability then send them unpaid when they leave early.

Has anyone had success with these two? A shift-working mentality really makes both of these very unlikely for thepractices I have seen. We would have a riot if we deployed either - but we definitely have a shortage of anesthetists.

 

[IlDestriero]

If they want to nickel and dime you over 10-15 min, do it right back.
Check out with the call attending at 5 or 7. Nobody leaves early.
Task them out right to quitting time. Give IR a 10m break. Go to the NICU and start a preop. Hold the phone while I go see a man about a horse.
Then pay them their overtime in 15m intervals.
If they want to have an I’m just a shift nurse mentality to the detriment of the team, and maybe the patient as well, treat them like a cog. Give report to your replacement 5 minutes before shift end. That’s a crappy way to practice medicine.
We work hard to get them out on time, sit our own cases if necessary, keep late MDs in case things don’t work out, but if they started asking for overtime for a few min the chief would probably suggest this might not be the best place for them. Especially as they go home early far far more frequently than they stay a bit late.

 

[okayplayer]

This thread makes me so thankful to be in an MD-only private practice.

 

[deleted162650]

This thread makes me so thankful to be in an MD-only private practice.

This 👍 👍 👍

 

[jwk]

All of our FT anesthetists are salary plus OT. Perhaps 20% are straight 7-3 M-F. Another 20% are some type of shift variation including all our night shift anesthetists - 10x4, 12x3, 12x2 plus 8x2, etc. The remainder are our "call anesthetists" who are on a number system that basically determines who goes home when after 3pm. We start the day with over 100 anesthetists working, and are still using 60+ after 3pm. We don't want to pay too many shift people just to sit around, so the numbered call system allows us to keep as many people as we need working after 3pm, and as rooms close down, those people leave and the OT ticker ends.

We use a computer scheduling and timekeeping program to keep all this straight.

 

[anes121508]

For us, our responsibilities are explicitly dictated in our hospital contract - Full schedule at 730, X at 3 PM, Y at 5 PM and Z at 7 PM (barring emergencies ideally, and if that happens next case is bumped). We base our staffing off that.

We do a mix of 7-3, 7-5, 7-7 shifts (all chosen by anesthetists), 7-7ers have to do an extra 12 every 3 weeks or an 8 every 2 weeks to average out 40 hr/week. For breaks and possible out of OR stuff we add in a 9-5 shift, 11-7 and a 11-11 at our level 1 trauma center. We also have night time shifts. One or two do 7A-11P shifts, but they are grandfathered in and am not sure how that works. We also have call folks available - at our level 1 they get the next day off and extra pay after 11. Other hospitals go MD-only after then so the call person could work the next day.

I like how you find a way to even out the 12hr shift people

 

[anes121508]

You need to decide how much control you have over the surgeons, and OR schedule. Convert to fewer, longer rooms if possible, since it is really hard to get a <8 hr shift out of someone. Otherwise you will have CRNAs sitting or leaving early.

Then eval total need at each time (3 pm, 5 pm, 7 pm, overnight). Match to schedule.
Daily we have 8 hour, 10 hr and 12 hour employees, matched to surgeon schedules.

Look at CRNAs and how desired your job is, if high desirability then send them unpaid when they leave early. If low, then pay 40 hr weekly whether they are there or not. Overtime over 40 hours is common, but if you can avoid, do it. If you need to pay for 40 hours when they leave early and overtime if past shifts, then do it.

All of our FT anesthetists are salary plus OT. Perhaps 20% are straight 7-3 M-F. Another 20% are some type of shift variation including all our night shift anesthetists - 10x4, 12x3, 12x2 plus 8x2, etc. The remainder are our "call anesthetists" who are on a number system that basically determines who goes home when after 3pm. We start the day with over 100 anesthetists working, and are still using 60+ after 3pm. We don't want to pay too many shift people just to sit around, so the numbered call system allows us to keep as many people as we need working after 3pm, and as rooms close down, those people leave and the OT ticker ends.

We use a computer scheduling and timekeeping program to keep all this straight.

This is what we have and what is the most efficient thing but for some reason we are losing people and they hate the rotation due to lack of predictability

 

[AdmiralChz]

I like how you find a way to even out the 12hr shift people

Yeah, it’s been that way for a long time i guess - they do a good job of policing each other to ensure fairness.

In residency, the 12 hr folks worked only 3 12s and didn’t have to make up the difference. When administration told them that would have to change the AAs/CRNAs absolutely went bonkers and threaded to walk immediately, since they were short they backed off. It was pitiful and speaks to the overall issues the Department had as a whole, but this is the danger of allowing 12 hour shifts.