Nurse absenteeism

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Dr Mantis Toboggan

Dr Mantis Toboggan

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Interested in polling the board, how big a problem are nurse call outs or not having all the nurse/tech/MR shifts filled where you work?
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All hospitals are well staffed and nurses/techs never call in sick. Amazing work ethics.
 
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It happens, but it is rarely an issue. The main problem is that there is a direct correlation between being short of staff and patient volume; if there is a "flu outbreak" and we are being swamped, it is a good bet that it is going to take out a few of our people as well.
 
Dr Mantis Toboggan said:
Interested in polling the board, how big a problem are nurse call outs or not having all the nurse/tech/MR shifts filled where you work?
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This isn't possible.

Because nurses are perfect.
 
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Where I work, not an issue because said nurse will be fired. When I worked with unionized nurses, endless problem. Endless.
 
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No union. I think it's more due to hospital policy about "flexing" (i.e. you don't get your hours when it isn't busy) and paying a little less than some other hospitals in the area.
 
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The White Coat Investor said:
No union. I think it's more due to hospital policy about "flexing" (i.e. you don't get your hours when it isn't busy) and paying a little less than some other hospitals in the area.
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I hate it when house supervisor asks me as soon as I step out of a room whether that patient will go to floor, PCU, or ICU because she needs to call in or send home staff.
I try not to be obnoxious when I reply.
 
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emergentmd said:
All hospitals are well staffed and nurses/techs never call in sick. Amazing work ethics.
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They are really good at driving in the snow too. #heartofanurse, #brainsofadoctor, #madrallyskills.

Apollyon said:
No union, bad problem with staffing. Rural hospital, part of nationally known health system. Not Kaiser.
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HCA?
 
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I’ve worked as a paramedic for half a decade now, both in a 911 and an ED role. If you’re having problems with staffing, it’s the fault of department management. Despite rumors to the contrary, most nurses 1-3 years into a career make around $25/hour in non-union states. They accrue nominal PTO per pay period, which typically amounts to 4-6 weeks of vacation time per year. There is no additional sick time/personal days/etc. — PTO is it. Typically departments will schedule vacation time prior to the start of the calendar year, and they limit the amount of staff off per week. Call-ins result in “occurrences,” too many of which, in turn, result in termination. Usually, these are used strategically to supplement permitted vacation time.

Basically, what I’m getting at is this: there’s little disincentive to using PTO when you have it. When staffing sucks, it sucks for everyone (realizing that things move much more slowly and you all — and maybe me in seven years — rely upon volume and throughput for salary). We all have to pick up the slack, and admittedly, nurses perpetuate these problems by moving into management positions and maintaining the status quo. I like to criticize the crappier nurses, and sometimes the entire field, as well, but why kill yourself over $25/hour in an environment that is as abusive as an ED typically is.

I sympathize to a great extent with the vibe in this thread, but the myths of nurses making six figures while only working 36 hours per week and complaining their way through are just that - myths. The few who break 100k, average 60+ hours per week and have been working for a number of years (APRNs and CRNAs excluded, of course). Or they live in California/work at the VA.

In short, I know a lot of bad ones, but there are plenty of good ones who do work hard, are truly underpaid, and rarely call off. Talk with management if it’s actually a problem - it means that they are doing stupid things and probably have enormous turnover or can’t attract applicants. You wouldn’t believe the number of inane meetings, training, etc. that we have to go to on our off days, even in halfway decent departments.
 
Didn’t mean for that to come off quite so smarmy, but I stand by it. I enjoy reading through these threads and apologize if I offended anyone. I’m sure I’ll change my tune in ten years.
 
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24GaugeEJ said:
I’ve worked as a paramedic for half a decade now, both in a 911 and an ED role. If you’re having problems with staffing, it’s the fault of department management. Despite rumors to the contrary, most nurses 1-3 years into a career make around $25/hour in non-union states. They accrue nominal PTO per pay period, which typically amounts to 4-6 weeks of vacation time per year. There is no additional sick time/personal days/etc. — PTO is it. Typically departments will schedule vacation time prior to the start of the calendar year, and they limit the amount of staff off per week. Call-ins result in “occurrences,” too many of which, in turn, result in termination. Usually, these are used strategically to supplement permitted vacation time.

Basically, what I’m getting at is this: there’s little disincentive to using PTO when you have it. When staffing sucks, it sucks for everyone (realizing that things move much more slowly and you all — and maybe me in seven years — rely upon volume and throughput for salary). We all have to pick up the slack, and admittedly, nurses perpetuate these problems by moving into management positions and maintaining the status quo. I like to criticize the crappier nurses, and sometimes the entire field, as well, but why kill yourself over $25/hour in an environment that is as abusive as an ED typically is.

I sympathize to a great extent with the vibe in this thread, but the myths of nurses making six figures while only working 36 hours per week and complaining their way through are just that - myths. The few who break 100k, average 60+ hours per week and have been working for a number of years (APRNs and CRNAs excluded, of course). Or they live in California/work at the VA.

In short, I know a lot of bad ones, but there are plenty of good ones who do work hard, are truly underpaid, and rarely call off. Talk with management if it’s actually a problem - it means that they are doing stupid things and probably have enormous turnover or can’t attract applicants. You wouldn’t believe the number of inane meetings, training, etc. that we have to go to on our off days, even in halfway decent departments.
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Nurses in NYC start at about 90k and rates are similar in much of Massachusetts and the Northeast. With shift differential, they are easily starting at 100k a year. That's for a two year degree. Nurses in California start at about 120k and can easily get to 200k with overtime. I work in a nonunion state, and our nurses start at $28, but they only need an Associate's. After three or four years, they are earning well into the mid thirties hourly. Per diem, they start at $47 an hour with no experience. I'm not sure where nurses are earning $25 an hour average, but my state is the third worst paid in the country and it pays more than that. Where, exactly, is the average nurse earning $25 an hour?
 
If nurses aren't the best paid people in healthcare for their investment they're close. 2yr associates making 50k starting in much of the rural us. A doc making that much per year of investment would yield a 250k+ salary (4+4+3).

That said, good for them!
 
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Glassdoor is not a great reference, or maybe it is, but you just commented on two of the highest col areas in the contiguous US, one of which I made the point of explicitly excluding. Regardless, you’re hemming at the periphery of what I was saying - why not use the PTO one is allowed to use? If there’s a problem with staffing, it’s management’s issue, not the work ethic of all nurses, everywhere.

Admittedly, I commented in a thread for attending and resident physicians from the point of view of an ED employee, where the goal was to vent. I took it a little too seriously. I apologize for that.
 
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24GaugeEJ said:
Glassdoor is not a great reference, or maybe it is, but you just commented on two of the highest col areas in the contiguous US, one of which I made the point of explicitly excluding. Regardless, you’re hemming at the periphery of what I was saying - why not use the PTO one is allowed to use? If there’s a problem with staffing, it’s management’s issue, not the work ethic of all nurses, everywhere.

Admittedly, I commented in a thread for attending and resident physicians from the point of view of an ED employee, where the goal was to vent. I took it a little too seriously. I apologize for that.
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Even when doctors have PTO and are employed, they don't really call in sick.
 
I'm gonna back up 24Gauge here. Granted like him im not a physician but I've been ED staff for some time. Staffing is usually an issue of management. I can't tell you how often I get sent home or told not to come in because it isn't PRESENTLY busy. Charges, managers, and directors at least where I've worked are under pressure to fit in idiotic metrics that are reactionary rather than preemptive or strategic.
In regards to the associates degree making six figures, you're missing some key details, and Im not sure those exist without excessive overtime. It's kind of like saying physicians make too much money while ignoring debt, time in training, and so forth. Right now, typical associates level nurses struggle for jobs and here in Texas I haven't met a single one in the ED making more than 60k. Granted for an associates that's still fairly good pay but you're ignoring a lot of circumstances in the process. At least here in my area you're gonna fight to find a position with an associates and almost every place mandates that you finish your bachelor's within a certain amount of time which includes a pay raise when you finish and the hospital can maintain it's magnet status.

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It's lupus! said:
I'm gonna back up 24Gauge here. Granted like him im not a physician but I've been ED staff for some time. Staffing is usually an issue of management. I can't tell you how often I get sent home or told not to come in because it isn't PRESENTLY busy. Charges, managers, and directors at least where I've worked are under pressure to fit in idiotic metrics that are reactionary rather than preemptive or strategic.
In regards to the associates degree making six figures, you're missing some key details, and Im not sure those exist without excessive overtime. It's kind of like saying physicians make too much money while ignoring debt, time in training, and so forth. Right now, typical associates level nurses struggle for jobs and here in Texas I haven't met a single one in the ED making more than 60k. Granted for an associates that's still fairly good pay but you're ignoring a lot of circumstances in the process. At least here in my area you're gonna fight to find a position with an associates and almost every place mandates that you finish your bachelor's within a certain amount of time which includes a pay raise when you finish and the hospital can maintain it's magnet status.

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Click to expand...

There are plenty of nurses making six figures for a 36 hour week with an associates. Here they do not have a problem getting jobs at all- bonuses etc. That was my point. As to the bachelor's, the nurses I work with seem to do a bunch of point-and-click online coursework and voila, a BSN they got for free via the hospital. Seems like a really good gig. Even if nurses start with a BSN, it seems like they can do most of the coursework online.
 
miacomet said:
Even when doctors have PTO and are employed, they don't really call in sick.
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It's not normal to not be able to call in sick. This is a significant problem in EM. No other industry makes the employee responsible for finding his own sick coverage. This is another "EM Mindset" thing, where we convince ourselves and our underlings were above it all and getting ill is only for flawed people. Never once in 8 years as an EM attending was I able to be out due to illness. The only time I ever missed a shift due to illness was because I literally couldn't talk due to laryngitis (felt 100% fine), and I had to find someone to cover it. Although I by my nature, would rather work when sick and don't like staying home sick, I know this is soul crushing for some people.

In EM your made every day to feel you're a nothing more than an unimportant employed cog in a machine. But employed cogs in corporate machines get to call in sick. EPs don't. And the reasons given are B*** s**t. "If you don't show up, patients will die."

Not really. 85% of them are non-urgent, non-emergencies you want me to see in record time to make money for the hospital.

They build you up and tell you you're a cut above the rest, stronger, smarter, professionals, leaders and that you need to step up and act a cut above the rest. But when it comes down to having the simple courtesies the minimum wage workers get, "Sorry, not sorry." And when it comes time to make smarter decisions than others and lead, its, "Shut up. You're an employee. Sit down, cog."

If we're going to be treated like replaceable cogs with no power, at least we should get the simplest, basic protections and other benefits of the other replaceable cogs with no power.

If I don't let my nurse get a 30 minute uninterrupted lunch brake I'm in violation of employment law. But in the ED they violated that with me daily, for 10 years.

Damnit, if I'm a powerless cog, I want to be treated like a powerless cog!
 
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Birdstrike said:
It's not normal to not be able to call in sick. This is a significant problem in EM. No other industry makes the employee responsible for finding his own sick coverage. This is another "EM Mindset" thing, where we convince ourselves and our underlings were above it all and getting ill is only for flawed people. Never once in 8 years as an EM attending was I able to be out due to illness. The only time I ever missed a shift due to illness was because I literally couldn't talk due to laryngitis (felt 100% fine), and I had to find someone to cover it. Although I by my nature, would rather work when sick and don't like staying home sick, I know this is soul crushing for some people.

In EM your made every day to feel you're a nothing more than an unimportant employed cog in a machine. But employed cogs in corporate machines get to call in sick. EPs don't. And the reasons given are B*** s**t. "If you don't show up, patients will die."

Not really. 85% of them are non-urgent, non-emergencies you want me to see in record time to make money for the hospital.

They build you up and tell you you're a cut above the rest, stronger, smarter, professionals, leaders and that you need to step up and act a cut above the rest. But when it comes down to having the simple courtesies the minimum wage workers get, "Sorry, not sorry." And when it comes time to make smarter decisions than others and lead, its, "Shut up. You're an employee. Sit down, cog."

If we're going to be treated like replaceable cogs with no power, at least we should get the simplest, basic protections and other benefits of the other replaceable cogs with no power.

If I don't let my nurse get a 30 minute uninterrupted lunch brake I'm in violation of employment law. But in the ED they violated that with me daily, for 10 years.

Damnit, if I'm a powerless cog, I want to be treated like a powerless cog!
Click to expand...
We use a backup system. Just contact the backup and you're free. It doesn't get abused. We're also paid to take backup days and paid above our normal rate if we get called in. We also have a text alert system so any of us can easily contact everyone else to try to give up a shift last minute. I don't mind taking the occasional backup day knowing it means I can stay home if needed. Of course, it's a democratic group. The benefits of owning the job...
 
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miacomet said:
There are plenty of nurses making six figures for a 36 hour week with an associates. Here they do not have a problem getting jobs at all- bonuses etc. That was my point. As to the bachelor's, the nurses I work with seem to do a bunch of point-and-click online coursework and voila, a BSN they got for free via the hospital. Seems like a really good gig. Even if nurses start with a BSN, it seems like they can do most of the coursework online.
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I'm curious to know where you are. BLS.gov lists the national median for both BSN and ADN, because they do not differentiate, at 70k. The top 10% in the US are making 104k. The highest paying state is California (102k avg) which doesn't mean much in the face of its ridiculous cost of living. Hawaii is second with 97k avg. Which again COL is an important factor. Followed by DC, Massachusetts, and Oregon. Again there's no differentiation between adn and bsn. I find it doubtful that there are many ADNs making six figures in the face of BSNs without extentuating circumstances such as 10 or more years experience, excessive overtime, or advanced degrees in management and are not working the floor. I'm not arguing that nursing is a bad racket. I feel the exact opposite but it seems absurd to suggest that it's common that ADNs are making 6 figures anywhere and even less powerful when you consider COL.

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TooMuchResearch said:
We use a backup system. Just contact the backup and you're free. It doesn't get abused. We're also paid to take backup days and paid above our normal rate if we get called in. We also have a text alert system so any of us can easily contact everyone else to try to give up a shift last minute. I don't mind taking the occasional backup day knowing it means I can stay home if needed. Of course, it's a democratic group. The benefits of owning the job...
Click to expand...
Having to get called in last minute to work on my day off, is not what I’d consider a good deal. That’s called being ON CALL. This is another way EM administrators brainwash their people to think they’re doing things they’re not, and not doing things they are.

Do the majority of patients in EDs have urgent and emergenct conditions?

If not, then they can wait more than 15 minutes if the physician staff is a little short once in a while and maybe it’s not the end-of-the-world crisis that being a little short is made out to be, and so that Emergency Phsysicans can get the benefits of the same work laws hourly workers everywhere else get.

If so, then EDs need to be staffed at three times current physician coverage, and you’re just hallucinating all those URIs, toothaches, and soft tissue injuries.

Which is it:

1) Are EDs overwhelmed with emergent and urgent medical patients, or

2) Are hospitals trying to cram through as many non-urgent patients through as fast as possible, while making as much money as possible, while using a fake crisis made up mostly of non-urgent patients as propaganda to spur productivity?
 
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So if we go on averages, for a typical attending to get the same return on their education you'd be making $560K minimum (never-mind lost wages in residency). I'm dating a nurse, and she works hard, but she doesn't think she's paid poorly.
 
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And nurses never seem to have to pay for their education.
 
Cryc_to_the_point said:
So if we go on averages, for a typical attending to get the same return on their education you'd be making $560K minimum (never-mind lost wages in residency). I'm dating a nurse, and she works hard, but she doesn't think she's paid poorly.
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I'm not sure if you're responding to me but I never said they were paid poorly, haha. In fact, I actually made a point of saying they do well. I only contested the thought that an associates in nursing commonly gets you a six figures salary.

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Birdstrike said:
Having to get called in last minute to work on my day off, is not what I’d consider a good deal. That’s called being ON CALL. This is another way EM administrators brainwash their people to think they’re doing things they’re not, and not doing things they are.

Do the majority of patients in EDs have urgent and emergenct conditions?

If not, then they can wait more than 15 minutes if the physician staff is a little short once in a while and maybe it’s not the end-of-the-world crisis that being a little short is made out to be, and so that Emergency Phsysicans can get the benefits of the same work laws hourly workers everywhere else get.

If so, then EDs need to be staffed at three times current physician coverage, and you’re just hallucinating all those URIs, toothaches, and soft tissue injuries.

Which is it:

1) Are EDs overwhelmed with emergent and urgent medical patients, or

2) Are hospitals trying to cram through as many non-urgent patients through as fast as possible, while making as much money as possible, while using a fake crisis made up mostly of non-urgent patients as propaganda to spur productivity?
Click to expand...
Who doesn't realize they are too sick to work until last minute? The group voted on a backup system, it's not imposed by an administrator. And yes, our medical directors take backup days too. We also run several single coverage sites. Being down one doc at those sites doesn't work.
 
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miacomet said:
Nurses in NYC start at about 90k and rates are similar in much of Massachusetts and the Northeast. With shift differential, they are easily starting at 100k a year. That's for a two year degree. Nurses in California start at about 120k and can easily get to 200k with overtime. I work in a nonunion state, and our nurses start at $28, but they only need an Associate's. After three or four years, they are earning well into the mid thirties hourly. Per diem, they start at $47 an hour with no experience. I'm not sure where nurses are earning $25 an hour average, but my state is the third worst paid in the country and it pays more than that. Where, exactly, is the average nurse earning $25 an hour?
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Many nyc nurses make over 100k as do many nurses in boston (brigham average is 106k) as their base.
 
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TooMuchResearch said:
Who doesn't realize they are too sick to work until last minute? The group voted on a backup system, it's not imposed by an administrator. And yes, our medical directors take backup days too. We also run several single coverage sites. Being down one doc at those sites doesn't work.
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Our old SDG with over 100 docs tried a call schedule and it lasted about 2wks. Its not a matter of being called in or abusing the system, it was a matter of "being on call".
As being a SDG, everyone would have had to rotate through the call schedule, so paying extra to be on call didn't really mean extra income as the pot of $$$ doesn't change.

Now, if its a CMG and they paid extra to be on call that would be alittle different. Still, i would request atleast $100/hr to be on call just to make it worth it.
 
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emergentmd said:
Our old SDG with over 100 docs tried a call schedule and it lasted about 2wks. Its not a matter of being called in or abusing the system, it was a matter of "being on call".
As being a SDG, everyone would have had to rotate through the call schedule, so paying extra to be on call didn't really mean extra income as the pot of $$$ doesn't change.

Now, if its a CMG and they paid extra to be on call that would be alittle different. Still, i would request atleast $100/hr to be on call just to make it worth it.
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Fair enough. We rarely get called in, I'm on call less than once per month, and I like knowing if my spouse/kids/me gets sick or injured, someone is there to cover me. It's worked well in this group for years.
 
TooMuchResearch said:
Fair enough. We rarely get called in, I'm on call less than once per month, and I like knowing if my spouse/kids/me gets sick or injured, someone is there to cover me. It's worked well in this group for years.
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I am quite sure that an ED shutting down b/c a doc doesn't show up is as common as the 500 year flood. There is always an ER doc there and if not, that is what the director/assistant director is there for.

A groupwide SOS when an emergency happens usually fixes the problem. Its hard enough making schedules, add an extra day for everyone makes it that much more difficult for very little gain.
 
emergentmd said:
I am quite sure that an ED shutting down b/c a doc doesn't show up is as common as the 500 year flood. There is always an ER doc there and if not, that is what the director/assistant director is there for.

A groupwide SOS when an emergency happens usually fixes the problem. Its hard enough making schedules, add an extra day for everyone makes it that much more difficult for very little gain.
Click to expand...
Again, it's worked well in this group for years.
 
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Great for me! My wife is an ED nurse who works per diem and there are multiple times they can’t fill a spot and pay her bonus.
 
Birdstrike said:
Having to get called in last minute to work on my day off, is not what I’d consider a good deal. That’s called being ON CALL. This is another way EM administrators brainwash their people to think they’re doing things they’re not, and not doing things they are.
Click to expand...
Where I have worked/trained:
On Backup: You need to be in the area and sober in case someone gets sick
On call: You are responsible for patients in the hospital, and nurses call you either with questions or into the hospital for patient concerns


Birdstrike said:
If not, then they can wait more than 15 minutes if the physician staff is a little short once in a while and maybe it’s not the end-of-the-world crisis that being a little short is made out to be, and so that Emergency Phsysicans can get the benefits of the same work laws hourly workers everywhere else get.
Click to expand...

There are no laws protecting the right of employees to call in sick in the US. Very few states have any protections. California doesn't protect the right to call in sick, if that gives you an idea of how bad it is. Most of the US does, in fact, live in a world where calling in for an illness can be career ending. Most people who face termination for illness make less than $15/hour, have no savings, and have no guarantee of employment if things fall through.

Not saying you can't negotiate for better sick coverage, or whatever, but when you start saying that you want to be treated like everyone else try to be aware of how badly most people are treated.
 
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Tenk said:
Great for me! My wife is an ED nurse who works per diem and there are multiple times they can’t fill a spot and pay her bonus.
Click to expand...

Funny how they never treat docs that way. We are just a resource to be used and abused.
 
Pretty good where I am. Sometimes nurses get "cancelled" i.e. sent home which then leads to short staff later but I don't see a lot of them calling out.
 
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