Charge nurse doing staffing supervisor overriding orders?

My department just layed off a manager and the office coordinator, with no plan to hire anyone to replace them. They "downsized" The new "policy" is that if we are short staffed, or have a call in it is now the charge nurses responsibility to call staff to look for the extra help. But only calling part time or Per diem. If we can't get help there, we have to get approval to call full time staff. Anyone else work somewhere that you have to do this? Not sure how long this will last, as hopefully the union is getting involved.

Also, how would you handle this? Dr. writes an order for a patient to only have male staff on his 1:1. Supervisor decides it's not necessary and isn't staffing this way. Actually staffing with no males on the unit. Pt can be very aggressive and assaultive. I don't see how this is even legal for the supervisor who is not on the floor, and does not know the patient to make this decision, and over ride the order?
1. On our unit, it's currently the charge nurse's responsibility to call employees to get shifts covered. We usually start with per diem or part time staff, or ask full time staff to come in now and get one their other scheduled days off later in the week. If we have to call someone in for overtime, we need to get approval from the staffing office. It's not usually hard to do so. You simply call the staffing office and explain your census and your number of staff and ask to call in staff for overtime. 2. I'd call the person staffing directly and explain the situation and the doctor's order so that she is aware. If she refused to comply, I'd escalate to the supervisor and higher if needed. However, if a patient is that combative, I think there should be a security person stationed outside the room as well as a 1:1.

I have worked somewhere that tried this and it sucked! There is nothing worse than getting called before work letting you know that you are short and need to start making preparations. I would suggest trying to increase your PRN and Part-time pool now and making sure you have everyones availability and contact #'s. Until someone realizes this cost cutting measure is a FAIL you obviously need to CYA. I am sorry to say that until there is an "incident" probably nothing will happen & even then they will end up spending more $$ by using a staffing company (bringing another set of problems)

For part 2, what makes the MD think that if the situation is too dangerous for a female, that a male should be able to handle it? While this sound chivalrous, I would be quite upset if I was the one male on the unit and I got assigned to this "assaultive" pt. I think the real issue here is that the supervisor needs to come up with a plan to keep staff safe (as someone else mentioned, this could mean have security posted at the door.

Quote from Ashley, PICU RN1. On our unit, it's currently the charge nurse's responsibility to call employees to get shifts covered. We usually start with per diem or part time staff, or ask full time staff to come in now and get one their other scheduled days off later in the week. If we have to call someone in for overtime, we need to get approval from the staffing office. It's not usually hard to do so. You simply call the staffing office and explain your census and your number of staff and ask to call in staff for overtime. 2. I'd call the person staffing directly and explain the situation and the doctor's order so that she is aware. If she refused to comply, I'd escalate to the supervisor and higher if needed. However, if a patient is that combative, I think there should be a security person stationed outside the room as well as a 1:1.

Quote from psu_213For part 2, what makes the MD think that if the situation is too dangerous for a female, that a male should be able to handle it? While this sound chivalrous, I would be quite upset if I was the one male on the unit and I got assigned to this "assaultive" pt. I think the real issue here is that the supervisor needs to come up with a plan to keep staff safe (as someone else mentioned, this could mean have security posted at the door.

I could be wrong here, but specifying only males vs females allowed to care for a patient could be considered as discrimination. I would think they would do their best to get you a male, but I'm not sure they can actually require it be a male to care for the patient. Anyone else have thoughts on this?

1. I worked at ONE place in 19 years that made the charge nurse stop what she was doing (had a full patient load in LTC), and go through the phone list. I thought it was ridiculous and I was in the administrative bunch who would have gotten stuck with it .... having been a CN in LTC with a full patient load- I thought it stunk.2. If the supervisor is not the medical director, she has no authority to override an actual order. If the doc had asked for the sup to eval and decide- that's another story.... Lousy all around.

On my floor-- even though we have a full time manager, director and clinical nurse specialist-- staffing is the charge nurse's responsibility. The charge nurse is expected to round with all the medical teams (at least 4 separate teams covering the floor, sometimes more), manage the flow of the unit with admissions/discharges, help with all the unstable patients (she could spend hours helping the bedside RN to advocate for a patient that is going downhill and needs to go emergently to the OR/the ICU) AND manage staffing for the upcoming shift. Basically on my unit, you can't win. I get called ALL THE TIME asking if I would like to come in to work this shift tonight, etc because of sick calls. They have a hard time getting people to agree now because the deals offered are to benefit the floor. They want you to come in to work an extra 12 hr night on Sunday during a week when you're on days and all they'll offer is "to take you off 12 hours somewhere else". Overtime is non-existent on my floor. They also have a shady formula for shift diffs so working a night shift doesn't put any extra money in your pocket. I've stopped doing them favors because I'm sick of the abuse from above. I do feel for the charge nurses who have to bear the brunt of everything, though.

As charge nurses we do staffing all the time. It is our responsibility to try to get shifts covered. I only have to call the nursing supervisor for her to override NASH so that I can use overtime, but that is never a problem...if you need nurses you need nurses. As for the male only order...what if there in not a male scheduled for that day? That is a pretty stupid order IMHO. If they truly feel that way then they need a security guard to be with the nurse who enters the room at all times. It isn't fair to the guys at all, heck a few of the guys I work with I could take on and win lol Joking aside, that needs to be addressed. If I called my supervisor about that, she would have sent a security guard up.

All facilities that I have worked in required the charge nurse to make calls to staff call offs for the next shift. Just what you want to be doing when there are so many important things to be completed at the end of your shift.I would contact the doctor for a clarification to the order for when males are not available. Perhaps he needs to reconsider the decision to place the patient at this particular facility.

Quote from psu_213For part 2, what makes the MD think that if the situation is too dangerous for a female, that a male should be able to handle it? While this sound chivalrous, I would be quite upset if I was the one male on the unit and I got assigned to this "assaultive" pt. I think the real issue here is that the supervisor needs to come up with a plan to keep staff safe (as someone else mentioned, this could mean have security posted at the door.

Wow I had no idea that so many places have the charge nurse do the staffing. Crazy. As far as the male staffing, this is something that has been frequently done on multiple units. We have had it frequently happen in the past few months, due to some of the patients we have had. We have quite a few male staff, so there is always a male somewhere between our multiple units. The not honoring the order is recent. Because it is psych, we have patients who get room restriction, with someone sitting in their doorway. Patients can become psychotic. We get patients who do respond better to males, which is why it's specified male only. Or you get a patient who will swing at anyone, with no warning. So the doc wants a male there. This particular patient attempted to punch the male sitting with him when he redirected him back to his room. You have a 200 pound, 6 foot male...they occasionally prefer not to have a female sitting with him. Patients on psych are unpredictable. They can't have security sit with every psychotic patient who has a history of being assaultive. So we do the next best thing.