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My hours are starting to get cutback


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Our ED director has now been sending us flash reports daily on the volume load and patient's seen/hr. This new company that has bought out the group is now making my director send reports daily to the VP on ED performance, etc and in return, we are asked to be team players and cutting back our hours when we are not "needed." They have set the goal in our ED to be 3.40 patients/hr. Docs will be making $8 hr more while APP's will be making $4 more per hour paid out quarterly. 

 

The thing that is annoying me is my hours are starting to be cut down. We are asked to leave early (up to 2 hours earlier) when things are slow. There has been times where we have been asked to not come as the volume isn't high enough. We also have residents in our facility, so there are times where a resident will be in our pod to pick up procedures and the next APP is asked to "come in later because we have a resident right now and things are looking good." 

 

Not sure if anyone else has been experiencing this with their work. It's frustrating because I depend on a certain # of hours each month, and I'm consistently having to shave off 10+ hours each month with these adjustments. 

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Had one employer try this previously

 

I just simply refused to come in late - just show up at scheduled time

Or leave earlier then scheduled time

 

They are paying you an hourly rate and you are committing to being their available - to simply say go home is not fair nor right....

 

 

If everyone simply just works what they are assigned all is well - make sure you leave some paperwork till the end of your shift so that you can always "look busy"

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Corporate medicine at its finest....

 

Do you have a contract? What does that contract say about hours per shift, hours per month, etc?

 

Have the docs complained? Somehow, nothing happens unless the docs complain.

 

Has the group talked all together about these changes? Any prevailing opinions?

 

Is there anyone in admin to talk to and inquire?

 

Hope it gets better.

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The APPs are all upset because many of us are being called off to not come in due to lack of volume. Our director says, "if we aren't seeing patients than we aren't on the clock." So I couldn't sit and do paper work because it doesn't correlate directly with seeing patients. I love this hospital, the docs, staff. I absolutely hate this NEW ED group. 

This was a sample email that our director had sent us this week. I think it's the upper people pushing up on him for these numbers. The docs are kind of whatever about it as they are getting their hours but not as drastic as us. 

 

"While we are on “CODE STATUS”, every director in (OUR GROUP) must report the prior day’s metric to his/her VP, by noon (7 days/week), unless we die.   In addition, we are suppose to ge the daily data to you all (our teams) as well.   Likewise, all the VPs, must turn in reports to senior leadership in the afternoon, as to each of their assigned sites.   Once our company is back and resusitated (i.e. normal vital signs), then hopefully we can back off on the daily reporting.   I plan on sending out our DAILY metrics, of the prior day’s stats.   I will be looking at ways we could have improved, especially when we feel sinfigicalnlty short of our target (3.40).  In addition, I will watch for trends, that might allow us to cut hours [ahead of time] from our monthly schedule.  We are looking to get the RIGHT SIZE, so that our DAILY RESOURCES MATCH OUR DAILY DEMANDS.  
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CLASSIC bean counter admin vocabulary vomit and "metrics".

 

Doesn't sound like anyone in admin has looked at patient care, bouncebacks, call backs, wait times, radiology delay, lab delay or any other "metric" that associates with reality or real life. As usual - no one actually cares if the patient receives the right care in a timely fashion with proper instructions and follow up.

 

When I read emails like that - I vow to never get that masters in healthcare admin because then I could be "one of them" and hated by all.

 

My ideal spiteful dream would be that someone from admin comes to the ER as a patient and I walk into their room and say "sorry, I can't see you. I have been sent home on low census and I already saw my 3.4 patients this hour. Someone should be along at some point. Perhaps a resident or someone who is getting paid to be here." 

 

Sorry, super bitter about corporate types these days.

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3.4 pph is ridiculous unless you are pure fast track or are getting paid big bucks to work your butt off.  Hopefully your contract specifies hours in it.  This should be a lesson for all to make sure the minimum and maximum number of hours are listed in your contract.  Working more or less only if mutually agreed upon.    

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CLASSIC bean counter admin vocabulary vomit and "metrics".

 

Doesn't sound like anyone in admin has looked at patient care, bouncebacks, call backs, wait times, radiology delay, lab delay or any other "metric" that associates with reality or real life. As usual - no one actually cares if the patient receives the right care in a timely fashion with proper instructions and follow up.

 

When I read emails like that - I vow to never get that masters in healthcare admin because then I could be "one of them" and hated by all.

 

My ideal spiteful dream would be that someone from admin comes to the ER as a patient and I walk into their room and say "sorry, I can't see you. I have been sent home on low census and I already saw my 3.4 patients this hour. Someone should be along at some point. Perhaps a resident or someone who is getting paid to be here." 

 

Sorry, super bitter about corporate types these days.

 

I  dream of having coffee someday with RealityCheck2 as I have pondered that same thing about administration and whether or not to try to get in the fray.

I won't do it, especially after these last 2 weeks of my new schedule to squeeze more people in, and answering to bean counters.  Yuck. 

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We're actually a good volume, we range between ~220-250 a day. The numbers have been around 180s due to the winter.

 

Has anyone else experience this portion of corporate medicine?

 

180 is low volume?!?!?

 

In the ED I work 140 is bat sheet crazy and 80 is an average day.... And if we have 60 we all sit around and chit chat. My love for my place of employment just grew 10%

 

I was hoping ud talk about ur contract and if it has hour specifications.

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I think volume is all relative to degree of staffing and bed numbers (two "major rooms, ENT room, 15 regular beds, and a 4 bed FT with two beds facing the other two beds and a center aisle all separated by curtains).  At my end point we were covering with three overlapping physician shifts/24 hours (7-7/11-11? as I recall/7-7) and a PA M-F from 2-12, with two PAs on weekends from 9a-6/6p-3a respectively.  These volumes were as noted above at about 170+ folks/24 hours.  Busiest times were early evening.

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The hospital that I work at is a residency hospital with 50 beds. We have 3 pods, which 2 pods have doctors with 2-3 residents.  We also have a triage doc. We have 4 APPs throughout the day. 2 from 9-5 and 2 from 5-1pm. We definitely have the support and staffing here. So my shifts are between 7-8 hours. Last Friday, I worked from 6pm to 10pm and left early due to lack of volume. Our director was referencing to the whole department as 3.40 pt/hr, not individually. I'm around 2.20 pts/hr. Maybe it's time to start looking for more part time jobs.

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I used to work in an ED that was part of a huge inner-city academic center. 68 or so ER beds, close to 100k ER visits a year. Three care stations/ pods/ units, not counting the stabilization area in the middle. So volume was fairly constant, BUT on those rare occasions when the patients just were not coming for whatever reason, it was possible to close one of the pods. The staff and/or resident in charge of that care unit had to do a "closed unit dance" which usually involved exam lamps being swivelled around disco-style, and several people filming it with their camera phones.

 

The charge nurse would go around to nurses and techs and see if anyone wanted to go home early. Even if the issue was one of not wanting to pay people, there would usually be a volunteer.

 

So I'm not saying you are overstaffed for the volume, but even if you are, it's a residency training program so at least 2-3 people per pod are having their pay subsidized a little bit by ACGME. Cutting off your PAs like that is insulting and unprofessional. It also sounds like they are trying to use it as a band-aid solution to a bigger problem.

 

In your situation, I would be sorely tempted to do as Ventana describes, and just refuse to go off the clock. I would also agitate for a good detailed analysis of volume trends and staffing levels. And I would definitely dump the responsibility for fixing the issue squarely in the laps of the people responsible for making the schedule. That's where the problem actually is, I think. You showed up as scheduled, you're working as scheduled, it's an ER. You are being paid to be there and be ready. End of story.

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3.4 /hr is crazy.

we are asked to avg 2/hr in main or 3/hr in fast track.

when I worked at a union job we still got paid for the whole shift if called off or sent home early. that was sweet.

my current jobs are all hourly.  I work enough now that I don't mind leaving early if slow. sometimes it's a blessing.

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I am baffled as to how one counts patients per hour sometimes.

 

When I was in ER - mind you, about 15 years ago - we had 1-2 docs and 1-2 PAs from 6 pm to 6 am.

Level II urban ER in a city of over 8 million.

 

We saw whatever hit the rack. Some patients took 2 hours to work up and give a disposition. Some took 10 minutes and were out the door. Some were codes and some were active MIs and some were psych cases requiring restraint and IM meds on arrival. Some I took because I speak Spanish, some the docs took because they just wanted that particular problem. Some we did rock/paper/scissors because of a frequent flyer or problem patient. If it was quiet - shhhhh, don't say that - we would take turns seeing the next patient.

 

So, I never worried about what I saw per hour. At the end of the shift - you either had a zillion charts to finish on the archaic computer system or you were mostly caught up depending on flow and numbers. 

 

No one ever went home early and, more likely, some of us were stuck there an hour after shift trying to finish the dang notes.

 

Knowing that the providers have ZERO control over what walks through the door - I cannot fathom measuring volume by the hour or devising a "metric" for ER flow. Patients aren't widgets and you can't control them coming in - unless someone is out on the roads hitting them with cars to produce volume.....

 

If the volume at an ER is down then something else is wrong. Either word is out that the service sucks or there is an UC nearby with a shorter wait time or some UC has a candy-man who will write narcs. The admin bean counters should be looking at patient satisfaction and quality of care rather than numbers per hour.

 

Wrong focus - but, then again, they are admins.......

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The hospital that I work at is a residency hospital with 50 beds. We have 3 pods, which 2 pods have doctors with 2-3 residents.  We also have a triage doc. We have 4 APPs throughout the day. 2 from 9-5 and 2 from 5-1pm. We definitely have the support and staffing here. So my shifts are between 7-8 hours. Last Friday, I worked from 6pm to 10pm and left early due to lack of volume. Our director was referencing to the whole department as 3.40 pt/hr, not individually. I'm around 2.20 pts/hr. Maybe it's time to start looking for more part time jobs.

 

So how are you supposed to make up that income? They send you home after 4 hours???? No Freekin way for me......nope, nada, not gonna happen......

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