Last Minute Sick Calls Wreak Havoc on Nursing Units

Awhile back my husband, employed at a hospital, came home from work saying, “Hey, if you’re thinking about going back to PICU nursing, they’d probably hire you tonight. They’re down three nurses from sick calls.” 

by jparadisi

by jparadisi

Ah, yes — sick calls and their impact on nurse-to-patient staffing. Is there any phone call that wreaks more havoc on nursing units than the last-minute sick call?

In the outpatient setting where I work, sick calls from coworkers are not as dire as they are in hospital settings. Even if I detect a slight grimace in the voice of the nurse on the other end of the phone as she sizes up the day’s schedule, she always says, “I hope you feel better. Get some rest,” and I know that she means it. We take care of one another that way. In fact, we encourage one another to stay home when sick — not only to protect our patients, but also because we don’t want exposure to one another’s illnesses.

Not all nursing units share this courtesy, however. Years ago, I worked for a hospital with centralized staffing. Schedulers, not nurses, received and tracked all staff sick calls within the hospital. For the one I spoke to, calling in sick wasn’t enough. She demanded a diagnosis: “What exactly do you have?”

Never exposed to this sort of interrogation over a sick call before, I was annoyed.

“I have projectile vomiting and diarrhea,” was my response.

She ended the conversation abruptly, after excusing me from work.

It’s hard to argue with projectile vomiting and diarrhea.

Some hospitals have developed methods for dealing with unexpected sick calls, such as float pools of resource nurses with a variety of skill sets, scheduled on call for several units. In others, nurses agree to come in for an ailing coworker, who then picks up one of that nurse’s shifts, offering the unit nursing coverage while avoiding overtime.

It’s contradictory to urge nurses to give compassionate patient care if their employer does not treat them compassionately, too. Sick calls cost healthcare institutions money, no doubt, but it is unrealistic to believe sick calls are completely preventable.

Staffing is an ongoing dilemma in healthcare: There often are not enough nurses, and just as often, there are too many. Like Goldilocks looking for a place to rest, we strive to get a staffing number that’s just right. This predicament is unlikely to disappear, so why not be civil about it?

How does your institution manage nurse sick calls? Have you or another nurse been penalized for sick calls? Has your institution developed solutions?

The Damaging Effect of Preciosity

Preciosity is over-refinement in art, music, or language, especially in the choice of words.

Nurse as Sisyphus by jparadisi 2012

Nurse as Sisyphus by jparadisi

I am struggling with preciosity while writing this post. A clever idea isn’t coming, and I feel distress, because I need to wrap it up. If I cannot write something profound, then at least I should be entertaining.

Preciosity is an art term with a negative connotation. An artist should never hold something she makes so precious that she cannot bring herself to change or even destroy it, because the bit of paint or brush stroke that’s considered precious enslaves the painting.

Writers are familiar with preciosity too. Sometimes the best-loved words are the very ones that need editing to clarify the thought. Any precious bit a writer or artist insists on retaining becomes an obstacle to the larger creative process, very often ruining the result.

Being a nurse also requires a resistance to preciosity. The best care plans are never perfect. A beautifully constructed work schedule becomes overwhelming, because of a staff sick call or unexpected admissions. We administer a medication, and the infusion is delayed or halted, because the patient has an allergic reaction to it. We are disheartened by the recurrence of disease in a favorite patient. On very bad days, we make an error.

There is no preciosity allowed in either art or nursing. Everything is up for grabs and can change in a heartbeat. Nurses striving the hardest for preciosity are the most doomed to disappointment in colleagues, patient outcomes, and themselves.

A good day of patient care cannot be summoned on command from a nurse any more than a masterpiece can be summoned from an artist or the next great American novel (or a blog post) can be summoned from a writer. Some days, both in nursing and in art, the best you can do is show up and try your best.

At the end of a shift, you may have made someone feel better, but perhaps all you did was prevent that person from getting worse. Likewise, after painting all day, you may end up taking a palette knife to the canvas and scraping all that newly applied paint to the floor, so that you can start again tomorrow.

Seated in my favorite chair while writing this post on a laptop, I struggle to keep myself from deleting it. Some days, both as  nurse and a blogger, this is the best I can do.