5 Ways to Manage a Low Census

Every nursing floor or unit has been there at some point. It’s a slow shift, the patient census has suddenly dropped, and the charge nurse is asking you, the nurse manager, if nurses should be sent home. It can be tempting to immediately say yes — especially if you’re focused on the budget.

But there are other, employee-centric options available for dealing with low census. In hospitals, there aren’t any one-size-fits-all solutions since every facility and unit often has unique needs and conditions to consider. Still, there are many creative approaches to managing staffing that you can use as a starting point for creating a fair strategy for your team.

In this article, we’ll discuss what a drop in census is and take a look at five ways to manage it in ways that build trust and will leave your staff feeling like valued professionals and members of the team.

What Does Low Census Mean?

The healthcare system is by nature a very fluid industry because it depends on human health and accidents — factors that can be hard to forecast. Seasonal variations in patient volume impact the number of beds being used on units, which in turn affects revenue and staffing. Some fluctuations cause a predictable ebb and flow that can be anticipated ahead of time.

There are also factors that are entirely unpredictable, like mass casualty incidents or pandemics, that cause drastic, unexpected changes in the patient census. All of these fluctuations make appropriate staffing a challenge and many facilities struggle with finding safe solutions that are flexible enough to meet the needs of patients and staff.

Low census happens when there’s a significant decrease in the number of patients in your facility or floor, regardless of whether it’s expected. For example, more patients were discharged from your unit than were admitted, causing a drop in census. The nurse-to-patient ratio is suddenly higher than predicted, and there are more nurses than would typically be staffed for that shift.

Why Is Adequate Staffing Important?

Managing drops in patient numbers requires a flexible, creative approach to staffing. All too often, the knee-jerk response is to cancel shifts or send nurses home and reassign their patients to the remaining nurses. However, a reduced-staffing approach can leave your floor understaffed, creating negative impacts on patient care and staff satisfaction.

Studies show that adequate staffing increases patient safety and nurse well-being. In fact, better staffing is associated with many benefits, including:

• Fewer patient falls.
• Lower patient mortality.
• Higher patient satisfaction.
• Fewer hospital-acquired pressure injuries.
• Fewer surgical site infections.
• Higher quality of care ratings.
• Lower nurse job dissatisfaction.
• Reduced nurse burnout.

With this in mind, flexible staffing strategies must expand and contract to accommodate for census fluctuations, while at the same time ensuring adequate staffing. Staff satisfaction and patient outcomes depend on it.

Ways to Manage Staffing That Support Your Team

Here are five effective ways to deal with lean times and manage a drop in census with solutions that are staff- and patient-focused.

1. Support Professional Development Through Cross-Training and Floating

Showing up for a scheduled shift and then being asked to float to another unit — unexpectedly and without formal orientation — can be an incredibly stressful experience for any nurse. On the other hand, many nurses on your team are likely looking for professional development opportunities to expand their scope of practice.

Creating a plan to formally cross-train staff to other floors can be a major win for both management and staff. After a structured orientation with adequate training, nurses will feel confident and competent floating to another floor and will appreciate the investment in their professional practice. As the manager, you benefit from a more flexible workforce. The next time there’s a significant change in the census, you’ll have an internal pool of nurses to draw from who will be eager to help out, rather than feeling unprepared and exploited.

Key Takeaway: Training investment on the front end will reward you with a more adaptable team and benefit nurses with an opportunity for professional development.

2. Use the Opportunity to Promote Staff Wellness

Going home early or having a shift called off can be a huge boost for mental and physical health — if the nurse wants to take the time away. Promote wellness by looking for volunteers first and encourage the nurses who want to go home early to do so, when the census allows. On the other hand, being “sent” home can leave staff feeling mistreated.

Do you get paid for low census work? It depends on whether your facility places staff on-call or calls shifts off entirely. Many facilities allow nurses to choose between using paid time off (PTO) or unpaid time to cover the hours (while maintaining their FTE) when they are called off or sent home. This strategy gives staff the option of saving their PTO for when they need it most — during an illness or vacation.

Be sure your practices align with state and federal employment laws, in addition to any facility policies or union guidelines.

Key Takeaway: Giving your team the option of going home or being called off can boost morale and wellness.

3. Establish a Fair Low Census Nursing Policy

Following a policy for dealing with census staffing issues is essential for bringing transparency and fairness to the process. The policy should define the process for deciding who will get called off first (e.g., travel nurses, per diem, staffing agencies, nurses earning overtime pay, etc.). Account for any contracts that give contract nurses “guaranteed hours”. Make sure the policy complies with state and federal employment laws (including worker misclassification laws), in addition to any facility policies or union guidelines.

Key Takeaway: A policy brings standardization and impartiality to the process.

4. Budget for Additional Office/Administrative/Education Time

Why send staff home when they can help with other tasks and initiatives? Consider using the extra nurse to relieve nurses for their meal breaks, or help with competencies, or training. Often there are new skills or equipment that nurses must be signed off on. Use this time to complete those educational activities or a quality improvement project. Some managers budget for office, administrative, or education time to separate pay for these duties from patient care.

Key Takeaway: Create a budget that supports your team and educational activities during a drop in census.

5. Use Creative Staffing Solutions

Consider using flexible staffing solutions to help accommodate a fluctuating census. Find the best fit for your unique needs. Your floor might benefit from travel nurses, per diems, float nurses, a staffing partner, or agency staff.

Key Takeaway: Explore alternative staffing solutions to find a customized fit for your needs.

Looking for More Ways to Utilize Flexible Staffing?

Now that we’ve answered the question, What is low census? and you have five ways to manage it, you might be interested in more ways to create a flexible workforce. Reach out to us today and learn about our wide range of staffing solutions that can help you build a stronger and more resilient workforce.