How Many PRN Shifts Are Too Many PRN Shifts for the RT?

PRN Shifts

If you’re working as a PRN therapist, your employer likely has requirements you have to meet for number of shifts you are available to work.

How many of those shifts you pick up, and how many you’re working at your primary place of employment or through other PRN jobs, can mean the difference between providing a good life for your family or falling short when the bills come in every month.

But it can also mean the difference between delivering safe respiratory care and stretching yourself so thin that you aren’t really at your best when you enter the patient’s room to provide services.

Should RC managers track how many shifts their PRN therapists work? We asked three managers to weigh in.

Too many hours

Mary Lou Guy, MBA, RRT, manager of respiratory care at Saint Luke’s Northland Hospital in Kansas City, MO, believes PRN therapists who schedule themselves for more shifts than they can handle do pose a risk, and she has the personal experience to back that up. “I was actually one of those people who did the stints of too many hours and look back now as to how lucky I was not to have made a significant mistake — at least one that I know of,” she says. “I was going to RT school, doing 40 hours of clinical, and working a full time job while having two young children as a single mother.”

It was hardly an ideal situation, but like many other people in the profession, she felt it was necessary at the time. “We had to eat and I had to have a career to make that happen.” She feels fortunate that she only had to keep it up for three years and it took place when she was “young and healthy.”

Today she only has two PRN therapists on staff and she doesn’t monitor their lives to see how many shifts they are working altogether, but she does monitor their behavior to ensure they are delivering safe care. “These are adults — they have to have accountability to make decisions related to their needs,” she says. “Anyone burning the candle at both ends and in the middle will eventually exhibit unacceptable behavior.”

It boils down to this

At Tallahassee Memorial Hospital in Tallahassee, FL, Christy Clark, BSRT, RRT, has 12 PRN therapists on the roster and three open PRN positions. She staffs these therapists based on acuity, long-term sick leave, and vacation requests. Policy requires that they provide 16 hours of availability per pay period and most of them average 16 hours.

“Most of our flex therapists only work for our department and are waiting on full time positions,” says the AARC member. “For those that have a full-time job, we typically know where they work and what shift they work on at that facility.” Therapists with full time jobs usually schedule themselves in alignment with their primary shift or cover weekends when they are not scheduled at their primary job. Several work for local college RT programs, which makes PRN work on the weekends fairly easy.

Clark never schedules PRN therapists for overtime and would only schedule a therapist for 40 hours per week if she knew that therapist did not have another job. As a manager, she thinks ensuring safe care really boils down to establishing a personal connection with your therapists. “Taking the opportunity to get to know your therapists is important in helping you recognize when a therapist may be working dangerously,” says Clark. “If it is recognized that a therapist is performing below the standard, every effort would be made to ensure that they are safe to continue care or continue scheduling themselves without the interference of the department.”

Not a problem

James E. Shuke, MBA, RRT, manager of respiratory therapy medicine services at the University of Virginia Health System in Charlottesville, says he doesn’t have a set limit on the number of shifts PRN therapists can work, but like Clark, he never schedules them for any overtime. With just three PRN therapists on the roster at the present time — only one of whom also works a full time job in respiratory care — it hasn’t been much of a problem. One of the RTs only works one 12-hour shift per pay period and the other two work just two.

A bigger issue for him is full time employees who pick up overtime hours. While he doesn’t limit overtime hours for these therapists, he does remain vigilant to their performance and behavior. “If we notice that it is impacting the employee’s health or patient care seems to be affected, we would counsel them and limit their additional hours,” says the AARC member.

For employees who are having trouble financially, he says his hospital has resources that can help too. “We have an excellent Faculty and Employee Assistance Program that we can refer employees to if they are working many hours due to some type of financial distress. We would offer PRN staff the same actions and services if we had any concerns.’

Elephant in the room

For Mary Lou Guy, the 12 hour shift is really the elephant in the room when it comes to ensuring therapists — PRN or otherwise — are rested enough to provide safe care, and it’s one she believes should be changed. “Twelve hour shifts are too long, and too many 12 hour shifts are way too long,” says the AARC member. “At our hospital, the times when people likely need to be most alert — new patient, new information, new critical thinking needs related to discharges and new admissions and hand off — are falling at the end of the 12 hour shift when the employee is at their lowest energy trying to tie up everything so they can leave. Add to that the oncoming employee is likely just out of bed — not fully mentally awake and/or had less sleep than needed — and hand off information becomes very iffy.”

She often thinks about returning to the eight hour shift, but knows it would be a hard sell. “I’m sure there would be significant push back,” says the manager.

Heading to the New Era

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