Our nurses can be either green people or purple people. The choice is theirs, as are the perks - more hours for green people who are willing to float, more time off for purple people who'd rather not. Let me explain the concept behind what has become the backbone of our freestanding multi-specialty center's staffing plan.

Green goes places, purple plays on time off
Green people are willing to float to any of our four designated departments - OR, endoscopy, pre-op and PACU - and to perform any job. In return for floating, green people are guaranteed to work more hours. Purple people are willing to go home when their work is done to ensure that they don't have to float to other departments. We say green "goes" other places and purple "plays" on time off, but my staff refer to green as "greedy" and purple as "poor" in their paychecks. Both green and purple people are very valuable, giving us the best of both worlds: a ready supply of trained staff willing to help out whenever and wherever they're needed, as well as those content to flex their hours and go home when the schedule ends. Although neither is preferred over the other, I've found that it's best to have an equal supply of green and purple people. Our 30-person staff is a little green-heavy right now (70 percent are green), but we let our nurses and other clinical staff change their designation every six months.

Green people are entitled to complete projects, work on quality improvement or float to another department at the discretion of the charge nurse. For that privilege, the green person must maintain her competency in the other departments - this way, a nurse who wants to work her eight-hour shift on a slow day can't use as an excuse that she hasn't been oriented to PACU or hasn't worked there in a long time.

Low-census days
When there's not enough work in our four ORs and three endoscopy suites to justify the staffing we have, I work my way down the names on our alphabetized low-census list and offer nurses the chance to take a day off. I either write in the box next to a nurse's name the date of the low-census day, or "no" to indicate a nurse passed on the day off.

Some days, I can let anyone but an OR person off, and on those days I skip the OR team members' names until the next opportunity. This came up because the PACU staff rightly complained that the OR and endo staffs were getting low-census days, but they never did. (One of the departments is usually busy.) Now we rotate the opportunity to be off. This gets somewhat complicated for me to make sure that I have experienced staff in all departments, but it all works out with some flexibility.

Not so easy being green
This program was an instant hit with the staff who don't want to float and don't mind going home early, but a bit of a struggle for those who chose to be green. This is because the green people wanted to retain the best of both worlds. We had to emphasize the benefit of being able to get their hours, and the fact that we supported their going to other departments in their slow periods to keep up their other skills. I also pointed out that being green was not for everyone and any staff member could chose the option to be purple.

The nine months since we instituted this plan have been fabulous for me. When I need to float someone now, I don't get the long faces or the complaints that used to happen. And equally important, our staff is very happy with the plan.