How to Handle a Low Census: Know Your Options

A male nurse walking down a hallway
Written by
Hargun Kaur
April 9, 2024

How to Manage Low Census in Healthcare

Every healthcare facility or medical center has two major priorities: quality care and cost efficiency. The interconnection of these priorities lies in one key component of the healthcare environment: nurses

Hospitals and other facilities with favorable work environments, adequate staffing levels, and qualified nursing staff provide high-quality patient care. However, these factors have more nuances for both clinicians and facility managers. 

The challenges of today's healthcare system require all the actors involved to deal with staffing adjustments due to patient census, nurse burnout, and nurse turnover, all of which have human and financial consequences.  

As we go deeper into the meaning of low census, let's start with the basics. 

What Is a Low Census?

In the medical field, census refers to the population of patients in a medical facility. So, what does low census mean?  

A low census is a lower patient population than would require the complete staff of a facility. When there are fewer patients at a facility, fewer nursing staff are needed to provide high-quality care and are typically sent home. 

Keeping track of a facility’s census implies keeping up with the staffing, the scheduling of the nursing staff, and all the resources they will need to execute their jobs efficiently. 

What Causes a Low Patient Census?

Many facility managers opt to work with a fixed census throughout the year. Yet, when managers take this approach, they risk the financial weight of being overstaffed during an unplanned low census season.

Every nurse and healthcare administrator knows that census peaks generally occur during the end-of-the-year holiday season. For example, December typically requires more staff since this month has a higher rate of heart attacks and seasonal illnesses such as influenza, among other conditions.  

On the other hand, in many cities, summer means more travel for residents, resulting in a lower census due to a reduced local population. 

When you keep the score of your facility’s patient census, you can determine accurately when a higher or lower census season may fall upon your medical center and, therefore, plan strategies for the low census in your facility. 

Options for Nurses during a Low Census

As nurses educate themselves on this matter, they can find different ways to prevent or reduce the direct impact of low census on their paychecks. 

One of the essential elements to consider in the matter is understanding your facility's low census policy fully. This policy includes the order in which facilities can ask staff to go home, whether the released staff will receive credit hours and other specific details.

Some nurses' contracts may state guaranteed work hours, which provides relative certainty regarding their minimum income. 

Other clinicians take low census leave as paid time off (PTO) to maintain consistent pay. Now, while this measure can give you a sense of financial safety, there are other options for the nurse who wants to choose how and when to use their PTO. 

So, let's dive into the options for nurses during a low census:

1. Float Pool Nursing

A float pool nurse is a clinician who thrives on gaining experience and appreciates changing the pace of their daily routine, covering tasks and requirements in different units of the same facility. 

Since they work in different areas, a float pool nurse is easier to keep in the staff schedule and has potentially higher earnings. Float pool nurses may also find inspiration in the novelty of each assignment. 

2. PRN Nursing

While travel nurse pay is decreasing, nurses can delve into PRN jobs and pick up shifts to increase their earnings instead of tying themselves to ongoing contracts and fixed hours with a single facility. PRN nursing is an excellent option for becoming part of the medical field’s flexible workforce.

Working on a PRN basis allows clinicians to earn higher rates while taking full ownership of their time, working extra shifts to maintain a steady income, and maintaining a work-life balance. Nursa is a way to go beyond a single job, craft your own schedule, and request the shifts you want to work, when and where.

How Can Facilities Manage a Low Census?

Facilities can significantly prevent low census from affecting patient outcomes, staff well-being, and budget. 

Let's look at some effective tips for managing low census. 

1. Work on a Low Census Policy

Even if your facility already has a low census policy, it is always a good idea to work closely with the nursing staff and hear their needs and recommendations—they can offer you ideas for your staffing strategy. 

Whatever your approach might be, the policy needs to be fair to the staff and align with state and federal employment laws and union guidelines. 

2. Use the Cross-Training Strategy

Some managers opt to include educational costs in their budget when the patient census does not cover the need for the staff on shift. 

This strategy allows more experienced/qualified clinicians, such as registered nurses (RNs), to teach and guide other clinicians with less experience during on-clock hours.

Cross-training provides a win-win situation for an adaptable clinician pool in a facility’s team and for the professional development of the staff.   

3. Create an Administrative Budget

A low census can also become an opportunity to use the available staff to relieve other nurses of paperwork and administrative tasks. This strategy allows clinicians to take their well-earned breaks and focus their attention on their patients, resulting in better patient care and shorter patient stays. 

According to a 2021 observational study:

"Hospitals would have collectively saved over $117 million annually from length of stay reductions just among Medicare patients—cost savings which could be reinvested into financing safer nurse staffing ratios."

4. Apply Flexible Staffing Solutions

Managers are opting for fast and flexible staffing solutions in a world where the workforce's choice of flexible schedules is increasing, and nurse turnover creates a massive gap in the facility's finances. 

While many facilities are already working with travel nurses and staffing agencies, PRN nursing apps are proving to be a faster and cheaper solution for medical centers. 

"The hiring process can cost a facility an average of $4,683, translating into savings that hospitals can make using Nursa." 

Fluctuating Demand Doesn't Have to Catch You by Surprise

Nursa exists to put a nurse at the bedside of every patient in need, so let us help you.

Whether you are a clinician looking to take charge of your career with your first PRN shift or a hospital manager strategizing how to bring your facility to the top, you can register with Nursa now


Hargun Kaur
Blog published on:
April 9, 2024

Meet Hargun, a contributing copywriter at Nursa, passionate about life, travel, and spirituality. She specializes in content about locations where nurses can find work and topics related to preventive medicine and holistic healthcare.

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