Where others have failed, Helen Merillat succeeds.

She manages the registry, eight full-time positions and a pool of more than 260 RNs, LPNs and ancillary staff who self-schedule and work as needed to cover illnesses, vacations and leaves of absence at The Toledo Hospital.

Merillat's registry has gone a long way toward solving the hospital's nursing shortage and increasing satisfaction of patients admitted through the emergency room.

When Merillat took on the registry two years ago, she inherited 25 people. "The administration gave me numerous full-time positions and I had no takers," she said. "People were gun-shy," the result of a series of changes in leadership and philosophies about the use of pool staff.

With stability, though, including Merillat's 31 years at the hospital, "I have people coming to me asking for permanent hours," she said.

Registry staff, about 75 RNs among them, fall into three categories: med/surg, adult critical care and women and children. Each nurse goes through an orientation and is assigned a mentor.

"I think the secret right now to getting nurses is flexibility in their scheduling," Merillat said. "I have nurses who are moms and they get their kids home from school, feed them supper and come to work from 7 p.m. to 11 p.m. I have moms who are home-schoolers and they just work on weekends."

She calls self-scheduling an employee pleaser, but it comes with a caveat:

Don't get yourself in trouble with attendance by being too optimistic in scheduling.

That's more of a temptation for interns and externs who-through the registry-get their first taste of the real world, as Merillat puts it. Interns are nursing graduates who have yet to pass their state boards; externs are LPNs and nursing students.

The registry builds in them a loyalty that is key to internal recruitment, and gives unit managers a chance to assess potential full-time employees' skills and work habits. Merillat makes regular rounds of registry staff, "looking to see if they are in over their head on anything," and observing patient care.

An admissions nurse, one of Merillat's full-time positions, is assigned to the emergency room when it's bogged down and is responsible for a surge in patient satisfaction. "We're a tertiary care center and we have a lot of people fed into us," Merillat said. "Tuesday to Saturday, the census can go straight up."

The registry admissions nurse provides continuity for patients, handling paperwork and physicians' orders, Merillat said. "When there is a bed, they can just take the patient, give a report and turn them over to the unit nurse. It really takes some of the pressure off the unit nurse who is trying to do her best to finish up with patients who are going home.

"We get things rolling," Merillat said. "It's a satisfier for the nurse and a satisfier for the patients."