Mention the words "nursing shortage" and a feeling of panic arises. A shortage creates situations that require nurses to work long hours under stressful conditions, which can result in fatigue, disengagement, and ultimately, turnover. Additionally, nurses working in stressed environments are more prone to making mistakes and medical errors, resulting in reduced quality of patient care. Patient satisfaction can suffer. Replacement costs can rise.
Yet, organizations often engage in practices that create own nursing shortage. These problem can be avoided by examining a few common staffing practices:
What's the Right Staffing Mix?
Every healthcare organization needs to develop a staffing mix uniquely its own. Most organizations simply create hiring targets in line with the budget that the finance department gives them. Instead, nursing and other departments should work with finance departments to leverage analytics that reveal true need and then adjust targets in line with actual demand. Additionally, many organizations hinder their own staffing ability by requiring too high of credentials when new grads and early career clinicians could possibly fill certain positions quite well. Some leading organizations have developed excellent programs for new grad and early career nurses that provide better orientation and long-term mentoring, developing a home-grown supply of nurses with long-term commitment to an organization. This can be important, because Avantas research shows that staff with less than 3 years of tenure at an organization have a higher likelihood of turnover.
Current Staff Not Meeting FTE Commitments
Too often, healthcare organizations do not schedule staff to meet the full-time equivalent (FTE) that they were hired for, or for their holiday and weekend commitments. This common practice exacerbates existing staffing problems. Organizations can seem to run short of staff because they are not requiring staff to work up to these FTE commitments, or they don't have a solution in place that automatically tracks and flags these situations in time to fix them. Some organizations address this problem through a requirement that no schedule can be approved unless all staff are scheduled to their FTE. Not requiring staff to fulfill their commitments can create an atmosphere of favoritism that corrodes morale and can increase the risk of turnover.
Ad Hoc Scheduling and Staffing Policy
A disconnect between an organization's policies and practices that vary from department to department is another common problem. Seemingly insignificant things, like not following a cancellation order when overstaffed or not adhering to the established staff float order, can have a negative effect on morale. Staff appreciate consistency with the application of policies. Even if they don't necessarily like a policy, clinical staff appreciates that rules are the same for everyone. Unbalanced schedules and allowing too many people to take off certain days (first day of school, Mother's Day, Halloween, etc.) can lead to artificial shortages, requiring the use of unnecessary overtime and external staffing sources.
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Effective and efficient staffing and scheduling practices can be achieved through modern business tools, designed for healthcare, that ensure that sound policies are followed. Analytics tools can be utilized that help establish better staffing level targets at the department and system level. Predictive analytics can help ensure staff are scheduled in line with demand to reduce instances of overstaffing and understaffing, overtime, core staff floating, and cancellations.
The first defense against a nursing shortage is to optimize the human resources you already have. For the foreseeable future, workforce supply and demand will remain a real challenge for almost every healthcare organization. Let's not make it worse through inefficient scheduling and staffing practices.
Jackie Larson is president of Avantas and Dan White is president, strategic workforce solutions, AMN Healthcare