Even though everyone knows the only constant in life is change, implementing that change can be difficult. When faced with a scheduling and staffing problem on several units at Lake Forest Hospital in Lake Forest, IL, the team of nursing supervisors, human resources and even the chief nursing officer looked for ways to encourage PRN staff to pick up their required hours. They also sought a better way for nurses on the floor to complete their schedule without as much last-minute scrambling.

"The whole hospital was undergoing some changes, and we were looking for a way all departments could be more accountable for their scheduling and for our PRN staff to pick up their hours as well," said Tami Heidenthal, RN, team leader for nursing supervisors.

Benefits & Challenges

By creating pools of PRN staff based on their commitment to working hours and pay, the team of supervisors also examined their scheduling software systems looking for various improvements that would enable nurses to schedule their time in advance and more effectively. By installing a new computerized timekeeping system, supervisors have been able to look at the schedule in advance and see where staff is needed.

"We were trying to eliminate the need for an agency or overtime," said Heidenthal, noting implantation was a lot of work. "We are trying as a hospital to give the best care to our patients with the staff we have and this program has helped tremendously. Now that we have implemented the program, PRN staff can pick up their hours and we have lost very few nurses over the change."

One of the challenges for the team was working with human resources and establishing a pay rate that was competitive and would encourage staff to schedule their time and honor their commitment. After months of strategizing and planning, the program was rolled out to the staff members who were willing to try something new.

"It took about 3 months once we rolled it out for everyone to get on board," Heidenthal acknowledged. "Everyone is really proud of the program we created."

Team Effort

Nancy Nozicka, BSN, RN, CEN, is a staff nurse in the emergency department who was part of the committee for the scheduling change. She said what made the process a success was being able to work with different managers, staff nurses and schedulers to get a sense of what the various issues were.

"We spent some time with HR and payroll after creating this program before rolling it out to the staff. We wanted to make sure we had a desirable, flexible and economically feasible package to offer that had something for everyone," she said.

The new process was well-received because so many people from the various levels of employment around the hospital felt they were listened to and presented with a scheduling program that was fairly complete.

"We didn't have to go back and say we'd forgotten about something," Nozicka said. "Of course, there is never a perfect system, but we have a lot of options and flexibility. Ultimately, we want the patients to be taken care of properly, and we want to be well-staffed. Not adequately staffed, but well-staffed."

Kim Fiester, MSN, RN, team leader of the telemetry unit, said creating this system was exciting and frustrating at the same time, but she said the team worked well together to create a system fair to everyone.

"It wasn't just nurses," she said. "We had input from a lot of different people and, as a result, we have a system that is a lot less stressful; there is less scrambling trying to fill holes at the last minute. There are still some shifts we have to fill in, but we have the schedules more complete farther out. It offers more with less work."

Fiester said the experience was further enhanced thanks to the support the scheduling team received from upper management levels. She said they were given the responsibility to ensure every department's needs were heard and hopefully met.

"They trusted their units had input," she said, noting she feels a special pride knowing the team is being recognized for their effort. "There is a lot of pride in knowing you are helping to make strides and make a difference."

Julie Young is a frequent contributor to ADVANCE.