It is no surprise that nurse staffing is a subject of contention. After all, it is a highly complex issue regardless of the setting-acute care or outpatient. Many organizations focus solely on the inpatient issues surrounding immediate staffing concerns and fewer resources on the act of scheduling. Research shows, for instance, inpatient charge nurses spend up to 90% of their day on staffing-related issues. Think about all the time that could be spent on initiatives such as patient experience, pay for performance, and staff engagement if we could just solve staffing issues!
Over a decade of research, which includes a meta-analysis 1 and work through the Agency for Healthcare Research and Quality (AHRQ), has provided overwhelming support that nurse staffing affects patient outcomes. There is no doubt that adding RN hours to patient care can save patients’ lives. But, can we obtain the effect of the additional RN hours without adding an RN through smoothing the patient flow, or the “churn”?
With an average RN turnover of 15.1%, with RNs planning to turnover in 2015-2016 at 42 %2.3 and a projected shortage of at least 20 % in the next decade, healthcare leaders need to address the issues that drive RNs to leave. Additionally, 44 % of healthcare workers cite a heavy workload as the biggest reason that prevents a satisfied work/life balance. Long hours and juggling multiple patient needs with insufficient staffing levels to meet those care requirements are not reasonable.
ANCC Magnet® organizations and decades of research in acute care and outpatient settings have shown that when nurses can provide quality patient care, they are more satisfied! Allowing nurses to have the time to build therapeutic nurse-patient relationships communicate and care for people is integral to nurse satisfaction. Creating an environment conducive to nursing care improves morale and retention of nurses.
Smoothing the Context First
Quite often, when I am working on staffing and scheduling issues with organizations, the main focus of management is to do more with the resources at hand. Those resources are nurses. The actual process of staffing and scheduling go through a Lean process transformation, new policies are put into place and organizations implement staffing and scheduling acuity tools. Yet, the context-or patient flow-remains unchanged. Thus, the unsmoothed variability creates a fire drill each day for the charge nurse and the nurses providing care, trying to provide care that is safe, sane and satisfying, yet within the target hours per patient day!
The first thought an organization should have going into resolving staffing and scheduling issues is to smooth out the variability of the patient flow. Yes, this is quite possible. Patient flow is both natural and artificial (man-made!). Before you attempt to retool staffing and scheduling processes or change your delivery model, resolve your artificial variability first. Artificial variability is how we schedule patients to come into the hospital or outpatient setting. This can have a tremendously negative effect on nurse staffing. Traditional staffing and scheduling systems, for patient and nurses, do not take patient flow into consideration.
If you have staffing issues, the first step is not staffing and scheduling software, nor creating Lean processes and new policies around staffing. It’s smoothing patient flow, fixing the context in which patients enter our clinics and hospitals so that nurses can provide meaningful care.
1.Kane, R.L., Shamliyan, T.A., Mueller, C., Duval, S., & Wilt, T.J. (2007). The association of registered nurse staffing levels and patient outcomes. Medical Care, 45(12), 1195-1204.
2. Harris Interactive, 2013
3. SIA, 2012, 2013, 2014
Mensik is the chief nursing officer at LeanTaaS.