Improve the work environment for your nurses with better scheduling and staffing
November 10, 2016
Danielle Miller, PHD(c), MSN, RNC-OB, Chief Nursing Officer, Clinical Applications
Nurse scheduling problem (NSP) is a phrase used to describe the multiple complexities associated with nurse scheduling in healthcare. While nurse leaders may dread hearing anything about NSP, I think we all know that challenges exist. And the challenges are likely to get even greater, since our ability to schedule and staff appropriately is crucial as we transition from fee-for-service to a value-based care delivery model in healthcare organizations across the globe.
When I was in a leadership position in labor and delivery, just like many of you, I had to deal with NSP. Staffing for patient needs can be overwhelming, since the needs of patients change from moment to moment and meeting those staffing requirements can be like shooting a moving target. When I published the schedule for staff, I only had historical data to make staffing decisions. What I didn’t have was access to the peaks and flows in the daily schedule and when I would have an influx of patients.
Every six weeks I faced the challenge of publishing a schedule for what I thought I needed. Every day, I would then try to staff based on what was actually happening in the unit and on the unique needs of the patients we cared for. I also needed to constantly work toward minimizing labor costs, maximizing quality indicators and outcomes, and maintaining patient and employee satisfaction. I really needed access to real time data in order to make the best staffing decisions to truly impact patient care.
Inadequate staffing and schedule management are contributing factors to a poor work environment, burnout and eventually turnover in any healthcare organization. Having the tools to publish a fair and equitable schedule and staff accordingly is the Holy Grail in Healthcare. Having access to data in real time would have made my job and the jobs of my nurses much easier. While you can attempt to be as predictive as possible, the rubber meets the road on the day-to-day staffing needs of the patient. On more occasions than I care to remember, leaving for the day with adequate staff only to come in the next morning to find out the census changed dramatically and more nurses and support staff were needed to provide appropriate care to patients was never a feel-good moment.
The operational management of inpatient nurse labor through nurse scheduling and staffing techniques is not as simple as supply and demand. When I was in the inpatient setting, staffing decisions had many variables to consider. Part of the complexity includes nurse and patient characteristics, length of shifts worked, number of available staff, geography of the unit, and regulations of the nurse bargaining units. All of this must be considered when trying to provide an improved work environment and for healthcare providers to deliver great care to their patients. Having the ability to schedule according to the needs of patients and provide assignments that are fair and equitable leads to employee and patient satisfaction. Thus, the achievement of adequate staffing is imperative for nurse job satisfaction and the retention of qualified nurses. The burden of losing experienced nurses has significant financial ramifications for health care institutions related to replacement costs as well as the possibility of adverse patient outcomes.
If you can impact and improve the experience of the providers of care, you can impact the care patients are receiving. Improved provider experience leads to a boost for patient care. A happy and engaged workforce leads to a more engaged patient population with better health and better outcomes.
So what is the solution? Organizations need to provide front line leaders with the tools to make appropriate staffing decisions. Consider starting with acuity based staffing. The ability of acuity systems to pull objective data from the EMR allows for nurse leaders to predict staffing needs based on the needs of the patient. Since acuity systems are based on documentation, the need for real-time data capture becomes even more critical to create a foundation for decision-making. The more data the acuity system has, the better able it will be to provide direction for scheduling and staffing.
Ideally, in a high-tech, meaningful use environment, nursing interventions would be captured as discrete data elements that could be codified by the EHR to help quantify nursing acuity to inform staffing decisions.
The advances in healthcare technology provide us with an opportunity to be creative and innovative in addressing and finding solutions to the nurse scheduling and staffing challenges in healthcare. Ideal scheduling and acuity based staffing are linked to operational and clinical excellence. By leveraging technology, you’ll be able to provide high quality care to patients while being fiscally responsible to your organization.
- North America