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“Good Nurse Staffing”: What is it? How do you measure it?

June 25, 2015

Jocie Strong - in the beginning!

Our Guest Blogger: Jocie Strong MSN, RN, PCCN

(Picture from “back in the day!)

One of the most frustrating challenges I faced as a nurse manager was the capacity to consistently make “good staffing” decisions.  And to feel confident that unit charge nurses would be able to continue making good decisions on the off-shifts and on weekends, when I was not present.  The frustration stemmed from: (1) defining “good staffing” and (2) being able to track and measure “good staffing” on a day to day basis in real time.First let’s talk about defining “good staffing” decisions.  Most managers have productivity measures that they are held accountable to and often it is HPPD or nursing hours per patient day.  Usually these productivity targets are set annually and are static budgetary targets, based on a unit’s midnight patient census.  Typically, caregiver skill mix, as well as supplemental labor, is also factored into staffing performance to focus on the cost of labor.

However, with hospital reimbursement tied to performance metrics, more hospital organizations are trying to determine how staffing levels impact the patient experience from a quality perspective and patient satisfaction scores.  Staffing that meets budgetary targets, but places strain on quality care delivery, is not ultimately good for the organization.  Additionally, the level of staffing can influence the satisfaction and engagement of employees – a chronically understaffed unit with a high number of vacancies and unpredictable open shifts can lead to low morale, employee disengagement and costly turnover.  On the other hand, a well-staffed unit that can flex with volume and workload requirements can promote staff engagement and satisfaction, leading to positive patient outcomes.

So the optimal way to define “good staffing” would be to align to budgetary targets and flex to real-time workload requirements that support quality of care and a healthy work environment.

Now to the second issue – how can we track and measure “good staffing” decisions each shift?

In many cases, hospital finance provides a productivity report monthly and maybe even bi-weekly.  Unfortunately, this type of report only reveals past performance and does not provide shift by shift decision analysis.

Instead, to measure and manage good decisions each shift, unit-based decision makers (often the charge nurses) require visibility to patient turnover or churn, the contact census, (which includes admissions, discharges and transfers), the actual workload effort.   Charge nurses that have visibility to volume-based staffing needs, as well as projected workload requirements can use their professional judgment skills to provide safe and accurate staffing needs for the next shift.  In addition, the charge nurse can test different scenarios – “if I keep an extra CNA to cover our 1:1, what is the HPPD impact for the shift, the cost and will it meet quality of care requirements?”

Once a “good staffing” decision has been made, the charge nurse has supportive documentation that promotes paperless communication between all parties and the process has been simplified for the unit manager with real time reporting.

Finally, so staffing decisions can be “beneficial” for the whole organization, and not just for a single nursing unit, house-wide visibility is crucial for organizations to staff efficiently and safely to patient flow activities.  This visibility increases efficiencies, reduces overtime use and supplemental labor can be managed wisely.

Fortunately, modern integrated workforce management solutions have sophisticated decision tools to assist organizations when making “good staffing” decisions, addressing both fiscal and care quality challenges.  The successful nurse manager of the future can avoid staffing frustrations and can focus energy on evidence-based patient care while mentoring the next generation of nurses at the bedside, where it matters most.   The hospital in turn has a healthier environment.

Benefits of Measuring Workload in Nursing

June 10, 2015


Guest Blogger: Gerry Connors, MS, RN, LHRM,

Clinical Solution Specialist at Kronos

A workforce management solution enables healthcare organizations to gain insight into a myriad of important information about their most vital resource, their labor force.  Time and Attendance, Scheduling, Absence Management, HR/Payroll, Hiring, Analytics and Workload measurement are all key components in managing and sustaining a vital workforce for the future.

Workload measurement specifically is at the forefront in today’s landscape as hospitals take a closer view of the population they serve.  Workload measurement should always provide synergy to the equation.  Workload measurement is vital to the accurate and equitable allocation of resources and a complete picture of labor resource requirements.  Caregiver characteristics, the environment, level of team support, ancillary resources, unit geography, continuity of care guidance, and family dynamics with a real time plan of care should all be in concert to provide safe quality care.  The benefits of this synergistic approach provide a more meaningful balanced workload for the nurse and safe delivery of care for the patients.

Transparency of data including real time ADT information, physician orders along with nursing orders build collaboration of patient flow activities to staffing demands.   Staffing decisions will be in sync with operational efforts creating forecasting opportunities and trending data.  The multi-dimensional approach to workload measurement can also assist organizations in measuring staff satisfaction with the work environment itself building a stronger workforce for the future.

Hospitals that incorporate workload strategies within labor management will gain an advantage. In addition, current workforce management solutions that do not address workload measurement are not fully measuring the interrelationships, of staffing, scheduling and patient care outcomes.

Solutions that do NOT incorporate workload measurement into the staffing equation are not capturing the full picture.  With increased choices and a highly competitive market to attract and retain nurses, hospitals that reflect the full spectrum of workload in their staffing strategies will see a competitive advantage over their peers.

A Tribute to Nurses

May 12, 2015

A Tribute to Nurses
by Joyce Tyquiengco, Kronos Solution Consultant

From birth until death

In freedom and in war

In sickness and in health

Whether near or far



Their passion, their pain, their tears

Their love, their loss, their ache

They hope, they dream, they inspire

Saving, nurturing, healing, do they partake



They know you, their patient, by name

They keep you close in their heart

Silent heroes they remain

Amazing Nurses from the start



Not just during this week, but always

We honor you and all you do

Because when you take the hand of a patient, a person

The very essence of a Nurse shines through


To our Nurse colleagues near and far, thank you for all you do, for all you’ve shared, continue to share, and teach us in healthcare to improve who we are and what we do every day in the field.


Have a wonderful Nurses week!!!

Happy #NursesWeek!

May 6, 2015

Kronos created this video in honor of National Nurses Week (May 6-12, 2015). The purpose of this video is to recognize nurses’ unrivaled smarts, strength, and savviness in delivering quality care. Share this post and thank a nurse for all they do.

Patient Classification Data: Electronic Health Record vs. Workforce Management Solution

April 2, 2015

LoganWhere should Patient Classification solutions and staffing data reside:  Electronic Health Record or Workforce Management Solution?

Logan Brittain RN

Clinical Solution Specialist, Kronos Incorporated

 Hospitals in the past have purchased Patient Classificaton solutions for nursing to further evaluate the clinical picture of the care needed for each patient and in turn make better shift by shift staffing decisions.  Nurse Scheduling solutions have been purchased by hospitals to manage the largest and most costly group, nursing, because of the complexities of scheduling and staffing.  The idea was that utilizing both types of solutions would enhance care, give nursing a voice around patient activities and daily staffing.  This has been a long fought battle between finance and nursing leaders for decades because productivity is always in the balance and often the classification of patients led finance leaders to believe it would only serve to increase staffing.  Nursing on the other hand believed that patient classification would identify patient characteristics not measured in a scheduling solution and would reflect nurse activities throughout the shift thereby creating precision staffing for the oncoming shift.

Today the Electronic Health Record is essentially the bible of healthcare delivery, designed to gain efficiencies, standardize and produce volumes of data necessary to help build and sustain a vital healthcare system across the country.    While the EHR adds enormous harmony to the delivery of patient care the documentation alone cannot clearly define or translate all the necessary staffing characteristics that support patient care efforts across the enterprise and is often not timely for making moment to moment staffing decisions.

So when we step back and look at the reasons hospitals choose to use a Patient Classification system, shouldn’t we really be thinking about the whole versus the part and remember that sustainability for organizations today lies within the Workforce Management solution where staffing characteristics, patient flow, patient activities and workload collaborate together.  Let’s not confuse the issue, patient acuity serves “the patient” and more important how the entire organization is impacted.

Gamification is Becoming Serious Business in Healthcare

March 19, 2015

gamificationGamification – the trend of creating computer-based employee games and contests for the purpose of aligning employee productivity with the organization’s goals – is currently a popular topic with business leaders and IT. For proof, consider that Gartner recently projected that by 2015, 50 percent of all organizations will be using gamification of some kind, and that by 2016, businesses will spend a total of $2.6 billion on this technology.[1]


With numbers like these, it is clear that that gaming is serious business and that it is here to stay. But at this point, you may be asking yourself, “Could gamification work in my healthcare environment? What potential benefits could it have?”


Today, many healthcare organizations are looking to the future and considering gamification as a way to increase employee engagement, collaboration, and productivity as well as to align their behavior with larger business goals – but they don’t know how to do it quite yet. Also, gamification can be a delicate decision, complete with advantages and risks. After all, employees’ day-to-day work responsibilities and careers are not games and can’t be trivialized. Healthcare organizations must be careful to avoid sending the wrong message to their workforce, or the whole program could backfire, or even lead to more negative consequences.


A Closer Look at Gamification in Healthcare

Why should gamification be so attractive to healthcare organizations, and how does it work? Quite simply, gamification is the concept of applying game mechanics and techniques to motivate people to achieve a particular goal. The most common methods include the use of points, badges, levels, and leaderboards. Many games also include the aspect of a community to offer even more collaboration and encouragement.


It’s a familiar concept for individual users. There are already many games and apps designed to help people achieve a specific health or fitness goal such as games that promote running, exercise, and nutrition. There are even more specialized games to help users with specific issues like helping patients remember to take medication or helping children manage their diabetes. By tapping into people’s natural desires related to competition, collaboration, and achievement – in a fun way – these games can be very effective in changing behaviors and outcomes.


Innovative healthcare organizations are now attempting to use these same principles for their employees. Their hope is that these games will improve employee engagement and productivity while also generating better results for the overall organization – the ultimate win-win scenario.


Gamification in Action: Workforce Management

One area where gamification could deliver significant benefits is workforce management. Functions such as scheduling, time and attendance, training, can be time-consuming to manage or suffer from low voluntary participation. This means that managers tend to waste time getting employees to sign up for shifts, stay current on training and policy changes, complete self-assessments, participate in candidate-referral programs, and more.


Yet with gamifcation, these workforce management challenges can become opportunities for improvement. Employees are already familiar with frequent flyer points and loyalty programs, so applying this same concept to workforce management can be perceived as an extension of consumer practices to business use. When implemented effectively, games and contests engage employees, foster collaboration and team building, and increase productivity. Additionally, by aligning the games’ goals with larger “business” objectives, healthcare organizations can reap a number of significant organizational benefits.


Prizes could include just about anything that employees might find compelling or rewarding, such a VIP parking spot of the month, movie tickets, gift cards, group lunches or other events, and more.


Proceed with Caution

Implementing the right gamification technology is not as easy as it may seem. For example, the same Gartner research report predicted that up to 80 percent of workplace game apps will fail, often with adverse effects.[2] As healthcare organizations attempt to develop the right games and contests, they must be aware of their audience and how these games will be perceived by that group. For example, the healthcare workforce is currently comprised of different generations of workers. Where baby boomers may see games and contests as frivolous, millennials are already familiar with gaming may embrace the concept, but could be turned off if they are not truly easy to use and deliver results.


In addition, they can’t be games just for games’ sake. This means that the gamification strategy has to be tied to something valuable and can’t be perceived as a distraction. Employees’ work lives are serious business, so healthcare organizations will need to do all they can to avoid seeming like they’re turning careers into games.


Gamification as a Competitive Edge

Like any other technology implementation, healthcare organizations must evaluate the underlying challenges and outline the benefits they hope to achieve from gamification. They must also carefully consider their employees and take care to roll out a game or contest that all employees will embrace – and not perceive as just another task they must do. If these organizations can successfully develop the right strategy and the right execution, gamification can be an effective way to help them achieve significant – and long-lasting – benefits.

  1. Gartner, Gamification: Engagement Strategies for Business and IT, November 2012.

[2] Gartner, Gamification: Engagement Strategies for Business and IT, November 2012.

Celebrating Emergency Nurses Week (#ENWeek)

October 3, 2014

In the spirit of Emergency Nurses Week (Oct. 5–11), the second video in our 1 in One Hundred Million series is a compelling profile of Vanessa Barrett and the daily life-and-death challenges she faces as an ER/trauma nurse for a Level III trauma center.


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