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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.

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