I've been busy lately, as I'm sure many of you have been, as well. I'm also finishing up an online leadership class, and my focus area is staffing/scheduling. I've been interested in this area since nursing school and, sadly, I can't see that much has changed. I'm particularly concerned that in the area of staffing/scheduling/workload, nurses don't take the advice of the much heralded Evidence Based Research we are all so frequently reminded to implement.
In a nutshell, much of the EBR demonstrates that 12hr shifts are problematic, at best, dangerous, at worst. Yet, since the 1980s, when 12hr shifts went into effect, nurses, nursing organizations, and medical facilities have not budged much on the 12hr shift/schedule. I know the research also shows that for every nurse that doesn't like the 12hr shift, another nurse does, so, nurses themselves are mixed on the decisions. Nursing organizations and governing bodies have largely been silent, or at least, lax, with the exception of California's statutory legislation mandating nurse-patient ratios.
I believe there is, or has to be a better way. One proposal that I've thought about is in the realm of more nurse autonomy in scheduling, which also flies in direct opposition to management/administration/hospital executive policies and practices. I believe flexible scheduling could achieve cost-cutting goals, patient safety goals, and boost nurse morale, as well.
I also think that nurses have to decide what they really want! I'm not doubting that nurses want to do right by their patients. I'm not doubting that nurses are professionals and deserve to be treated as the most trusted & honorable profession in the United States. I think many nurses experience intra-personal conflict and don't know how to work out the personal and professional ethical dilemmas going on within some of us.
On the other hand, I believe management is content with the status quo, as it is in their best financial and personnel costs to leave things as they are, despite the evidence-based research. But, I don't think either of us can have it both ways, at least not forever.
So, I ask, what do we really want? If we push EBR as the standard, why don't we use the standard when it comes to scheduling/staffing? Or, are millions of annual medical errors totally unrelated to anything having to do with staffing, scheduling, and workload? And, why aren't our membership-based organizations doing more on our behalf in this area?
And, what about the research that consistently demonstrates the low morale, abbreviated family time, sleep deprivation, high attrition, and other cons of the scheduling/staffing/workload mix? What about the much touted "work-life balance" and "holistic" living for nurses? Do we ignore the parts of EBR that we just don't like?
Does management ignore the research that demonstrates that nurses want more flexibility, financial incentives, more time off, and more standardized/mandated workloads & nurse to patient ratios? Does management take into account any of the reasons why nurses are leaving the profession or at least leaving the floor, in droves?
Is either side ready to take a seat at the table and work out the hard spots, always with the idea that there has to be a win-win? Both sides want the best for patients, but, is that same spirit given to both sides in the debate?
My fear is that things won't change until something devastating happens that will exceed the risk management/liability limits set aside by any medical institution. In other words, when it costs more to pay out medical claims than it does to hire nurses for 12hours shifts, then we will see the need for paradigmatic changes in our profession.
