Advice - Creating a Study on Scheduling & Short Staff Challenges

VORB · Jan 28, 2009

Oh boy, here we go again with the 'short staffing', 'nursing shortage', etc.

The way I see it, depts are staffed exactly as administration sees fit. If you ask the average nurse, they will say they are short-staffed probably 80 percent of the time. But on a nightly basis we have nurses either get down-staffed (take no pay or take vacation pay), or float to other depts. Then in the middle of the night the ADON will take away our one patient care tech on our floor and ship them off to another dept or send them home. This would be fine if we had 4 pts apiece, but it is 5,6, or 7 apiece, and post-op or stroke pts who cannot do for themselves or are in constant pain or dementia.

Basically, they try to keep us at a certain nurse-patient ratio (supposedly), but planning and reality are two different things. That has nothing to do with a lack of applicants (or 'shortage'), and everything to do with administration governing the nurse-patient ratios based on numbers on a speadsheet.

As far as your report goes, I would interview hospital admin, nursing admin (ADON), and staff nurses. Maybe talk to patients too, but they will always feel we are understaffed, and it is admin who defines what understaffed means.

Derric · Jan 28, 2009

Thanks for the input! What are your thoughts on real time scheduling? What if you had a process/technology that allowed you to accomplish this? You're absolutely right, planning is far different from reality, and I suspect trying to build predictability may not be the way to go.

This is the other aim of wanting to engage the study. Reality is, short staffing would almost be impossible to eradicate (i.e. someone will always get sick and cancel a shift), so why not create an environment that can respond to that real time. If trying to find people to fill shifts will always be a reality, why not optimize that process? Maybe we can always fill shifts as long as we had the tools to do so. Thoughts? Pie in the sky thinking?

VORB · Jan 28, 2009

We have float nurses in my hospital that can be called in when needed. I think the problem is not so much the ability to get staff coverage in each dept, but rather the mindset of admin and nursing admin that they'd rather be one nurse short on a floor than one nurse over.

Real-time is tricky. Sure, the hospital bed census continually changes, but it's unrealistic to operate on that variable in real-time when it comes to staffing levels. You have to have a set number of nurses in a particular dept at shift change ready to take over the care of patients based on the census about two hours before. This allows upstaffing or downstaffing taking staff travel time into account. I don't see how you can get any more real-time than that. It's not like they are going to adjust staffing levels throughout the shift based on real-time bed census. They may add or take away patient care techs through the shift, but probably not nurses.

I'm not sure if we're communicating. Are you trying to come up with some new software for staffing mgt you don't want to disclose here? Otherwise, maybe you could be a little more specific with your proposal in this matter - it sounds interesting.

Derric · Jan 28, 2009

Right, and I would safely assume the policy of staffing under rather than over is cost-control-centric. If it weren't for this, I would assume that over staffing would be the norm.

Could you clarify the idea that staff coverage is not the problem? If this is the case, doesn't the administration's policy to under staff and compensate with floaters actually work then? Then maybe the perceived "shortage" as you mentioned, is actually the result of the frustrations from managing floaters? Would this be an accurate statement? It's not that there's not enough nurses, but it seems like there's not enough because you always have to call out to get more. But in reality, the policy was to always understaff. If this is the case, then the idea is to optimize the process to satisfy the understaffing policy (if you couldn't change the policy).

You were on the right track in regards to developing technology. My company actually has technology to tackle this specific scenario, but I wanted to respect the policies on this forum and avoid directly marketing it. Nonetheless, understanding this environment is still valuable for us to make sure we truly understand what's going on.

llg, PhD, RN · Jan 28, 2009

Thank you for clarifying your purpose. We don't like deception around here. I thought you were a nursing student trying to write a paper on the topic.

My suggestion would be to partner with some nurses with nursing management --

1. ... perhaps hire them to provide your company with the expertise it lacks

2. ... perhaps work with the faculty and graduate students of a university that offers graduate degrees in Nursing Administration. Such people are often looking for industry partnerships to help them further advance the nursing profession

3 ... perhaps offer a grant through a major nursing organzation or a school of nursing to sponsor the work of nureses researching and developing strategies to address staffing patterns

That's how other companies work with other professions. You need nursing expertise. Nurses have nursing expertise. "Hooking up" should be a legitimate business deal. Nurses should not be expected to give their expertise away for free any more than you would donate your expertise/work/products to us for free.

Derric · Jan 28, 2009

Thank you for the guidance. This is incredibly valuable information and we intend to make sure that the individuals that co-author the study will most definitely compensated as you stated. Thank you again.

Derric

VORB · Jan 28, 2009

I have to disclose that I am NOT in mgt -- thank God -- just a lowly floor nurse. But it took me about 1 week on the floor after nursing school to realize that there WAS NO nursing shortage, when they were downstaffing almost on a daily basis - which continued for weeks and months.

I didn't say staff coverage was not a problem, by the way; I said the ABILITY to get staff coverage was not a problem. I really think any given dept is staffed exactly how admin sees fit on any given shift. There may be trends over this period or that in terms of weeks or months, but I'm speaking generally. I can't really speak to whether staff coverage is a problem in my 500 bed hospital - only in my dept. [i will tell you that we now have an abundance of applicants, not an abundance of unfilled-positions, and that's probably hospital-wide if not nation-wide.]

We have a grid in our dept which shows exactly how many nurses and patient care techs we are to have for any given number of pts. They pretty much stay in line with that. The problem is that they changed that grid several months ago, and you can guess which way it went. Not in nurses' or patients' favor. Throw on top of that the fact that you have an ADON in charge at night that answers to higher powers and would probably look good to that power if she cut back even further than that grid would dictate, and you see yet another variable in the mix. She's got a lot of leeway.

Well good luck with developing your system. I see no problem getting info on this forum.

Atheos · Jan 28, 2009

Oh boy, here we go again with the 'short staffing', 'nursing shortage', etc.
The way I see it, depts are staffed exactly as administration sees fit.

That's a big generalization.

Some facilities (like my non profit private pay facility) break laws of physics to maintain a certain level of staffing. Even with perks, bonuses, decent pay, all kinds of deal making we still end up short sometimes.

It's not always 'administration' wants us to be short. It's a lot bigger than one myopic view. Sometimes, no matter what 'administration' does there just aren't enough people able or willing to work.

Also, as a cna and nurse, ones view on 'staffing' tends to be limited at best. Once one has worked as a staffing coordinator they realize that it isn't exactly as easy as all nursing staff seem to believe. Staffing facilities, even WITH proper staff is harder than any floor position in the facility. You can take that to the bank.