An Interesting Thread: Productivity

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Specializes in Acute Care Cardiac, Education, Prof Practice.

**Disclaimer: I deem this an "interesting thread" only in a sassy jab to my friends in other less interesting threads :p **

Anyway, perhaps it is the masters classes sinking into my brain but I have been thinking a lot about staffing.

A little background: I have a lot of interest in working with new graduate nurses and helping reduce burn-out when I have completed my MSN. I have noticed that one of the biggest complaints from nurses are staffing ratios. I have discussed this with bosses and managers while I was nursing and was often met with resistance in reference to productivity. It seems there is a delicate balance between increasing staff and keeping productivity.

Recently I asked a co-worker, of whom was complaining about how terrible her night was, what would have made her night easier. She responded with an overwhelming "well of course more staffing would help". I know from experience on this floor that they run 6:1 with one tech. It was often agreed that the patient load was ok if we could have a second tech (like the old days before our hospital ran out of money). It was argued that with two techs there was a decrease in productivity and they wound up sitting around a lot. I understand the knee jerk reaction to call for more staff, but is that really the answer?

Now each hospital is different and I do understand, especially from some of the threads on here, that places ARE painfully understaffed.

How do you feel, related to your personal situation, patient ratios affect productivity? Where is the tipping point on staffing where it negatively affects productivity? How do you encourage productivity when you have adequate staffing?

Tait

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Specializes in Trauma Surgery, Nursing Management.

I worked on a med/surg unit that had a 6:1 ratio with 2 techs during the day shift. The acuity of the patients was high. Many of the staff members felt overwhelmed and went to the NM to voice their concerns. The staff wanted more help.

So the NM hired more nurses. Most were PRN nurses, and were called in when the census was high. She also gave us the option of being "called off" when the census was low. We had to use our PTO if we chose to stay at home, but we were glad to do it.

This unit had very little turn over, and morale was high. I think this NM had the right idea!

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How does productivity equate to working with people?

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Specializes in Acute Care Cardiac, Education, Prof Practice.
I worked on a med/surg unit that had a 6:1 ratio with 2 techs during the day shift. The acuity of the patients was high. Many of the staff members felt overwhelmed and went to the NM to voice their concerns. The staff wanted more help.

So the NM hired more nurses. Most were PRN nurses, and were called in when the census was high. She also gave us the option of being "called off" when the census was low. We had to use our PTO if we chose to stay at home, but we were glad to do it.

This unit had very little turn over, and morale was high. I think this NM had the right idea!

I think having PRN to lift the load on heavy days is a great idea! Though I wonder how this balances fiscally.

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Specializes in Med-Surg, Cardiac.

I certainly don't have much experience in nursing (3 years) and none in management, but I've been noticing that a lot of what stresses me out is stuff that we don't need nurses for, toileting etc. I was wondering what would happen if we hired a lot more good techs and decreased the numbers of nurses on the floor.

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Specializes in Trauma Surgery, Nursing Management.
I think having PRN to lift the load on heavy days is a great idea! Though I wonder how this balances fiscally.

I don't know the answer to your question, because I am a self-admitted idiot when it comes to finances. However, it seems that it worked out.

Perhaps you can educate me, Tait since I am the Forrest Gump of finances.

1. Wouldn't a higher census mean more revenue for the hospital?

2. Since we had the option of being called off for low census (and almost ALL of us chose to stay home), would that not balance out the times that we had to use PRN staff during a high census?

3. Since the NM hired only PRN staff, wouldn't that still be cheaper than hiring a traveler, or having to pay for OT?

4. Because we used PRN staff, we had very little turn over. Would this in effect HELP the budget since we did not hire perm staff who then turned around and left after a year?

Enlighten me, please!

Yours truly,

Forrest

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Specializes in Med/Surg, Academics.

This might seem minor, but I wish downtime would be used to maintain/organize the unit. I don't know how many times I have walked to an isolation box and there were no gowns in it or went to put something in the sharps container and it's full or walked to the linen cart and there were no towels in it or went to get water for a patient and there were no cups or went to draw up a med and the right gauge/right size syringe isn't in the drawer. Searching around for basic supplies is time-consuming and unproductive.

When I get some downtime during my shifts, I would rather do some basic restocking/replacing to make my job and the next shift's job easier than sit around and gab. In fact, I could probably gab while I'm doing some of this stuff.

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A big problem is the emphasis on the customer service model. One can care for 6 patients, yes, but the scores won't be high, esp. if one has needy, demanding ones.

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Specializes in Medical Surgical Orthopedic.

When a unit is chronically understaffed, people lower their standards and cut corners because they have to. For example, they go without labeling their IV tubing because they have 8000 more important things going on. They take too long to answer call lights because there are too many call lights and not enough staff.

When staffing improves, people are used to meeting those lower, well-established standards. They continue to leave their IV tubing unlabeled. And since it's usually hectic and it usually takes about ten minutes to answer a call light, ten minutes becomes an acceptable amount of time to keep a patient waiting- even when it's not busy.

At that point, someone needs come in, re-set high standards and follow up to make sure they're being implemented. They also need to make sure staffing stays reasonable enough to meet those new standards or it's back to square one.

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Specializes in Trauma Surgery, Nursing Management.
This might seem minor, but I wish downtime would be used to maintain/organize the unit. I don't know how many times I have walked to an isolation box and there were no gowns in it or went to put something in the sharps container and it's full or walked to the linen cart and there were no towels in it or went to get water for a patient and there were no cups or went to draw up a med and the right gauge/right size syringe isn't in the drawer. Searching around for basic supplies is time-consuming and unproductive.

When I get some downtime during my shifts, I would rather do some basic restocking/replacing to make my job and the next shift's job easier than sit around and gab. In fact, I could probably gab while I'm doing some of this stuff.

Very good points.

During our downtime, we have an "accountability" checklist that includes re-stocking, straightening, cleaning and organizing the unit. We are grouped in small teams, so that if others are busy, one or two can check off items from the list. Our manager keeps track of who completes this list and who NEVER does, and it is reflected on our evaluation scores.

This really helps with both productivity and accountability. It enables us to take a tangible ownership of our workplace instead of just complaining about it. The satisfaction of completing the tasks also helps build teamwork, because we DO gab and work at the same time!

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
I think having PRN to lift the load on heavy days is a great idea! Though I wonder how this balances fiscally.

It never balances fiscally anymore as acuity and the "heaviness" of the patients doesn't translate onto paper. Most budgets are figured on fixed numbers......X amount of staff for X amount of patients. Any variance outside that "number" skews the budget and you go over "allotment". I don't think the patient satisfaction "reimbursement" movement will help because the heaviest patients that require the most care usually can't fill the forms out.:rolleyes: PRN"s do save some on not having benefits but that often doesn't defray the costs to go over variance. Some PRN pools utilize "floating help", althought this is usually just for care, and the float "charges " their time spent to the unit which defrays the "cost".

What I really wonder is....does the coporate model really work when the human factor, illness and acuity is thrown a part of the model. I don't think it does. Human illness is unpredictable and the need for how much or how little care is required is diffucult to assess........it typically doesn't translate well onto paper. If cost and budgets can reflect the reality of what it takes to care for patients in not only a timely manner but with how hard it is, I think what is done and how long it takes would in the long run it would be profitable. It has been proven staffing equals positive outcomes, less post op infection, lower pneumonia rates, faster recovery times and less readmittance......all that would lower over all costs and raise reimbursement profit........but it would be an expense at first, and that I'm not sure the CEO's would buy in the long run.....Just my :twocents:

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Specializes in Med/Surg, Academics.
It never balances fiscally anymore as acuity and the "heaviness" of the patients doesn't translate onto paper. Most budgets are figured on fixed numbers......X amount of staff for X amount of patients. Any variance outside that "number" skews the budget and you go over "allotment". I don't think the patient satisfaction "reimbursement" movement will help because the heaviest patients that require the most care usually can't fill the forms out.:rolleyes: PRN"s do save some on not having benefits but that often doesn't defray the costs to go over variance. Some PRN pools utilize "floating help", althought this is usually just for care, and the float "charges " their time spent to the unit which defrays the "cost".

What I really wonder is....does the coporate model really work when the human factor, illness and acuity is thrown a part of the model. I don't think it does. Human illness is unpredictable and the need for how much or how little care is required is diffucult to assess........it typically doesn't translate well onto paper. Just my :twocents:

I wrote something about this in another thread, but I was talking about the time needed for admits and discharges--things that aren't taken into account with ratio staffing. There has to be a better staffing model to use!

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