An Interesting Thread: Productivity

Nurses General Nursing

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**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

Specializes in Acute Care Cardiac, Education, Prof Practice.
My favorite manager quote was: "I can't justify paying for more staff when you all have so much overtime!"

Great points have already been brought up - people cut corners to get by when understaffed. I agree that people should be having the work ethic to spend any extra time on improving safety and not cutting corners anymore. It has been very rare for me to see nurses sitting around doing nothing. And as was brought up before, having nurses pushed to the limit is not good for productivity as it increases burnout and turnover, and ups the safety risk when there is an emergency. The research shows over and over that nurse patient ratios are critical in mortality rate.

But there is no proper acuity tool out there that can really assess the 'human' factor, as that can change even hourly for patients. My second favorite manager quote is "Our new acuity tool showed that there needs to be more staff per shift, so we are changing the acuity tool" (these are true quotes!)

That is why I advocate for California style CNA/NNOC staffing, because at least that gives some legal ceiling on the number of patients. I never did feel safe when I had 12 patients myself, such as when another nurse was going to lunch.

I've been at hospitals where they tried different tactics such as a resource nurse, or a nurse that goes to each floor and asks what they can do to help, such as a dressing change here or there. But I have found with this method, time is wasted checking for what I can delegate, and explaining what to do. What really helps me far, far more, is having an admissions nurse. Admits that I have to do really mess up my whole shift - they come up in pain and have nothing ordered, and lots of questions, and I have to ask them a million questions myself before I can get them anything, and I'm constantly being interrupted by my other patients needing things. Its demoralizing to not being able to make them comfortable quickly because I'm always being pulled in so many directions, and an admit needs a good solid chunk of time to be able to set up properly.

The other critical thing is a strong charge nurse who knows the patients on the floor well and knows nurse strengths and weaknesses well, so they can properly distribute the patient load.

While there is no perfect solution out there, I think many places yearn for change.

I actually breached the idea of an admission/discharge nurse to my hospital. I don't think anything will ever come of it, however I feel it would increase positive patient outcomes and make patients feel more attended to while allowing floor nurses to keep up with busy patient loads.

I wonder if a concept analysis has been done on the concept of "productivity" and nursing. Hmmmm.

Productivity in my definition is making the best use of a nurse's time.

For example, if a hospital wants to switch to computer charting, it has to be willing to install enough computers. There need to be computers in the patient rooms, computers at the nursing station, and a few laptops on wheels. The program needs to be user friendly.

If pharmacy does their job in keeping medications stocked, I am make better use of my time with patients rather than constantly calling for missing meds.

You want tubing labeled, then keep labels and a pen on the bedside cart, and voila, all tubing gets labeled.

Open visitation makes my day less productive. Every visitor who walk in is another person with needs to be met, and who do you think bears the brunt of that? I'm not against visitation, but it does have an effect on how efficiently we are able to take care of the patients.

Sometimes an extra nurse is the answer, sometimes making an effort to eliminate the big time-wasters in a nurse's day makes a bigger difference.

Specializes in Medical.
My second favorite manager quote is "Our new acuity tool showed that there needs to be more staff per shift, so we are changing the acuity tool"
I think I've worked with her - or her spiritual twin!
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