Healthy Work Environments and Safe Staffing - an Interview with Nancy Blake

[traumaRUs, MSN, APRN]

Healthy workplaces are essential to keeping nursing staff. There are several steps to achieving this and all steps are important to achieving excellent patient care. 

Nancy Blake, PhD, RN, CCRN-K, NEA-BC, NHDP-BC, FAAN has been at the forefront of healthy work environments since its inception. She has been very involved at both the national and local levels. Mary Watts, BSN, RN, allnurses.com's Content and Community Director was fortunate to visit with her recently. There have been research studies and several papers published that state improving communication is key.

What Defines a Healthy Work Environment?

Hospitals recognize that a healthy work environment encompasses six points:

• Communication - between all levels in the facility, from the Chief Nursing Officer to the transporters to housekeeping to dietary
• Collaboration - among all teams in the hospitals
• Staffing - adequate and individualized staffing matrixes
• Effective decision making - researching the problem and bringing a variety of solutions to the table for discussion
• Authentic leadership - managers and leaders who come to the bedside to talk to staff
• Meaningful recognition - for all members of the team

Safe Staffing

Those are the primary elements. Nancy Blake then honed in on safe staffing.

Quote

"There has been a lot of research about safe staffing in facilities. Overall, we are coming up on a large nursing shortage and making sure you have the right staff mix in place for the right patients.”

Acuity tools need to be used to ensure the experience level of the nurse as well as their training matches the patient acuity. "Also ensuring nursing competency is very important,” she continued.

How is the Safe Number of Nurses Determined?

She went on to state there are many different factors to consider when using an acuity tool. This involves making sure you have the right numbers for the right patient acuity. Patient acuity means making sure you have the right number of patients to the right nurse. The nurse needs the skill set to care for a particular patient as it relates to their medical condition. There are times where a patient needs two or three nurses. "It's really important that nurses get refreshed during their shift - take their breaks.” Staffing is not a one-size-fits-all matrix. Even in an ICU, patient acuity must be taken into account. "I'm not a fan of ratios, it needs to be individualized.” "Actual acuity depends on the patient.”

What Can Nurses Do to Improve the Work Environment?

They next discussed what nurses can do to improve the care situation:

• Have a positive attitude that the situation can be changed.
• Provide feedback to administration regarding concerns. Talk with your manager and then go up the chain of command if needed.
• Be a team player. Important to realize that you are not alone - you are part of a group.
• For managers - please listen to the bedside nurses. Help them to succeed and ultimately provide the care your patients need. Realize that you need to consider many factors when determining what nurse or nurses are taking care of which patient.

How does your facility work to provide you with a safe work environment? What could be done to improve the situation? Do you feel comfortable going to your leadership team to try to find solutions?

References:

Programs that Support a Healthy Work Environment

The Healthy Work Environment Standards, Ten Years Later

Appropriate Staffing for a Healthy Work Environment

[lumbarpain56]

Staff retention is key..having people who do their work without being told what to do every single moment of the shiftwithout lame excuses... Having competent staff who aren't AFRAID of doing something themselves if possible without getting someone else to come in to do it. Housekeeping and cleaning is ESSENTIAL every single day which at my facility is non existent. and having Staff who are literal pigs who think the nurses station is a food court to leave their foods and empty soda bottles and such all over the place.. And my personal opinion is not having carpets in nursing homes....we just had them installed....its a germ carrier and is most difficult for staff to push those heavy carts and have patients wheel themselves down the hall......just too much to mention here....sorry to say.

[SunCityInsPhysical, BSN, RN]

Your article caught my eye. Well written and valid content. After two on the job injuries I had to be Medically retired 5 years ago. I wasn't ready, after only 35 years. Hahaha, if I added up all the overtime I've worked I've probably got 50+ years under my belt. I Would dearly love to continue working, but on a limited basis

I was forced to work 36 straight hours in the OR due to staffing shortage, poor management, admin and risk management. My feet have been problematic ever since.

So, to focus on the current Nursing shortage I have to laugh. I love the OR, I have been looking for a position in which I can continue to utilize my expertise. I can manage to be on my feet for an eight hour shift two days a week.

Can I find such a position? NOPE. Every hospital in a 45 mile radius ONLY hires 40 plus on call.

I guess all those Ivy League administrators missed the class about the last severe nursing shortage.

I gets calls or emails inviting me to hiring fairs or notifying me of openings, they offer insanely high amounts of hiring bonuses. When I return calls out of courtesy or curiosity it's always the same result. 40+ on call. I always ask about job sharing. NOPE. So, I politely decline and try to hold my laughter until after I hang up. There is no learning curve.

The nursing shortage is industry induced. Just like in the 80s There are plenty of licensed nurses young and old. Single and married. With children or dependent parents or retired husbands who like to travel or play golf with us.

Many nurses who would like to work but we aren't working. We are available for limited days or short shifts. After years of working overtime, or having days off cancelled or being fired because of too many times when We needed to care for children or parents or have balance in our lives. We have called a halt. We want balance, we refuse to be used and abused.

I didn't know what I was missing in life UNTILL I got disabled. It was a blessing in disguise. I was always at the bottom of the list. I'm healthier now, physically and emotionally. I won't go back to the old self sacrificial ways. I won't go back to unrealistic expectations, lack of professional recognition, and a healthy professional and personal work schedule.

I sincerely hope the Nursing Nation wakes up, speaks up and puts their foot down. We have the numbers to demand a change. Will the ANA step up? I haven't seen it yet, I've been a nurse since 1978. We don't have a national license, retirement or insurance plan. Hmmm. Why? Florence Nightingale syndrome and kick the can is my diagnosis. Too late for me. I'll still be praying for a change for the rest of you.

As for me, I've recently reinvented myself. I got educated and certified for doing infusions at a Cancer clinic two days a week. Mon and Thurs. I'm well rested, I have time to play and I am always eager to go to work. I feel respected and appreciated. I plan to continue working for another 5 years.

Wishing you the courage and conviction to push for change in our profession.

[JKL33]

On 8/1/2019 at 2:00 PM, traumaRUs said:

Staffing is not a one-size-fits-all matrix. Even in an ICU, patient acuity must be taken into account. “I’m not a fan of ratios, it needs to be individualized.” “Actual acuity depends on the patient.”

The thing about staffing ratios is that they have never been held out as a ceiling that limits anyone's ability to provide additional resources according to patient acuity and need, but rather a floor.

When people say that ratios would limit their ability to consider a patient's acuity, what they mean is that it limits their ability to tinker with and fudge the acuity and use that to provide fewer RNs.

There may be other arguments against (or concerns about) ratios, but this isn't one of them that even passes basic muster. If a facility is told that, at baseline, they must have an RN:patient ratio of 1:4, absolutely nothing about that prevents them from providing a particular patient with a 1:1 ratio. It really bugs me when the examples used to argue against ratios involve ICU patients and patients who may temporarily need two or more nurses for a time, because the desired implication is that ratios would limit the RN care that hospitals are allowed to offer the sickest of patients. That is completely disingenuous, to put it kindly.

[Jedrnurse, BSN, RN]

6 minutes ago, JKL33 said:

The thing about staffing ratios is that they have never been held out as a ceiling that limits anyone's ability to provide additional resources according to patient acuity and need, but rather a floor.

When people say that ratios would limit their ability to consider a patient's acuity, what they mean is that it limits their ability to tinker with and fudge the acuity and use that to provide fewer RNs.

There may be other arguments against (or concerns about) ratios, but this isn't one of them that even passes basic muster. If a facility is told that, at baseline, they must have an RN:patient ratio of 1:4, absolutely nothing about that prevents them from providing a particular patient with a 1:1 ratio. It really bugs me when the examples used to argue against ratios involve ICU patients and patients who may temporarily need two or more nurses for a time, because the desired implication is that ratios would limit the RN care that hospitals are allowed to offer the sickest of patients. That is completely disingenuous, to put it kindly.

Thank you for pointing out the huge hole in the anti-mandatory minimum staffing argument!

[JKL33]

I wonder how Clairvia works in reality.

I didn't hear anything about how it accurately assesses that a patient requires assist x4 for movement/positioning, or that they use the call light at a rate 5x every other patient, or that the bedpan was placed and removed 4 times over the course of an hour before the patient was finally able to void, or that there are time-consuming psych/social aspects of their care or any number of other aspects that affect bedside RN care. Also, just a guess, but it seems that even more documentation might be involved in proving that all of these things are going on - - which is a losing battle in that it further reduces time available to provide the care. It's bad enough as it is already, patient care and documentation are at odds and in direct competition for everyone's time.

[DNPStudy, MSN]

I have worked in California at a level one busy trauma center and then at a local small community hospital with 8 bed ICU. Having a ratio is great but shouldn't  necessary be a strict statewide requirement. I could have taken 3 ICU patients in that smaller ICU with lower acuitu patients. I agree with whomever said it should be individualized. The Massachusetts Safe Patient Limit in ICU Law has some merits compared to the California ratio mandate.

This is a study I am working on for my DNP