Competence-Based Staffing Model in the NICU

Purpose:
Our level III-C NICU experienced rapid growth over an 18 mo period resulting in an unequal balance of experienced (expert) nurses vs. new grads (novices) each shift. A staffing model based on Benner's Novice to Expert was developed and implemented by the charge nurses to address this disparity.

Significance:
Due to a staffing disparity, charge nurses had difficulty making appropriate assignments. Newer nurses were not given the assignments needed to grow their clinical/critical thinking skills and experienced nurses lacked the time to mentor the new staff - all this potentially impacting patient care.

Strategy and Implementation:
The NICU leadership team challenged the charge nurse group to develop a staffing model based on Benner's model of Novice to Expert, which had been successfully implemented at another NICU using levels of expertise They worked on the project for a year, making changes to the model based on feedback from their peers. Prior to implementation, a PowerPoint presentation was presented to all staff. Each nurse was asked to let their manager know which level they felt they fell into based on the criteria developed by the charge nurse group. Any discrepancies between what the nurses thought their level should be and the managers' thoughts, required a face-to-face meeting. The project was then handed over to the Unit Scheduling Committee. They developed a color-coded template of levels in an Excel spreadsheet in which each nurse signed up in their color. In order to maintain the same skill level each shift, nurses were only allowed to switch shifts with either the level above or below theirs.

Evaluation:
A survey of staff was taken one month prior to implementation and then again after one year. The staff were surveyed in subgroups of <2yrs, 2-<5yrs, and >5 yrs. Success was measured as schedule flexibility, advancement of skill level, mentoring opportunities, and professional growth.

Implications for Practice:
Patient care has been directly impacted by providing more opportunities to increase clinical and critical thinking skills, professional growth, and mentoring while maintaining schedule flexibility and providing the nursing staff with the resources they need.