Innovative Strategies for Improving Nursing Staffing and Resource Adequacy

Purpose:
To describe the strategies used to improve the nursing practice environment by engaging bedside nurses, union nurse leaders and hospital executives in the identification and implementation of policies and infrastructures that support improved staffing and resource adequacy.

Significance:
Staff nurses at a South Florida Hospital rated staffing and resource adequacy as their top practice environment concern. Research indicates that higher nurse to patient ratios has been identified with improved patient, nurse and financial outcomes. Resource adequacy is essential to quality of care.

Strategy and Implementation:
Union nurse leaders identified two innovative strategies to improve both nurse staffing and resource adequacy. To improve staffing, a literature review on safe staffing was performed and a series of “staff nurse ratio hearings/testimonials” were held. These testimonials and research findings eventually resulted in the formation of a nurse ratio staffing policy to be used as a guideline for safe staffing. To address staff nurses' concerns regarding resource adequacy, an online efficiency survey was developed to identify where costs could be saved and where resources could be allocated. A joint union - management Operational Efficiency Task Force was formed, as a forum where staff nurses could present their ideas for improving hospital efficiencies. Staff nurses also participated in work teams to implement efficiency ideas.

Evaluation:
2009 Practice Environment mean scores for the quality indicators of staffing and resource adequacy will be compared to 2010 scores. Anecdotal reports indicate the literature review, nurses' testimonials and formation of the operational task force were regarded as valuable professional activities.

Implications for Practice:
Researchers need to target barriers related to identification and implementation of ratios. Staff nurses are important stakeholders in identification of operational efficiencies and resource adequacy. Effective leadership practices are needed to initiate and sustain these innovations.