Bridging the gap between nurses and staffing decisions

Purpose:
Designed and implemented a Nurse Staffing Council (NSC) made up of nurses from all levels, finance, education, QI and staffing to examine literature, impact of staffing decisions and take action to improve the work environment and quality outcomes.

Significance:
Staffing decisions impact the work environment, as well as individual nurses and patients. Increasing frontline nurses' knowledge of evidence related to staffing and participation in an inter-professional partnership can create a healthy, safe, work environment.

Strategy and Implementation:
The NSC was implemented in 2011. The council is comprised of nurse managers, Vice President of Nursing, Staffing Manager, representatives from finance , quality & compliance, education and 6 frontline nurses representing the clinical specialties (birth center, rehabilitation, medical/surgical, critical care, emergency department, and peri-operative services). NSC functions were defined to include education; review staffing plans; provide input into organizational staffing issues and standardize policies, staffing, schedules, scheduling and floating; and pilot innovative staffing processes. Education was provided to members on the budgetary process, productivity measures, acuity and quality outcome measures. ANA staffing principles were applied to revise a unit's grid to increase RN and decrease CNA staffing. Based on a review of literature and nurse feedback, RN's shifts were limited to a maximum of 4 consecutive 12 hour shifts and break time naps were approved to decrease fatigue.

Evaluation:
Press Ganey nursing satisfaction surveys report improvement in means for staffing (43 to 55), quality (73 to 80) and feelings of accomplishment (76 to 81). Patient falls were reduced with reduction of agency staff. Results from the NDNQI RN Satisfaction Survey are pending.

Implications for Practice:
A Nurse Staffing Council improves frontline nurse knowledge and ownership of staffing decisions which is consistent with shared decision making principles. The work environment for staff satisfaction and patient safety is improved through implementation of safe staffing principles.