Implementing a Patient Focused Flexible Staffing Model

Purpose:
Today's healthcare landscape includes high patient churn and constant evaluation of fiscal and quality outcomes. The goal of this initiative is to develop a flexible care delivery model that includes: core staff, core-flex staff, flex pool and, expanded flex pool resources to cover staff shortages.

Significance:
In 2012 hospital "A" experienced 252 days where at least one nursing unit had profound staffing shortages. As a result nurses were experiencing fatigue and burnout. The 2012 Nurse Satisfaction Survey validated this issue with one of the lowest scored indicator being: Work/Life Balance.

Strategy and Implementation:
During the 3rd quarter of 2012 two committees were developed to gather and analyze staffing data, make recommendations, and implement action plans for improvement. First, the Safe & Effective Staffing Committee (SES)met bi-weekly to analyze trended staffing data including concerns solicited from direct-care nurses. Trends included: shortages on unit schedules, unexpected high census, RN shortages on holidays and weekends, and limited ability to utilize RN resources across the division. Based on the trends the Staffing Strategies Committee proposed a new staffing model which included: core staff, core-flex staff, flex pool and, expanded flex pool resources. The committee also recommended new processes to cover scheduled shortages, for example; a rotation of on-call days. The new model and guideline revisions were taken to nursing councils and special colleague forums to solicit input and make changes. The model and guidelines were implemented in April of 2013.

Evaluation:
Post implementation the following data will be reviewed and collated monthly: Staffing deficits over 16 hours per unit per 24hrs. The data will be shared with managers and the professional nurse council quarterly, and with the hospital board annually.

Implications for Practice:
The presentation identifies staffing challenges in the current healthcare landscape and strategies to meet these challenges. It demonstrates the impact that trended staffing data and the importance of the participation of nurses at all levels in the revision of the care delivery model.