Internal Agency Nurses: Creating a Totally Integrated Centralized Staffing Solution

Byram, Stacy

Purpose:
The purpose of this innovation was to provide the right staff, at the right time, in the right amount, and at the right location through a totally integrated centralized staffing solution.

Relevance/Significance:
Our 13 hospital system did not have a sufficient structure to share and provide staffing resources. Staff could be called off in some areas, while others utilized overtime, incentive pay or agency staffing. The decentralized float pools at each hospital made it difficult to quickly react to changes in patient census across the system. Having an internal centralized staffing structure allowed for a decrease in cost-prohibitive and reactive processes.

Strategy and Implementation:
A central staffing office was trialed to oversee staffing and scheduling for select units in two large markets. Project deliverables included: consolidation of float staff and budget into a centralized staffing office, adequate quantity of competent float staff, effective usage and understanding of services, and creating competency and capability of flexing staff across facilities. The budget was neutral, consolidating staff and dollars from local float pools into a new corporate cost center. All existing float pool staff had the opportunity to join. External hiring only occurred for the first few months which prevented depletion of unit staff. Consultation with another health system allowed for best practice technology and creation of an allocation tool to assign staff based on volume needs to be fair and consistent.

Evaluation:
2014 outcomes: • Reduction in the number of in-scope unit travelers from 73 to 4 • 92% of leader customers would recommend our services • 68% of the unit RN requests were filled • Quality misses dropped from 14 to 1 • Safety event involvement dropped from 4 to 1 • Overall employee satisfaction was 90%

Implications for Practice:
Implications for practice included optimization of staffing resources, reduction of time spent searching for adequate coverage, deployment of safe, competent, flexible float staff, and the flexibility to float our own internal staff to create a safe, high quality experience for nurses and patients.