Redesigning the Staffing Model to Improve Patient and Staff Satisfaction

Purpose:
The goal of this initiative is to promote teamwork in order to re-design the unit staffing model to enhance the patient and family experience, deliver high quality care and increase staff satisfaction on a 14 bed patient/family centered care medical surgical unit.

Relevance/Significance:
When working on a 14 bed, primarily private rooms, patient & family centered care nursing unit, careful attention must be placed on adequate staffing in order to ensure quality patient care. This initiative focused on reducing nurse patient ratios, while remaining budget neutral. This is a key variable that affects nurses' ability to deliver high quality care and connects the concepts of quality, safety and staffing to improve patient outcomes.

Strategy and Implementation:
Staff engagement scores showed decline in staff feeling “involved in decisions that affect my work” and in “I have the tools and resources I need to provide the best care or service to my patients”. As a team we met to address these concerns. The majority of patients are isolation and have high acuity. The staffing model used a charge RN with no pt assignment & 2 RNs who took responsibility for providing direct care/documentation to 7 patients each. This was challenging for the RNs, to not only complete direct pt care, but also be able to allot time for developing familial relationships and redefining the ever changing plan of care for each patient. Our plan of action redesigned the role of the charge nurse. It was decided that the new design would include the charge nurse taking full responsibility for the 4 least acute patients on the unit. This would then reduce the remaining 2 nurses' assignment to 5 patients each. We implemented this new staffing model in early 2014.

Evaluation:
Press Ganey patient satisfaction scores: “likelihood to recommend” post implementation increased to 92.5%. Hospital goal was 91.1%. Our unit received the highest Press Ganey score for medical surgical service lines, hospital wide, for 2014. Unit staff morale is positive and cohesive. Repeat staff engagement scores will be available in 2016. We expect to see improvement.

Implications for Practice:
Re-designing the charge nurse role can be duplicated on other medical surgical units. This supports RNs by reducing nurse patient ratios while maintaining budget neutral. This model will allow RNs increased time to address both physiological and psychological needs of patients and families.