american nurses association - confex · 09/10/15 3 americ making the quality connection areas of...
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The Case for Optimal Staffing: A Call to Action
2015 ANCC National Magnet ConferenceOctober 7, 2015 2:30‐3:30pm
Session C721
Mary Jo Assi, DNP, RN, NEA‐BC, FNP‐BCDirector of Nursing Practice and Work Environment American Nurses Association, Silver Spring, MD
Pat Patton, MSN, RN, FCNVice President, Nursing Operations
Catholic Health Initiatives, Denver, CO
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Identify challenges posed by the evolving role of nursing
in the current healthcare landscape and strategies that
can be used to meet these challenges
Objectives
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Incorporate best practices to achieve positive patient outcomes by integrating science‐based research
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American Nurses Association
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nursingworld.org
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ANA Programmatic Work
Publications: ANA Principles for Nurse Staffing
Registered Nurse Safe Staffing Act
Promotion of staffing q alit meas resAN
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Promotion of staffing quality measures
Staffing focused environmental scan and analysis
Creation and support of networking opportunities
Focus on technology
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Current State
Site visits
– shift in patient characteristics
– shift in nurse characteristicsAN
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– external and internal pressures related
to regulatory, quality, and safety concerns
Insight
“I fear we are preparing new graduate nurses for a healthcare reality that no longer exists.”
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Current State
Staffing white paper: Key findings
research and evidenceAN
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– research and evidence
– recommendations
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AM
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Making the Quality Connection
Areas of continued focus:
Staffing impact on quality outcomes and cost
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Making the financial case
Promoting transparency in reporting
Providing tools to nurses in all areas of practice to support optimal staffing for safe patient care
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The business case for staffing
ANA Programmatic Future Work
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Decision‐tree for automated staffing and workforce systems
2016 ANA conference
The Case for Optimal Staffing: A Call to Action
Pat Patton, MSN, RN
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VISION & DESTINATION GOAL
To be known as a System with Exceptional, Best Value Care and Experience
• Increase quality while providing cost effective care
• Provide the right care at the right time and place
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• Find the “sweet spot” for staffing
• Determine the best value equation for care
– Standardized Staffing and Scheduling and Acuity Implementation
– Nursing Services Dashboard– Nursing Research
VALUE – BASED RESOURCE MANAGEMENT
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ENABLING CLINICAL & OPERATIONAL EXCELLENCE
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ASSESS
Assess for what you need
• Gather your data- Know your resources- Application is appropriate
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• Format presentation applicable to a CFO—’speak finance’- Spreadsheet- Draw trend lines- Use resources e.g. you tube, library etc.
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BEHAVIORAL HEALTH UNIT IN A LARGE SYSTEM
• Gathered data over 6 months
• Had been trending lower and budgeted lower than previous year
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• Found out there was an issue with screening
• Issue resolved and saw an influx of patients
• Average Daily Census (ADC) increased dramatically
• So now what do you do?
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MAKING THE FINANCIAL CASE FOR STAFFING
Getting your act together‐going in prepared
• Speak to the dyad (CNO and CFO)
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• Utilizing the nursing process but speaking finance
• Evidence, evidence, evidence
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FY 12 ‐ Budget FY 12 ‐ ADC FY 13 Budget FY 13 ADC FY 14 (YTD) Budget FY 14 (YTD) ADC
8E 23 24.0 25 22.5 22 26.8
8W 18 19.1 20 18.3 17 20.4
1700
Monthly Volume
500
700
900
1100
1300
1500
Jul‐11 Aug‐11 Sep‐11 Oct‐11 Nov‐11 Dec‐11 Jan‐12 Feb‐12 Mar‐12 Apr‐12 May‐12 Jun‐12 Jul‐12 Aug‐12 Sep‐12 Oct‐12 Nov‐12 Dec‐12 Jan‐13 Feb‐13 Mar‐13 Apr‐13 May‐13 Jun‐13 Jul‐13 Aug‐13 Sep‐13
4152100 8 West
4150100 8E
PLAN
• Coaching and practice—find a manager/leader/director with known experience who will critique you honestly
• Make sure CNO is aware of your plan and presentation prior
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y p p pto speaking with CFO (buy‐in)
• Plan on incremental change (provide more than one scenario)
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CARDIAC SHORT STAY UNIT
• Department was having issues with productivity
• Felt busy all week but productivity numbers at end of pay period and of month were not showing it
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period and of month were not showing it
• Used data from Staffing and Scheduling System to pull productivity by hour of day
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CARDIAC SHORT STAY UNIT
• After seeing productivity by hour of day they determined issue
• Busy middle of week middle of day as shared by the staff
• Emptied on weekends by 11 am
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Emptied on weekends by 11 am
• Shifted staffing appropriately
• Productivity was normalized and staff happier
• Manager able to obtain staff for other units after showing CNO and CFO results
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IMPROVED PRODUCTIVITY: STAFF UTILIZATION REPORTS
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CENSUS BY DAY OF THE WEEK
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IMPLEMENT
• Once approved, have your staffing plan ready so that you can speak to it clearly
• Communicate with your staff through shared governance‐how
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to best use the resource(s) you have gained—staff should co‐own this
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ORTHO UNIT
• High turnover Tuesday through Thursday
• Slowed down Friday through Sunday
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• Spoke with staff through shared governance re: staffing patterns
• Needed more help during the week and less during weekends
• Data confirmed this and staffing pattern changed
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EVALUATE
• Measure, measure, measure
• Tie quality outcomes to cost savings
• Connect with the finance to partner to clearly communicate
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outcomes
• Share best practices and failures with real or potential stakeholders
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ORTHO UNIT
• Manager measured census, OT, and staff satisfaction
• Staffing was adjusted without increasing FTE’s
ff
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• Staff happier with more help during the week and working less weekends (every 3rd)
• Shared governance committee agreed that change was correct
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ORTHO STAFFING EXAMPLE BEFORE AND AFTER
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20
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Ortho census with staffing
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0
5
10
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Census Nurses prior Aides prior Nurses after Aides after
A Call to ActionA Call to Action
• Build your tool box
• Gather the evidence
• Prepare, prepare, prepare
• Network with experienced colleagues and mentors. Attend annual conferences to keep up to date with latest evidence
• Practice, practice, practice
• Be a catalyst‐educate hospital leadership and clinicians about the link between staffing and patient outcomes
• Utilize your resources o American Nurses Association
o Healthcare Financial Management Association
o American Organization of Nurse Executives
o Others
