Balancing financial health of the organization with patient safety and nurse health make nurse staffing a challenge. Add to that many variables such as skill and experience mix of the nurses, patient acuity, working conditions, fatigue, patient and family dynamics and having enough of the right staff to provide safe compassionate care becomes even more complex. (See Robin Hertzel’s article in Jan 2012 Healthcare Reform and Issues in Nursing lists 36 variables: see page 7-Regulating Patient Staffing: A Complex Issue). Also there are lots of resources about safe staffing at the ANA website.
All of these variables make for a confusing situ b/c what works one day on one unit may fail miserably on another day or unit. The human interface that I keep talking about is grey and messy and requires creative solutions that allow for fluctuations in patient’ needs and nurse’ availability and engagement. I believe this is true whether there are mandated staffing ratios or not!
In my opinion, we should have an extra pair of hands to cover meal and rest breaks, make sure supplies are available, help with a two-person task, such as boosting someone in bed or during a clinical emergency. If we are going to provide safe, quality care and support the work nurses and assistants do. I know some of you are gasping, but a nurse or para professional with initiative could be shared among units and responsive to fluctuations of patient and staff needs.
There are some caveats to this idea:
- The culture must be healthy.
- Staff must be proficient in delegation skills.
- Everyone must be engaged in providing safe, compassionate, and cost-effective care.
- There must be reasonable continuity of staff.
If these things are in place, ideas will emerge in time such as having the extra pair of hands during the busiest times, taking turns playing this very supportive role, volunteering to go home or floating elsewhere on a slow shift and who knows what else your team will come up with when they are working well together and morale is high. Get the finance department in on the process to help evaluate costs and savings.
I strongly suspect that this would improve patient experience and staff retention and minimize wasted resources and horizontal violence. I suspect there would be less falls, less HAIs, less work-related injuries. I think patient education would be more effective, and there would be less readmissions. It would also promote a culture of empowerment that would naturally flow from staff to patients. Is it worth a try? (If you want help with the caveats let me know, I love bringing out the best in staff and medical improv with some OD consulting is a great way to do it!)