Overstaff? A Counterintuitive Alternative Approach to Safe Nurse Staffing

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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!

doc nurse handshakeIn 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.

BB closer Headshot 1-13 CherationsI 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!)






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6 Responses to Overstaff? A Counterintuitive Alternative Approach to Safe Nurse Staffing

  1. Beth, great article. I really like your idea of an extra set of hands for all the situations you listed. That could only improve safety, better working conditions, and more.

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  3. Garlic7girl says:

    I think a great idea. I don’t work in a hospital but a clinic setting. We have 7 different clinics and each nurse is trained in all of them. We have an on-call nurse (8 hours) who does something similar. She floats to whoever needs help whenever during that time period. Like you said if no clinic needs any help at all she can do those ‘other’ duties you mentioned. Trust me no matter the facet of nursing you do there is ALWAYS something that needs to be done!

    • Beth_Boynton_RN_MS says:

      Thanks for your comment, Garlic7girl! 🙂 I love hearing about staffing in any kind of HC organization where it is working for patients and for providers! I hear you, “There is ALWAYA something that needs to be done!”

  4. whisperingsage1 says:

    Interesting you mention a healthy “culture” we have jut been hearing about it but it seems no one quite knows what that is. Here is a hint- the Three Signs of a Miserable Job is a great and simple start. We must care about each other and we must get to know each other- it is our job as human beings- for more look up free lectures by Leo Buscaglia- he was the beginning of the journey for me.
    This bonding will help us work as a team. I have been lucky enough to have seen this work in action, and have these types of folks as mentors. It is connected to what he calls relevance- so we know how our job affects others on the team. This is a part of causing us to care. The most unfamiliar part of his work to me is measurement. But I’m looking at that. Another Patrick Lencioni book is the 5 Dysfunctions of a team, and finally, the 7 Habits of Highly Effective people By Steve Covey. Corny, but basic and brings meaning to our job and our workplace.

What are your thoughts?