Nurse staffing is top of mind for most nurse leaders today. In the 2021 American Association of Critical Care Nurses Healthy Work Environment survey released last week, the standard looking at RN staffing which ensures the effective match between patient needs and nurse competencies was rated at a shockingly low average of 2.35 (Likert scale of one to four) by the more than 9000 nurses who responded. We are losing ground in establishing healthy work environments, and adequate staffing is a core problem.
Nurse staffing is a conundrum because we have structural labor shortages among RNs and support staff. Couple this with surging patient volumes, and it is easy to understand the recruitment and retention challenges across the US in healthcare environments. Some systems are looking to create their internal staffing agencies using guidance from Dr. Dani Bowie, an expert in this area who prepared a white paper Dani Bowie White Paper on Staffing. Where do we go from here is the topic of this guest blog with staffing think tank recommendations.
By Sarah Delgado, Clinical Practice Specialist at AACN (American Association of Critical-Care Nurses)
“I love being a nurse. What I hate is not being the nurse I should be.”
Does that sound familiar? Many elements of the work environment affect frontline nurses’ ability to deliver care, but the most cited barrier is inappropriate staffing. Since 2005, nurses responding to surveys based on the American Association of Critical-Care Nurses’ Standards for Establishing and Sustaining Healthy Work Environments (HWE), consistently report that appropriate staffing is the least likely of the six HWE standards to be successfully implemented. Just as COVID-19 exacerbated many other longstanding deficiencies in our health care system, acute and critical care staffing is now a crisis.
Because staffing challenges require an all-hands-on-deck approach, AACN launched a partnership in 2017, with the American Nurses Association (ANA), the American Organization for Nursing Leadership (AONL), the Healthcare Financial Management Association (HFMA) and the Institute for Healthcare Improvement (IHI). The group, called the Partners for Nurse Staffing, assembled a Think Tank in January 2022. This Think Tank was composed of a diverse group of participants, including frontline and advanced practice nurses, administrators, as well as human resource, finance, quality, safety and patient representatives. Charged with identifying recommendations and action steps that can be implemented in a 12- to 18-month timeframe, the group met every two weeks for three months and published their “Priority Topics and Recommendations” in March 2022. Here are a few highlights:
- By a large margin, the group identified the health of the work environment as the top priority. Defining this priority further, the Think Tank provided actions that organizations can implement to ensure the physical and psychological safety of nurses and their colleagues. An additional recommendation is that specialty nursing organizations develop staffing standards, including investigating minimum staffing levels based on patient needs.
- Diversity, equity and inclusion are also key. Diversifying nursing leadership will strengthen the nursing workforce and improve the delivery of care. Additional actions that demonstrate Inclusive Excellence include establishing zero tolerance for harassment and recognizing organizations that demonstrate a true commitment to equity and inclusion.
- To maintain direct care roles, nurses need options for flexible scheduling, including variable start times and shift durations. In addition, providing opportunities for cross training and expanding hospital-based and enterprise-wide float pools can enhance workforce flexibility. In all cases, scheduling must account for staff breaks and professional development, including participation in shared governance.
- Addressing stress injury, which can include burnout, moral distress, anxiety and depression was also a priority noted by the Think Tank. Among the recommendations to leaders of health systems and hospitals, the document notes that, “The normal state is to need time and help processing experiences in the health care workforce.” At its best, healthcare is emotionally and ethically challenging so the need for support is expected not exceptional. One strategy to promote attention to well-being is incorporating the topic into routine conversations with questions like “What do you do to stay well and how can I support that?”
- While the work of nurses has changed dramatically, models for care delivery remain static. The Think Tank prioritized innovation in care delivery models, which includes changing our approach to in-person/onsite care, as well as expanding virtual care delivery and leveraging remote monitoring technology. The recommendations emphasize including nurses in all stages of planning and implementing innovative models for care delivery.
- In addition to flexible shifts, compensation models also must offer flexibility. Hospital and health system leaders can develop approaches that are specific to direct care nurses if they include nurses in designing compensation models. In addition, compensation for nurses must be approached with the understanding that nursing is not a hospital expense, but an investment in patient safety and workforce retention. Appropriate staffing is essential to generating revenue and providing quality care.
The Think Tank’s “Priority Topics and Recommendations” offer specific, actionable strategies to begin mitigating the nurse staffing crisis. The five organizations that comprise the Partners for Nurse Staffing are now leading a National Task Force that will identify recommendations for comprehensive change. There are structural barriers to achieving appropriate staffing, yet at the same time there are many strong voices with a sincere commitment to progress, meaningful change and real improvement. We must now move forward so that nurses can become the nurses they truly want to be.
© emergingrnleader.com 2022
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