Staffing in healthcare is such a complex topic that a proposal to limit the number of patients assigned to nurses was recently included on the Massachusetts ballot. The proposal was ultimately defeated, but at least it started a dialogue about the needs of patient populations and addressing staffing in healthcare.
The defeat of the Nurse Staffing Proposal in Massachusetts was welcomed by several industry bodies - not least the American Nursing Association (ANA), who issued a statement saying the one size fits all proposal failed to acknowledge the complexities of nurse staffing. The ANA said it would work with hospital leaders and the unions that brought the initiative to “identify a constructive path forward to develop shared solutions”.
To the casual observer, it might appear unusual that an organization dedicated to protecting the nursing profession is opposed to fixed patient-to-nurse ratios. However, the ANA is keen to point out there is a distinct difference between scheduling (predetermining a set number of nurses based on historical numbers and anticipated volumes) and staffing - which rarely looks beyond the next 24 hours to ensure the right nurses are in the right place at the right time.
Why is Staffing in Healthcare Such a Complex Topic?
Discussing the complexity of staffing in healthcare, the ANA states “appropriate nurse staffing …is achieved by dynamic, multifaceted decision making processes that must take into account a wide range of variables.” Addressing staffing in healthcare is made more complex by up to three staffing models being used simultaneously in healthcare facilities:
- The budget-based model, in which nursing staff are allocated according to nursing hours per patient day.
- The patient-to-nurse ratio model - which can be mandated by state law universally or for specific units.
- The patient acuity model, in which the needs of patient populations determine each shift's staffing requirement.
The patient acuity model is the most dynamic. Not all patients with the same disease or injury have the same needs, and factors such as the severity of an illness and the patient's ability to provide self-care can change staffing requirements at short notice. Further complexities exist during and after an emergency incident - such as a severe weather event - when the number of patients and the nature of their illnesses and injuries can vary dramatically.
Software Solutions for Addressing Staffing in Healthcare
Software solutions for addressing staffing in healthcare already exist. Typically these consist of mass notification systems that have geo-poll capabilities. Geo-polls work by sending a message to a database of contacts in the format of a question with a selection of answers. In the context of addressing staffing in healthcare, the Q&A may look like this:
Q: Looking to cover two early RN shifts in the Oncology Unit. Are you available?
Nursing staff receive the message on their mobile devices by SMS text, voice broadcast, and email. They respond by pressing keys on the keypad (no apps are required), and their answers are sent back to the web-based notification console. Once the required number of shifts has been filled, the poll automatically closes so that nursing staff are aware the shifts have been covered and unit managers are not spending time dealing with unnecessary responses.
One of the benefits of geo-polls is that personnel databases can be segmented by role, location, or other attribute. Consequently, if a unit manager required two RNs, the geo-poll could be send to only RNs and not the entire personnel database. This has benefits in all nature of notification events, such as severe weather blocking roads in certain locations, evacuation orders being sent to all on-site personnel, and checking on the wellbeing of nursing staff working in the community.
5 Best Practices for Addressing Staffing in Healthcare
Maximizing the benefit of a mass notification tool with geo-poll capabilities involves five best practices unit managers should employ - whether the solution is used exclusively for addressing staffing in healthcare or integrated into the communications element of an Emergency Preparedness Plan. These best practices can accelerate the speed at which polls and emergency notifications are sent, and the speed with which responses are received.
1. Prepare Templates for Different Situations
Staffing requirements will undoubtedly change with every vacant shift, but it can help to have templates already created to save time writing new messages every time there is a staffing shortage. Templates are essential if a healthcare facility is intending to use the notification tool to alert personnel to emergencies so they are clearly written at a time when managers will not be stressed or in danger.
2. Plan Reactions to Different Responses
Managers need to plan ahead for the different responses they receive. What if there are not sufficient positive responses to fill vacant shifts? What if personnel need assistance getting to a healthcare facility during a severe weather event? What if a message checking on the wellbeing of a community nurse goes unanswered? There needs to be a contingency plan for every use of a geo-poll message.
3. Explain the Importance of Replying
It can sometimes be sufficient to notify personnel they will be receiving geo-polls, wellness checks, and/or emergency notifications via their mobile devices, but it is advisable to educate nurses on the importance of replying to a message of any nature, even if they are unable to fill a shift, are safe in the community or are unaffected by the emergency in order to save time with follow-up messages.
4. Practice Dry Runs for Multiple Scenarios
Practicing dry runs for all the scenarios in which the geo-poll capability will be used will familiarize unit managers with using the notification portal and nursing personnel with receiving messages on their mobile devices and responding to them. A secondary best practice in this section is to have nursing personnel assign different ringtones for incoming messages to mitigate the risk of alert fatigue.
5. Keep the Personnel Database Up-to-Date
It is essential that personnel databases are kept up-to-date to avoid scenarios in which personnel are not reachable. Ongoing freshness checks with HR databases can ensure only current nursing staff are on the polling and notification lists, while nursing personnel should also ensure they advise HR of any changes to their mobile device numbers. Forgetting to do so could cost them their lives.
Find Out More about Polling for Addressing Staffing in Healthcare
The most important responsibility for healthcare facilities is maintaining a continuity of operations every day, especially during a public health emergency or a disaster. Having adequate nursing personnel during and after these events is critical to meet increased medical demands, yet many organizations struggle with addressing staffing in healthcare - while software solutions that can help overcome this issue quickly and cost-effectively.
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