Nurse scheduling, staffing issues continue to afflict hospitals: 8 key statistics

The national clinician shortage is being exacerbated by issues with nurse scheduling and staffing. Despite the emergence of predictive analytics that can be used to forecast future patient demands and workforce needs, one in four nurse managers still uses paper-based scheduling tools and nearly the same proportion don't use any tools at all, according to a survey by AMN Healthcare.

The survey report, "Predictive Analytics in Healthcare 2016: Optimizing Nurse Staffing in an Era of Workforce Shortages," was developed by Avantas, an AMN Healthcare company. Approximately 85 nurse managers, finance managers and registered nurses completed the survey between June 30, 2016, and July 18, 2016.

"With shortages of nurses and other healthcare professionals becoming an increasingly chronic problem, optimizing your workforce is imperative," Susan Salka, president and CEO of AMN Healthcare, said in a statement. "Knowing future patient demand so healthcare providers can accurately plan workforce scheduling and staffing is an invaluable asset for medical facilities."

Here are eight more findings from the survey report.

1. The vast majority of nurse managers (94 percent) agree that scheduling and staffing problems negatively affect overall staff morale, and 90 percent say the persistence of such issues makes them feel underappreciated.

"Nurses are trying their best to take care of patients," says Jackie Larson, president of Avantas. However, when nurses are called upon to pick up extra shifts, cover for someone at the last minute or work overtime, they become fatigued. "They become both physically and emotionally drained from the additional work, but it is also demoralizing when they feel like despite the fact they are doing their best, nursing shortages prevent them from being able to adequately serve their patients," she says.

2. Nearly 70 percent of nurse managers say they are very concerned about the effects of nurse scheduling and staffing problems on the patient experience and patient satisfaction, and more than half indicated they are very concerned about the effect on the quality of care. Nurse fatigue as well as inadequate numbers of nurses on hand could increase risk for medical errors, complications and readmissions, according to Ms. Larson. With a stronger direct link between patient quality outcomes and hospital reimbursement, the effects of poor nurse staffing and scheduling on the hospital bottom line has become clearer.

3. Nearly 50 percent of nurse managers say understaffing is a significant problem in their organization. More than 40 percent of survey respondents indicated that last-minute schedule changes were the most frequently occurring staffing problem. Rescheduling day-of sick calls, scheduling mistakes, patient acuity changes and specialty vacancies are also significant issues.

4. Even though technologically advanced solutions are becoming more accessible, 23 percent of nurse managers say they don't use any nurse scheduling tools at all, while 24 percent use paper-based staffing tools and 19 percent use digital spreadsheets. There are a few primary factors that account for the missed opportunity of using more advanced scheduling tools, according to Dan White, president of strategic workforce solutions at AMN Healthcare.

"First, nurse managers are extremely busy," says Mr. White. "They're focused on their primary job, which is taking care of the patient. Additionally, there wasn't really a need to worry about [increasing staffing efficiency] under the traditional fee-for-service model. Nurse managers could stay focused on their primary job without a care for what it would cost. Now, with a greater focus on costs under value-based care, they're being forced to make a change."

Another primary reason nurse managers have been slow to adopt more advanced scheduling tools is a lack of effective change management, according to Ms. Larson. "If we can't connect the dots and understand how these tools will positively affect patient care, there will be slower adoption and even resistance to them," she says.

5. Of the nurse managers with access to technology-enhanced scheduling tools, 43 percent still depend on manual scheduling.

6. The majority of nurse managers — 80 percent — say they are unaware that advanced scheduling technology, such as predictive analytics can accurately forecast patient demand and staffing needs up to 120 days into the future.

7. More than half — 60 percent — of nurse managers say advanced scheduling technology that can accurately forecast patient demand and staffing needs would be very helpful, while one-third said they think it would be somewhat helpful.

"Think about the paradigm shift [predictive analytics solutions] would create," says Ms. Larson. "With these tools, nurse managers could know how many patients they would have 30, 60 or even 90 days in advance, and how many nurses they would need at each skill level with 95 to 97 percent accuracy. In comparison, currently they are waiting until the day of and frantically calling nurses two hours before the start of the shift."

8. Healthcare enterprises that have adopted predictive analytics and advanced labor management strategies have realized various positive outcomes, including:

  • 97 percent accuracy when predicting staff needs 30 days out from the shift
  • 75 percent of open shift hours filled more than two weeks in advance
  • Marked increases in satisfaction among registered nurses
  • 4 percent to 7 percent savings in overall labor spending, totaling millions of dollars

"The first step to a solution is being open-minded," Mr. White says. "Clinicians are evidence-based decision makers. If they can be open-minded and see the evidence that doing things differently works and embrace it, tools such as predictive analytics can be implemented successfully."

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