As leaders, we want to create work environments where our staff want to be, and enable them to do their best work.
This is no truer, or more necessary, than within a patient care environment. When care staff are happy, empowered to do their jobs, have access to the resources they need, and know they are appreciated, they provide better care. However, a leader's best intentions won't result in an environment like this – it takes work.
The AMN Healthcare 2015 Survey of Registered Nurses highlighted that, "Nurses show very high levels of career satisfaction, though they often express dissatisfaction with their current jobs and other factors related to nursing and healthcare."
If this is the case, organizations must look at what specifically they can do to improve the working environment of nurses. Ideally, they must look for things they can actually measure and track. Questions to ask include:
• What do your nurses value in their work environment?
• What metrics speak to these values?
• Where do they go to find data?
• Do your nurses understand the data?
• Do they share and discuss data?
Quality of Work Life Council
Milton S. Hershey Medical Center recently embarked on an initiative to improve the working environment for nurses through the formation of a Quality of Work Life Council. Responsibilities of this council include decisions related to staff satisfaction, reward and recognition, team relationships, work environment, staffing and scheduling, workplace advocacy, and retention and recruitment among other topics.
One of the first steps of this process was to identify what metrics affected staff morale; these would make up the "Quality of Work Life Report Card."
The council determined that the following six metrics have a heavy influence:
• Vacancy rate
• Average daily census (Actual & Budget)
• Percent of adjusted demand rate RN/CHG & PCA
• Core vs contingency ratios
• Hours a charge nurse must take patients
• Incidental worked time (Early ins & Late outs)
It was determined that for Hershey Medical Center, vacancy rate is the driver of the report card. Vacancies make it harder to respond to census fluctuations, decrease fill rates, increase usage of contingency staff, can result in charge nurses taking patient assignments, and can result in incidental worked time, as staff struggle to get everything done.
For instance, one unit saw an increase in vacancy rate from 3.9% to 13.2% from January 2016 to June 2016. The result was lower fill rates for RN/CHG and PCAs. The unit also saw a significant increase in contingency staffing including overtime, extra time, float pool and agency usage. Another unit experienced an increase in vacancy rate from 6.8% to 10.6% over the same time period. The result again was an increase in overtime, extra time, float pool, agency, and the charge nurse taking patients. The changes in these metrics showcased conditions that nurses have identified as frustrations in their work environment.
A Single Version of the Truth
The Quality of Work Life Report Card is a public document within the walls of the Hershey Medical Center. The byproduct of this transparency is a common and indisputable source of data. It is a resource to connect the dots and tell the real story of staffing and how it affects the work and lives of caregivers. The stories the data tells can be good, and sometimes not so good.
Identifying areas that need improvement can be a difficult pill to swallow. But, when metrics are involved, the effort you make will produce results you can literally see. The transparency around this data has created a healthy competition between areas to improve their scores. It also sparks positive communication between nursing units on how to effectively manage census and vacancy rate fluctuations while maintaining nursing satisfaction.
The desire to improve scores is just the start. It takes continual focus and commitment. The Hershey Medical Center utilizes scheduling software that can forecast patient volumes/staffing needs and identify areas of over or under staffing, but the implementation of strategies that more effectively utilize staff is where the results become tangible. Examples of these strategies include right sizing of core staff by department based on demand, and the development of contingency layering that can cost effectively adjust to sudden changes in volume or staff behaviors, like call ins.
The same AMN Healthcare survey cited above makes the need for more effective utilization of staff very apparent. The survey showed that 62 percent of RNs over 54 are thinking about retirement, and most plan to retire within three years. Additionally, 21 percent of RNs in the same age range plan to switch to part-time. This, coupled with the fact that filling open positions is not getting any easier adds further credence to the idea that organizations must do everything they can to ensure their staff are happy in their work environments. The proactive work the Hershey Medical Center has begun to leverage data to empower staff to help solve the issues that affect staffing and patient care is an example of one such measure.
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