Think outside the box: 3 insights into a radically better model for nurse scheduling

Infusion centers have two key assets: chairs and nurses. Software can be used to optimize the allocation of chairs, but there has been little focus on the allocation of nurses.

Amid the current nursing shortage, infusion centers must find more efficient solutions to optimize nursing time while improving nurses' satisfaction and quality of life.

During a webinar hosted by Becker's Hospital Review and sponsored by LeanTaaS, Ashley Joseph, vice president of client services at LeanTaaS, shared insights about assigning nurses in infusion centers.
Three insights:

1. The two common methods for assigning nurses in infusion centers have major issues. These methods of assigning nurses are:

  • Pre-assignment: A schedule is created in advance and nurses are assigned based on that schedule. A nurse might be pre-assigned one patient at 8:30 am, another at 9:15 am, and so on throughout the day. The rationale for this method is that it is fair and gives nurses visibility. "Pre-assignment ensures that nurses get roughly the same number and type of patients," Ms. Joseph said.
  • Push method: In this method, a central entity assigns patients to nurses throughout the day. Centers using this method follow a notion of "protected time." When a nurse is assigned to a patient, the nurse's time is protected — often for 45 to 60 minutes. After this protected period, the nurse is assigned another patient.

The problem is these methods assume that days go perfectly as planned, with no delays or complications. But this is rarely the case. Infusion centers frequently experience unexpected disruptions. Patients arrive late, they have administrative issues, an infusion doesn't go as planned and other issues arise. "All of the volatility affects us . . . there are really good days and really bad days and sometimes you don't get out until 8:00 pm," Ms. Joseph said.

2. The pull method is a better way to allocate nurses in infusion centers. The pull method empowers nurses to select and "pull" patients from the pool of those who have checked in, at the speed that makes sense for the nurse at that time . "In this system, nurses make their own decisions throughout the day about which patients to take and when to take them," Ms. Joseph said. "It's by far the best way to run a center from a utilization, nurse satisfaction and patient satisfaction perspective."

The pull method requires two guardrails. "First, you need a protected time check," Ms. Joseph said. The charge nurse must periodically check on each nurse to keep things moving. It is rare that nurses abuse this system but if it occurs, "That nurse loses the privilege of pulling patients and gets extra scrutiny," Ms. Joseph said. The second guardrail is avoiding passed-over patients. Since nurses get to choose which patients to serve, there is a risk that a patient will be passed over and end up in the waiting room for a long period. Typically, when patients are passed over, they are well-known, difficult patients. Charge nurses must negotiate with nurses to take these patients.

3. Despite its effectiveness, the pull method is terrifying for infusion centers. Giving nurses the power to choose their patients is proven effective. But infusion center leaders are terrified of this idea and offer numerous objections.

The most common objections are, "We've tried it and it didn't work," fairness, laziness, safety, control and more. Ms. Joseph addressed these objections, explaining that with a diverse team of nurses, those who prefer more complex patients can gravitate toward these patients, while nurses preferring simpler patients can serve them. Also, nurse preferences can change. The bottom line is this method, with the necessary guardrails, works best. "It gives nurses much more control over their days and allows them to leave on time," Ms. Joseph said. She was told by one nurse, "I feel like I'm being treated like a real professional for the first time."

While no software is required to initiate the pull method, LeanTaaS is developing software to support its implementation. Infusion center leaders interested in learning more or participating in a beta test should contact LeanTaaS.

To register for upcoming webinars, click here.

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