My dad is amazing. At age 80, he remains active in his church, announces the high school football and basketball games and serves as mayor of his small town.
Recently, however, he was admitted to a small rural hospital and diagnosed with sepsis. As a nurse, I knew this diagnosis meant that we would be fighting for his life.
I was worried for other reasons, too. Hospitals face tremendous pressure to manage costs, and nurse staffing is often the greatest operational cost, receiving around one-third of the operational budget at most organizations. Often, hospitals have had to cut nursing positions as they balance their annual budget; other positions may go unfilled due to shortages of nurses. No region seems immune to challenges in nurse staffing: Urban hospitals must often compete for nurses, while rural communities may lose young nurses to better pay or lifestyle in the bigger cities.
These concerns led me to a greater question: Would my dad receive the nursing care he needed? The answer would largely depend on whether his hospital regarded nurse staffing as a cost to be managed, or, hopefully, as an investment in patient outcomes.
What is optimal nursing staffing?
Optimal nurse staffing is not about overstaffing or understaffing — it's about having an investment strategy. When we invest money, we make strategic choices and midcourse corrections to maximize the return on investment. The same pattern applies to strategies for optimal nurse staffing. Investing in nursing care means determining the optimal number and skill set of nurses, enabled by processes and technology to achieve the best patient outcomes. In other words, we trust the nurse leader to assign the right nurse to the right patient at the right time and the right cost.
Researchers have found that the quantity and quality of nurse staffing does matter. Optimal nurse staffing reduces pressure ulcers, falls, catheter-associated urinary tract infections, central line-associated blood stream infections, surgical site infections, medication errors, ventilator-associated pneumonia, hospital readmissions and mortality rates. The quantity and quality of nursing improves patient satisfaction and retention of experienced staff. The list is long, all with an impact on the budget.
Implementing an optimal nursing staffing strategy
Scheduling nurses and hospital staff is harder than it seems. Schedules built on spreadsheets cannot account for the hour-to-hour variability in the census, the patient's need for care and transitions between units. Past practices of calling nurses off or sending them home when the census drops mid-shift contribute to increasing vacancy rates.
A 2016 report found that voluntary overtime and the use of managerial staff were the top two methods hospitals employed to combat nursing gaps and vacancies — incidentally, these are two of the most expensive ways to fill those positions.
Thankfully, there are some technology systems that can help predict patient and staffing needs to prevent shortages, budget-busting overtime pay and the use of agency staff. The best technology will integrate data from different systems and provide decision support to help nurse leaders:
- Achieve optimal staffing
- Assign the best nurse for each patient's needs
- Foster a positive work environment
- Reduce the average length of stay per patient
- Reduce avoidable harm to the patient
- Reduce overtime and premium pay
- Stay within budget
This technology will allow systems to generate hospitalwide schedules that meet the needs of all stakeholders: nurses, doctors, support staff, leadership and — most importantly — the patient and their family.
Having technology with user-friendly dashboards and reporting capabilities empower nurse leaders to understand nursing workload on historical, current and predictive levels. When an organization is looking to invest in such technology, they should be looking for a system that integrates data like the census and location from the registration system, the patient's need for care from the rich clinical data in the electronic health record, the qualifications and experience of the nurse from the human resources system and the cost of care from finance and the presence of staff from the time and attendance system. This way, nurse leaders have visibility to experience and qualifications so that patients can get the care they need.
Investing in nursing
My dad received excellent care at his small, rural hospital. He survived, and barely a few weeks later, he went right back to work.
The chief nursing officer at the hospital told me that there is real pressure to manage costs, but there is also support for optimizing nurse staffing. New advances in technology gives hospitals the ability to both manage budgetary concerns and invest in nursing — and that combination supports healthy patients and a healthy community.
Better patient outcomes occur when you have the right care giver, in the right place, at the right time. To learn more about how Cerner's Clairvia technology can help optimize scheduling and staffing, go here.