A Way Forward: Navigating Healthcare’s Staffing and Scheduling Dilemma

Are you as weary as I am with the constant flow of information and the multitude of opinions on all topics? In fact, this is with every topic, including how to lead, how to follow, how to care, how to trust, and how to be well and balanced. With all this distraction and noise, my thinking tends to focus on the most simple and foundational.

I’m most focused on how we can help healthcare organizations lead in their own complex environments.

I have spent many hours these past few weeks talking to healthcare leaders about the challenges of staffing and scheduling their people, given the shortages of them today. This is their #1 operational concern: the labor shortage. It is imperative that our people — your people — are utilized in the most efficient and effective manner.

Getting Back to Basics

I spent time with a nurse leader this week. She is relatively new to her organization and her focus now is to work with each clinical unit in her multi-hospital system to review its staffing grid — or, in lay terms, how many nurses and assistive personnel are needed to care for each patient. This is happening across the United States. Many organizations are still playing the game to reach the optimal number on the staffing grid and achieve appropriate budgeted hours per patient, per day.

But, I have to wonder: Given the past few years, are budgeted numbers a target, a goal, or a barometer? How can we hold to a firm number when patients are increasingly complex and staff skills and competencies vary widely from one to another?

In fact, my first question to the leader was, “How do you as a healthcare leader know that you are providing the right staff to care for the right patient at the right time?” This challenge is not overcome by staffing by ratios (patient numbers to nurses or assistants), using the stagnant “byzantine-like” midnight census number, using external benchmarks and deciding what percentile of performance you will aim to deliver, using spreadsheets, and/or non-standard staffing and scheduling processes across the organization.

Reconsidering Staffing and Scheduling

In a new paper from The Workforce Institute — “Technology Innovation in Addressing Nursing Workload Intensity and Resource Allocation” — we offer a starting point. The paper is built on the premise that healthcare leaders today first and foremost must put their emphasis on the delivery of quality care that is safe for all people. The authors conducted a comprehensive literature review and interviewed many nurse leaders from across the country. These interviews revealed that many organizations are still staffing according to the midnight census or based on raw patient-acuity scores determined from the electronic medical record (EMR).

The white paper recommends a three-pronged approach, one that looks not only at nursing tasks and acuity scores generated by the EMR, but also includes professional nursing judgment — for example, a patient who has greater workload intensity requirements due to psychosocial or educational needs as well as social determinants of health.

In the paper, we outline and define the eight action steps that all healthcare leaders should consider adopting: 

1. Develop a consistent understanding and use of terminology. 

2. Improve the integration of existing systems for the EMR, workforce management, and finance and budget data. 

3. Provide nurse leaders with easy and real-time access to tools for valid decision making about nursing workload intensity and staffing. 

4. Integrate professional nursing judgment with data from technology solutions to determine nursing workload intensity. 

5. Test the validity and inter-rater reliability of the nursing workload intensity system. 

6. Engage nurse leaders and nursing staff in the successful implementation of the nursing workload intensity system. 

7. Apply technology in new and innovative ways to assist nurse leaders with deploying staffing resources optimally and safely.

8. Demonstrate the value of nursing.

As innovative labor models are put into place and virtual staffing explodes, it is time to get back to the basics to understand what each patient needs from us and to begin our conversations there.