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Workforce Management

Rethinking Nursing Productivity: A CALL TO ACTION

nurses working together in hospital

So here we are more than 2 years into the COVID-19 pandemic, and while we are far from settled into this new norm, I can share that there have been many lessons. Will we learn from these lessons and put the best into action? The profession of nursing is just one of the groups that MUST redesign how, where, and when work is done

The work of the nurse has been displayed and shared transparently for all to see over these past 2 years. The day-to-day activities and emotional investment that all nurses give to their daily work is like no other profession. This is in no way intended to diminish the work of pharmacists, psychologists, social workers, physical, occupational and respiratory therapists, or physicians, but the nurse works at the side of the patient for 8 -12 hours or more each and every day. The nurse is responsible for all aspects of care for the patient and is constantly assessing and reassessing each and every patient for their status towards their intended course of physical and emotional care.

But how we measure the impact of nursing MUST be reconsidered. To answer this call, Joanne Disch, PhD, RN, FAAN, Professor ad Honorem, University of Minnesota School of Nursing, and I conducted a thorough research study to evaluate nursing productivity and identified multiple themes and areas for future consideration. 

Current state in healthcare organizations interviewed:

  • We know the unit-based nurse sensitive quality indicators and understand that there is a correlation between staffing numbers, direct patient care, and quality outcomes

  • Many organizations continue to staff according to the midnight census and operate to ratios or mandates

  • Many CFOs give chief nursing officers their productivity numbers to meet, and the variance is monitored routinely with expected corrections to occur during the pay period

  • The dependency on agency staff comes with a huge burden of expense and is not a sustainable substitute for employed nurses

  • Patients across all care settings are more and more ill and there is often not a view of this workload intensity 

  • No single organization that we spoke with in our analysis has in place ONE VIEW of staffing to cost and quality outcomes

  • The financial, quality/safety, and resource allocation are each in siloed technology systems

  • More and more senior executives do see that staffing and the spending of resources are the operational leader’s responsibility as a team

  • There is no organizational visibility of an individual practitioners’ skills, knowledge, and abilities 

Where do we go from here? The number of nurses by shift or by day is only the “input of the equation” --- organizations must define what the output for their own organization should be. 

Our point of view on this current state:

Nurses are an investment. Patients come to your facilities for nursing care and leave your facilities safely because of the plan the nurse coordinates. 

How do you as an organization strategize and define your workforce plan? Does this workforce governance include all operational senior executives? If you are not meeting your financial or quality/safety goals, how do you innovate and test new resource care models? Your operational plan should include productivity—both the inputs and outputs and serve as a roadmap for longer term system level improvements vs. a shift-by-shift measurement. 

The work in our healthcare system requires more and more teaming across disciplines or settings. Technology to support this sharing must be a foundation to your administrative infrastructure.

Actions healthcare organizations need to take:

The nursing profession must capture a new way to measure and model the impact of our practice and care delivery. As we continue to evolve and find a new normal, we must be certain that our work and how it is done are directly impacting the outcomes we set out to achieve. 

Here are 6 steps that can be taken in your own organization: 

1. Strengthen relationships with key individuals and groups

2. Establish an organizational framework for fostering greater nursing productivity

3. Use common language, tools, systems, and processes

4. Examine nurse staffing and acuity tools

5. Establish communication vehicles to educate and engage staff

6. Create new staffing/leadership options and budget structures

Learn more about how and why your healthcare organization should take action on these steps mentioned above in our full study, Rethinking Nursing Productivity to Enhance Organizational Performance.

Read it here.