Nurse Staffing in New Hampshire

Implementing a Nurse Staffing Committee

NH Staffing Toolkit July 2010

Objectives

Toolkit contents will allow reader to: 1. Describe the events leading to the development of the Nurse Staffing Committee initiative.

2. Describe the role of the Chief Nursing Officer (CNO) in implementing a Nurse Staffing Committee.

3. Describe the duties of the staffing committee. 4. Describe the role of direct care nurses in implementing a Nurse Staffing Committee 5. Describe the yearly review of the facility wide nursing services staffing plan.

New Hampshire Staffing History

• 2009 Legislation drafted by New Hampshire Nurses’ Association (NHNA) in response to: – Increasing calls from nurses re: staffing concerns – Concern about consequences of legislatively mandated patient/nurse ratios, e.g., access to care impacted due to closure of units and hospitals – Lobbyist representing another states’ collective bargaining organization filed to lobby in NH

History Cont’d

• • • Dialogue between NHNA, NH Hospital Association and NH Organization of Nurse Leaders Led to withdrawal of legislation in favor of: – Voluntary, non-legislative approach to safe staffing – Influencing practice verses being dictated to Nurse Staffing Steering Committee formed: – Survey – Development of “tools” based upon results

Background

•

Ratios: legislative mandating of staffing minimums

– Fixed – each nurse “must have” only so many patients – Shift – the shift average meets the minimum (some nurses may have more, some less) – Puts nursing decisions in the hands of legislators – Significant recruitment strategy for unions • traditional focus on staffing – “the nurse as worker” verses • the nurse as critical thinker delivering quality care

Background – Cont’d

•

Staffing Committees:

– Clinical decision making is essential for professional practice – Provides a framework for evidence based staffing – Requires: • Education – both staff nurses and nurse leaders • Processes in place – Two options: • Legislative mandate (the drafted legislation proposed this) • Robust voluntary plan

Definitions

• “Direct patient care” – care provided by a nurse with direct responsibility to carry out medical regimens or nursing care for one or more patients.

• “Nursing care unit” facility.

- hospital or facility unit, including operating room or other patient care area, in which nursing care is provided to patients who have been admitted to the • “Nurse” – a person who is licensed to practice as a registered or licensed practical nurse under RSA 328 of the Nurse Practice Act

Definitions

• “Chief Nursing Officer” (CNO) facility – designated nurse executive with accountability for nursing practice within the • “Nurse Staffing Committee” – Standing Committee responsible for establishing staffing guidelines • “Staffing Guidelines” matrix, staffing plan – Established pattern of assigning nursing hours to patient needs, also referred to as a staffing

Sample Nurse Staffing Committee Composition

Administrative Representatives Chief Nursing Officer Clinical directors/nurse managers Off shift nursing supervisor Human Resources representative Finance representative (CFO designee) Direct Care Nurse Representatives Critical Care RN/Step Down/Telemtery Med-Surg RN Peri Operative RN Labor/Delivery/Post Partum/NICU Resource/Float Pool RN

Obtaining Input from Direct Care Nurses

• Surveys – Pencil and paper – Online – Utilize committee members to design • Unit specific staff meetings • Open staff forums • Open office hours • Solicit emails from nurses • Unit rounds • Post drafts online for nurses to review and respond to • Ask members of committee to hold unit meetings to discuss plan development • Seek suggestions from Public Relations, Communications or Human Resources

Nurse Staffing Committee Purpose

• Provide mechanism for collaboration • Establish minimum staffing guidelines • Meet patient needs • Provide healthy work environment • Recognize evidence-based standards

Core Principles

Structure of the Staffing Committee includes:

• Not more than 13 members • At least 50% direct care nurses • Representation by shift and specialty • Designated term of service • Time and resources to participate • Access to periodic quality evaluation tools • Meeting minutes accessible to all staff • Led by CNO or designee

Core Principles

Function of the Staffing Committee is to establish staffing guidelines which consider:

• Individual patient needs • Aggregate patient needs • Qualification and competencies of nurses • Availability of equipment and technology • Requirements for equipment and technology • Geographic environment • Patient safety • Evidence based standards • Care delivery models • Available resources • Emergency plans

Committee Duties and Responsibilities

• Review existing staffing guidelines for all units • Review current evidence based staffing standards • Offer revisions to staffing guidelines based on annual review • Annually review staffing guidelines using indicators – Patient satisfaction – Nurse satisfaction – Quality measures – Fiscal measures

Committee Duties and Responsibilities

Offer recommendations for nurse staffing guidelines that:

– Are cost effective – Ensure competent staff – Ensure specialized skills – Meet patient needs – Consides complexity of care – Consider patient assessment – Consider patient acuity – Consider patient census – Consider volume of patient admissions/discharges/ transfer – Adjust staffing based on patient needs

Access to Staffing Guidelines

• Facility shall provide access to the staffing guidelines to all direct care staff – Paper copy available in nursing department – Electronic document • Facility shall provide access to the staffing guidelines to patients and their families