Nurses face a lot of responsibility in the healthcare system that makes the pillar for effective health care provision achievable. Although the nurses are that important, several health care facilities still face a shortage of nurses, forcing them to deal with issues of developing and maintaining reliable staffing and workload practices (Frankel et al., 2019; Wolfe, & Mack, 2018). This paper provided a workload worries with the objective of providing solutions that will ensure reliable staffing and workload management modalities for nurses is achieved to foster a healthy work environment that would result in better productive outcomes for nurses. The paper also analyzes the decision-making tools that could be implemented based on the scenario provided.
Analysis of the Scenario
The workload worries scenario involves a pediatric care unit that consists of thirty-two bed capacity in a large tertiary care facility that operates on twenty-four hours. The newly hired nursing unit manager responsible for the day-to-day running of the pediatric care division, including staffing, ensuring quality patient care, and staff performance evaluation, faces the problem of nurses staffing and workload. The nursing unit manager is responsible for 15 RNs and 22 LPNs staff, with others working full-time, part-time, and as causal staff. Two working teams exist with other nurses having to work on both teams. The manager becomes aware of the frustration that the staff is undergoing that have been developed due to poor staffing, with others having to face workload that does not match their payment. The nursing unit manager is aware of the impact on staff productivity that can be caused by the issue and requires a solution to ensure a healthy work environment that would result in better productive outcomes for staff. The following section provides possible steps that the nursing unit manager could take to solve the issue.
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The Steps of Solving the Issue
To solve the problem, the nursing unit manager should first establish the roots for the current staff workload. The manager should identify the actual shortage of nursing supply by recognizing that the RNs are less staffed, which means they will likely face a high workload compared to the LPNs. The manager should also evaluate the human resource management issues within the health care facility that might render it possible for staff to be less productive such as a high rate of part-time work and long hours of working. The manager should also evaluate the ability of the health care facility to provide funds to hire the required number of staff to deliver the demanded level of care.
However, the manager should ensure the three key elements are incorporated into the problem-solving plan, which includes workload planning, workload administration, and workload evaluation. The workload planning involves the evaluation of patient population needs, determination of the base staffing pattern, evaluating the required full-time, part-time, as well as, casual staff, understanding skill mix requirements that are most appropriate, and conducting forecast of the required budget. According to Griffiths, Saville, Ball, Jones, Pattison, Monks, & Safer Nursing Care Study Group (2020), the management or administration of the workload involves ensuring the staff number and skill mix is well balanced to satisfy the patients’ care needs. The workload evaluation or measurement involves evaluating the direct and indirect time of care required for a group of patients within a specific shift.
The decision-making tools that could be applied in solving the issues in the scenario comprises of strategic decision-making, logistic decision-making, and tactical decision-making. The tools are used in planning, implementing, and evaluating staffing and workload practices to ensure the staff available in the health care facility have the capacity to facilitate the delivery of safe, culturally sensitive, competent, and ethical care. The strategic nursing decision-making tool provides guidelines that determine staff utilization rate, staffing levels, and staff mix. The recommended actions under the strategic nursing decision-making tool include ensuring the alignment of the budget with the stuffing needed for patient care demands. The full-time and part-time ratio is recommended to be maintained to enable continuous care characterized by the quality work environment, patient safety, and productive staff (Canadian Nurses Association, 2015). The strategic decision-making also recommends the staff utilization rates to be maintained at a position that can accomplish an equilibrium between the staff efforts, patients’ needs, scope of nursing staff’s practice, and the demands of the health care organization.
The logistical decision-making tool is based on the scheduling of the staff for a fixed period. The recommendations under the logistical nursing staffing process include ensuring nursing personnel is utilized appropriately by allocating financial packages based on the workload and experience. It also recommends putting in place a process that provides a schedule that addresses the trade-off between preferences of the staff and the coverage needed in meeting the care needs of the patients while aligning with the policies of human resources and contractual obligations (Registered Nurses’ Association of Ontario, 2017). Lastly, the tactical decision-making tool is utilized for last-minute adjustments. The tool is used in balancing the actual and required staff on each shift, team, and time-frame of care. The tactical staffing decision-making can be achieved by using contingency staff in adjusting the supply of staff and by conducting an adjustment of staff required through patient transfer, scheduling nurse visits, or canceling admissions.
In conclusion, the nursing unit manager can approach the workload issue by considering the measures provided. By identifying the root causes of the issues, incorporating the three basics of workload, and engaging the three proposed decision-making tools, the manager would be able to address the issues and ensure the effective staffing and workload modalities for nurses is achieved to foster healthy work environment.
References
Canadian Nurses Association. (2015). Evidence-Based Safe Nurse Staffing Toolkit . Ottawa, Ontario: Canadian Nurses Association
Frankel, L. R. Hsu, B. S., Yeh, T. S., Simone, S., Agus, M. S. D., Arca, M. J., Coss-Bu, J. A., Fallat, M. E., Foland, J. Gadepalli, S., Gayle, M. O., Harmon, L. A., Hill, V., …… Conway, E. E. Jr. (2019). Criteria for Critical Care Infants and Children: PICU Admission, Discharge, and Triage Practice Statement and Levels of Care Guidance. Pediatric Critical Care Medicine, 20 (9); p 847-887. doi: 10.1097/PCC.0000000000001963
Griffiths, P, Saville, C., Ball, J., Jones, J., Pattison, N., Monks, T., & Safer Nursing Care Study Group. (2020). Nursing workload, nurse staffing methodologies and tools: A systematic scoping review and discussion. International Journal of Nursing Studies, 103 (2020). https://doi.org/10.1016/j.ijnurstu.2019.103487
Registered Nurses’ Association of Ontario. (2017). Developing and Sustaining Safe, Effective Staffing and Workload Practices (2nd ed.). Toronto, ON: Registered Nurses’ Association of Ontario. https://rnao.ca/sites/rnao-ca/files/bpg/Staffing_and_Workload_Practices_2017.pdf
Wolfe, H. A., & Mack, E. H. (2018). Making care better in the pediatric intensive care unit. Translational pediatrics, 7 (4), 267–274. https://doi.org/10.21037/tp.2018.09.10
