Effective workforce management starts with leveraging technology, while staffing optimization requires true collaboration

Effective staffing is at the very core of quality patient care. Staffing that achieves a balance between quality, safety, labor costs, and staff satisfaction is incredibly complex. Technology can make the complexity manageable and provide health care leaders with the tools to optimize their most valuable resource--their employees. Through such a partnership, the business intelligence brought forth will not only meet the unique needs and goals of each organization, but will also result in innovations and advancements in best practices around excellence in staffing.     

What every nurse executive should know about staffing and scheduling technology initiatives

Staffing in hospitals has a history of being based in opinion and tradition, not evidence. In recent years, for many, staffing practices have spun out of control creating chaos in overtime, the use of incentives, entitlement behaviors, dissatisfaction and frustration among nurses, and has opened doors for such things as staffing ratio legislation. Unprecedented pressures around budgets and financial performance have no doubt compounded this situation. We are in a new day, where technology can help us more than ever in a move towards staffing excellence and staffing practices based on evidence. Highly successful implementations of new technologies are the result of good leadership. The effectiveness of staffing and scheduling has significant business, safety, and quality implications that sit at the heart of the nurse executive's role.     

Value-added care: a paradigm shift in patient care delivery

Spiraling costs in health care have placed hospitals in a constant state of transition. As a result, nursing practice is now influenced by numerous factors and has remained in a continuous state of flux. Multiple changes within the last 2 decades in nurse/patient ratio and blend of front-line nurses are examples of this transition. To reframe the nursing practice into an economic equation that captures the cost, quality, and service, a paradigm shift in thinking is needed in order to assess work redesign. Nursing productivity must be evaluated in terms of value-added care, a vision that goes beyond direct care activities and includes team collaboration, physician rounding, increased RN-to-aide communication, and patient centeredness; all of which are crucial to the nurse's role and the patient's well-being. The science of appropriating staffing depends on assessment and implementation of systematic changes best illustrated through a "systems theory" framework. A throughput transformation is required to create process changes with input elements (number of front-line nurses) in order to increase time spent in value-added care and to decrease waste activities with an improvement in efficiency, quality, and service. The purpose of this pilot study was two-fold: (a) to gain an understanding of how much time RNs spent in value-added care, and (b) whether increasing the combined level of RNs and unlicensed assistive personnel increased the amount of time spent in value-added care compared to time spent in necessary tasks and waste.     

The leader as chief knowledge officer

The most strategic asset a leader has to work with is the competency of her/his staff to perform at a level of excellence. The successful leader has the ability to create Communities of Practice within the organization that create highly bonded and effective communities of practice throughout the organization.     

Transition programs for internationally educated nurses: what can the United States learn from the United Kingdom, Australia, and Canada?

It is critical to conduct competency assessments of internationally educated nurses (IENs) to ensure public safety, as well as uphold accountability to nursing as a regulated profession. Transition programs are needed because of the required proficiency of the working language, as well as differences in nursing education, national health care systems, nursing practice and culture, etc. Transition programs in the United States are grossly under-developed because of lack of recognition of their importance, lack of funding and standardization, and decentralized regulation in nursing. United States can learn from the United Kingdom, Australia, and Canada regarding how to best transition IENs. Its current hit-and-miss approach is inadequate and inconsistent with the emerging global trend to systematically deal with the transitional challenges of IENs at the national level.     

The impact of state regulations on nursing home care practices

This article assesses the effect of the minimum quality standards of deficiencies and nurse staffing requirements on the nursing home care practices of physical restraint, indwelling urinary catheter, and feeding tube use. National longitudinal data on nursing homes reveal that the effect of specific deficiency citations on care practice use depends on the clinical complementarity or substitutability of the deficiency and the specific care practice, while a high number of deficiencies can lead to a greater use of each care practice. Higher direct care staffing requirements increased the use of physical restraints and decreased the use of feeding tubes. Increases in licensed nursing staff requirements had no effect on the care practices studied. Regulators should be aware that using minimum quality standards when quality is multidimensional creates incentives for offsetting quality improvement practices.     

The implications of nurse staffing information: the real value of reporting nursing data

There is a dearth of information about the relationship between the patient care contributions of nursing and its financial contributions to an organization. As consumers and legislators are becoming more aware of the ramifications of nurse staffing issues, and as they endeavor to address them with legislative solutions, the decision on how best to develop optimal staffing strategies may soon be taken away from nursing leaders. To maintain control of this important issue and develop solutions that will help highlight the economic and patient care contributions of nurses, a thorough understanding of the problem, and a new commitment are needed from nursing leaders to take charge of the issue. To relate nursing care to patient outcomes, meaningful data on the nursing care provided is needed in addition to data on the nursing needs of patients. Staffing and performance monitoring tools should be used to effectively plan, implement, and control financial and operating resources as well as measure the economic value of the nursing profession's contribution to the cost and benefits of patient care.     

The language of business: a key nurse executive competency

The ability to interpret fiscal data pertaining to patient outcomes, human resources, customer satisfaction, and financial positions is a vital evidenced-based nurse executive competency. The ability of nurse leaders to influence and contribute in health system executive decision making requires fluency in accounting, "the language of business." After examining challenges faced by nurse executives, faculty at the Loewenberg School of Nursing at the University of Memphis integrated intensive accounting education into a new executive MSN program. Woven throughout the management accounting course is the concept that accounting data must be relevant and accurate for use by organization decision makers. Evidence-based decision making is emphasized when teaching planning and control activities. In addition, fluency in accounting is enhanced which leads to greater skill in patient and nursing advocacy. As competency in management accounting increases through the semester, executive MSN students are encouraged to apply cost accounting course content to their practice settings and to analyze how planning or control activities improve quality outcomes.     

The impact of nurse staffing on hospital costs and patient length of stay: a systematic review

Research examining the relationships between nurse staffing, hospital costs, and length of stay is varied using a range of methods and definitions. This lack of coherence in definitions and measurement tools for cost and length of stay makes it difficult to conclude with certainty the results of nurse staffing on hospital cost and length of stay. However, the evidence reflected that significant reductions in cost and length of stay may be possible with higher ratios of nursing personnel in hospital settings. Sufficient numbers of RNs may prevent patient adverse events that cause patients to stay longer than necessary. Patient costs were also reduced with greater RN staffing as RNs have higher knowledge and skill levels to provide more effective nursing care as well as reduce patient resource consumption. Hospital administrators are encouraged to use higher ratios of RNs to non-licensed personnel to achieve their objectives of quality patient outcomes and cost containment.     

Analysis of ambulatory nursing practice

A nursing patient classification system can be used in ambulatory care to facilitate decision making relative to staffing assignments and to begin examining differences in patients' nursing care requirements according to medical diagnosis or other patient characteristics.     

The impact of nursing on patient and organizational outcomes

The impact of nursing on patient and organizational outcomes has received significant attention from researchers in the past 10 years. Although some research has been based on a theoretical framework, to date, there has not been one, consistent framework that can guide this research. In addition, the frameworks that have been used do not identify nursing as the pivotal concept in the model. The purpose of this article is to identify a framework to guide such research with an emphasis on nursing as the essential concept. Unit culture, nurse staffing, staffing mix, and other variables do not have a direct effect on outcomes. It is only through these variables' influence on the delivery of nursing care that outcomes are affected.     

The MISSCARE Survey-Turkish: psychometric properties and findings

One measure of the process of nursing care is missed nursing care, which refers to any aspect of required care that is omitted either in part or in whole or delayed. Little is understood about how the quality and processes of nursing care differs among countries around the world. The aims of this study were (a) to test the psychometric properties of the MISSCARE Survey-Turkish and (b) to compare the extent and type of missed care as well as reasons for missing care between Turkey and the United States. There was less missed care reported by Turkish nurses as compared to U.S. nurses (p < 0.0001). Turkey nurses identified more problems with inadequate staffing resources (p < 0.0001), materials resources (p < 0.0001), and communication/teamwork (p < 0.0001) as reasons for missed nursing care than did U.S. nurses. Missed nursing care is a critical problem that needs to be addressed in both countries.     

Factors influencing organizational participation in the Clinical Nurse Leader project

When the American Association of Colleges of Nursing introduced the Clinical Nurse Leader"s (CNL) pilot project in 2004, it was the first time in more than 40 years that an attempt was made to introduce a new role to the profession. This new role was designed to address many challenges related to patient care in the current health care delivery system including a need for more effective clinical problem solving, better coordination at the point of care, stronger interdisciplinary relationships, and more rapid implementation of evidenced-based practice findings at the patient-provider interface. Critics from both academic and practice settings have questioned the need and wisdom of introducing a new role to the profession at this time. The factors that led some nursing leaders in early stages of this project to be proactive and involve their organizations as early adopters of the CNL role were examined in this study. Five major factors were identified from the research to form a framework designed to explain organizational participation: organizational needs, a desire to improve patient care, an opportunity to redesign care delivery, the promotion of the professional development of nursing staff, and the potential to enhance physician-nurse relationships. The ability of academic and service partners to forge the types of relationships and promote best practices as is occurring in the CNL project may be a critical success factor in confronting the current and impending nursing shortage.     

Nursing leadership: championing quality and patient safety in the boardroom

OBJECTIVE: Identify the extent to which hospital boards of trustees, CEOs, and CNOs are engaged in quality and safety at the leadership and governance level and how CNOs can support board engagement in quality and safety. BACKGROUND: Although research is emerging, still relatively little is known about the impact and interface of hospital boards of trustees, CEOs, and nursing executives related to improving quality and patient safety. METHODS: 73 telephone interviews were conducted with hospital board chairs, CEOs, and CNOs from a convenience sample of 63 U.S. hospitals. The interviews (22 of which were with CNOs) lasted 30 to 45 minutes and were supplemented by a focus group of five nursing executives. RESULTS: There are significant differences in the perceptions of CNOs versus those of board chairs and CEOs. CNOs reported a greater familiarity of landmark reports on quality and patient safety than board chairs. CEOs and board chairs gave substantially higher ratings to integration of quality planning. Boards have limited comprehension of salient nursing quality issues. CONCLUSION: CNOs have a critical role as boardroom champions of patient safety and quality improvement.     

Linking nursing workload and performance indicators in ambulatory care

More and more ambulatory care organizations are using nursing report cards to monitor and evaluate the quality and effectiveness of nursing care in the ambulatory setting. Nurse staffing levels is usually one of the items included in a nursing report card and the one most scrutinized by ambulatory care administrators. One strategy employed by the nursing leadership at the South Texas Veterans Healthcare System to justify nurse staffing levels is linking administrative staffing monitors with nurse-sensitive outcomes via workload and performance indicators. Through this approach, nurse leaders are able to justify nurse staffing level changes, needed technology changes, process improvements, and/or workflow needs to administrators with positive results and support.     

Evidence-based staffing: potential roles for informatics

Over the last 15 years, evidence has been accumulating relating higher levels of nurse staffing in both quantity and experience to lower rates of adverse patient outcomes. Consequently, to promote quality patient outcomes efficiently, making staffing decisions based in evidence is of increasing importance. However, there is still limited data to help decide how to effectively allocate scarce nurse resources in practice. Existing principles, frameworks, and guidelines provide a foundation for nurse staffing decisions but face poor adoption. To determine optimal nurse staffing practices and provide evidence-based recommendations for policy, and integration into operations, comprehensive data are necessary. Information technology can assist nurse staffing decisions. Four informatics processes that may support evidence-based nurse staffing are described: (a) Data acquisition from multiple data sources, (b) Representation of data in a way it can be re-used for multiple purposes, (c) Sophisticated data processing and mining, and (d) Presentation of data in standardized and user-configurable ways.     

Factors influencing work productivity and intent to stay in nursing

The researchers document the individual and workplace characteristics associated with decreased work productivity and intent to stay in nursing for nurses employed in direct patient care in the hospital setting. Factors associated with decreased work productivity were age, total years worked as a RN, quality of care provided, job stress score, having had a job injury, and having a health problem. Nurse leaders must place additional efforts on changes needed to improve the hospital workplace environment to decrease job stress, improve RNs' ability to provide quality care, and to assure the health and safety of nurses. Reducing job stress and providing adequate staffing so quality of care can be provided will enhance job satisfaction which will also encourage RNs to stay at the bedside. Improved work environments may delay older RNs' retirement from the workforce.     

Capacity planning in hospital nursing: a model for minimum staff calculation

An aging population, emerging technology, heightening patient expectations, rising health care costs, shorter patient stays, and growing pressure to improve quality have made the management of nursing resources even more critical today. While approaching a model for staffing levels, the authors considered factors such as patient acuity, work redesign, and minimum quality standards. The methodology for analysis included estimating the time needed to complete nursing tasks and calculating the average number of tasks per patient. With respect to nursing quality measures, the study examined the adequacy of nursing documentation including admission history, assessments, nursing procedures, and discharge report as well as nursing-driven outcomes such as fall and phlebitis rates. Lastly, the authors determined the theoretical number of staff needed to provide nursing care according to quality standards.     

制造业服务化背景下技能人才胜任力模型构建与评价

制造业服务化转型是“中国制造2025”的核心任务之一,对技能人才提出了更新、更高的要求。在分析制造企业服务化转型对技能人才胜任力需求的基础上,从专业知识与技能、学习与创新能力、客户协作意识与能力以及职业角色认同4个维度,构建并验证技能人才胜任力模型。在此基础上,运用主成分分析法对制造企业技能人才胜任力进行评价。结果显示：技能人才总体胜任力处于中等水平,其中专业知识与技能以及职业角色认同维度达到良好水平,学习与创新能力以及客户协作意识与能力维度偏低;90后技能人才的职业角色认同显著低于80后和70后,高级工和技师的总体胜任力相当,民营企业和小企业技能人才总体胜任力相对较低。     

Using technology to support the CLAS Standards

Effective communication is essential for ensuring effective patient education to support patient acquisition of self-care knowledge and behaviors. National standards have been developed suggesting methods for meeting this need and systems changes are either mandated or recommended within health care delivery organizations to assure movement toward the goal of effective patient-provider communication. By availing themselves of the opportunity to assign these nationally standardized cultural competency modules as part of institutional requirements, nursing administrators and managers can implement a cost-effective method for improving the cultural knowledge base of nursing personnel.