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Revamp Nurse Staffing Policies and Cut Costs

 |  By Alexandra Wilson Pecci  
   June 04, 2013

The more disordered a nursing unit is with its staffing, the more turnover and costs will go up. A thorough assessment and overhaul of scheduling, tracking, and staffing policies can put an end to the chaos.

It seems like a simple thing: If you hire a nurse to work 36 hours per week, you expect her to actually work those 36 hours. But what if he or she isn't always doing that? What if sometimes the nurse puts in a 32-hour week?

And what if you found it that it's been happening more often than you think, among nurses who are regularly just a few hours shy of their full-time status?

What if a-few-hours-shy was the norm across several units or even across many sites in a multi-hospital system? "That doesn't happen, does it?" wondered Mary Lou Wesley, senior vice president and chief nurse executive for WellStar Health System, based in Marietta, GA.

Oh, yes it does. In fact, "It's pretty amazing how much it does," she came to learn.

Wesley says the more chaotic a unit is with its staffing—when shifts perpetually seem to be short-staffed, and nurses are continuously on call—the more turnover will go up and staff satisfaction will go down.

Switching to scheduling software that allows managers to see who's working what hours has allowed managers at her hospitals to be alerted when nurses aren't working enough hours, or in some cases, too many hours.

It's also allowed managers to see other, smaller things, such as which nurses are regularly punching in a little early and out a little late.

Jolene Goedken, senior vice president and CNO at Mercy Health System, says making sure nurses work a full workweek means "you don't have the reliance on needing to fill those hours with other contingency resources."

"Any time you're using contingency resources," she says, "that's where you start to get some of the premium costs associated with that."

Yet identifying the problem is only half the battle. Wesley says making sure nurses work when they're supposed to be working has required more than simply knowing who was working when. Part of improving scheduling at WellStar involved doing a complete review—and in some cases, revamp—of hospital policies related to staffing, scheduling, and attendance.

Some policy changes were simple. For example, the review revealed a wide variation in starting and end times for staff nurse shifts within the five-hospital WellStar system. Sometimes the differences were between different facilities, but some were actually between units at same facility.

"If we want to utilize resources more effectively… we really need standardized shift start and end times," Wesley says. WellStar also made policies about punching in and out of shifts on time more explicit; when hundreds of nurses do that every day, the costs associated with it really add up.

"There were no consequences for the staff who continued to do that day after day after day," she says. "We really need our policies in some cases to have a little more teeth in [them], and have more ownership on the employee side."

Other changes involved making sure nurses don't work too many hours. This helps to prevent fatigue and reduce overtime costs.

After revamping the hospital's policies, WellStar put together a communications strategy to alert nurses to the changes in policies. Shared governance groups were invited to explain the new policies to nurses at each facility to make sure that everyone was aware of and onboard with the changes.

Wesley acknowledges that there will certainly be "some folks who might not be too happy" with new rules. But she insists that so far, feedback from the vast majority of nurses has been positive.

Strong, streamlined policies means scheduling will be more organized and less chaotic. "We really believe that most of the staff are going to feel very relieved" by the changes, Wesley says.

Alexandra Wilson Pecci is an editor for HealthLeaders.

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