Selecting Staffing Models: How CNOs Can Nurture Patients and Nurses

Nurse leaders must determine what staffing model works best for both patients and nurses, says this CNO.

The nursing shortage continues to be one of the biggest concerns for CNOs across the country, and many are brainstorming creative staffing models to recruit and retain more nurses.

When implementing new staffing models, there are several factors to consider. CNOs must prioritize what works best for patients while also meeting the needs of their nurses.

According to Vicky Tilton, vice president of patient care services and chief nursing officer at Valley Children's Healthcare, there are several innovative staffing models that CNOs could implement at their health systems.

Innovative staffing models

Staffing models have recently been expanding to include more specialized roles and nurses of different designations, Tilton explained. Leveraging advanced practice nurses can help enhance care delivery while filling gaps in the workforce.

"Contingency labor and role specialization to ensure operational efficiency and adaptability in meeting patient care demands are being leveraged as well," Tilton said.

There are four examples of new staffing models that Tilton emphasized, the first being team-based care, which promotes collaboration between nurses, nurse practitioners, physicians, physician assistants, pharmacists, social workers, and other healthcare professionals. This model empowers nurses to be more autonomous, Tilton explained, and to participate in decision-making by contributing their expertise.

"Team-based care enhances coordination, communication, and efficiency in healthcare delivery," Tilton said, "leading to improved patient outcomes and satisfaction."

The second model is flexible staffing, which, can help health systems adapt to fluctuations in patient volume and acuity as well as staffing shortages, according to Tilton.

"These strategies may include the use of float pools, cross-training programs, per diem staffing, and contingency staff," Tilton said. "Implementation of innovative scheduling practices such as self-scheduling, shift bidding, and predictive analytics-based staffing algorithms are being considered to optimize staffing levels and match resources with patient needs."

Care continuity models are also necessary to promote patient safety, reduce medical errors, and enhance the patient experience, Tilton emphasized.

"Care continuity models aim to maintain consistent nurse-patient relationships across care transitions and settings," Tilton said. "These models may involve assigning care coordinators or a primary nurse to patients throughout their healthcare journey."

The last innovative staffing model is telehealth nursing. Virtual care has revolutionized nursing and other aspects of healthcare in general, by providing new opportunities for nurses to work remotely and flexibly, while still providing patients with quality care. According to Tilton, nurses in telehealth roles can provide direct patient care, health education, counseling, and support through virtual consultations, remote patient monitoring, and tele-triage.

"Telehealth nursing enables greater access to care, especially for underserved populations," Tilton said. "It improves care coordination and enhances patient convenience and satisfaction."

Choosing for patients

The second piece of the puzzle is choosing which staffing model works best for patients. According to Tilton, there are several factors regarding patient needs, nursing practice, organizational resources, and external details that CNOs must consider when making the right decision.

First, CNOs need to assess the demographics, acuity levels, and care needs of their patient population, Tilton recommended, while working with their teams to make sure their workforce is experienced and competent to address those needs.

"This assessment helps CNOs determine the appropriate nurse-to-patient ratios, skill mix, and expertise needed to deliver safe and effective care," Tilton said.

Next, CNOs must remain in compliance with regulatory requirements, accreditation standards, professional staffing, and patient care guidelines, according to Tilton.

"They need to stay informed about state regulations, nurse licensure laws, staffing ratios mandated by regulatory agencies," Tilton said, "and recommendations from professional organizations such as the American Nurses Association and the National Council of State Boards of Nursing."

Then, CNOs should assess their health system's financial resources, budget constraints, and reimbursement mechanisms to decide a staffing model's feasibility.

"Analyze staffing costs, productive metrics, revenue generation opportunities, and return on investment associated with each model," Tilton said.

Finally, Tilton recommended that CNOs engage with key stakeholders during the decision-making process, including the nursing staff, interdisciplinary team members, healthcare executives, patients, families, and community partners.

"Through soliciting feedback, gathering input, and fostering collaboration, [CNOs] can ensure buy-in and support for the chosen staffing model," Tilton said.

Throughout this entire process, communication is key. Tilton emphasized the need for CNOs to promote transparency, communication, and shared decision-making to make successful changes to the organization.

"By considering these factors holistically and collaboratively," Tilton said, "CNOs can determine the staffing model that best meets the needs of their patients, optimizes nursing practice, and supports organizational goals and priorities."