A Community Medical Center Data-Driven Staffing Model

A Quality Improvement Project

Sandra Crabtree; Sandra Kundrik Leh

Nurs Econ. 2022;40(6):278-288.

Abstract and Introduction

Abstract

Predictive analytics were used in this quality improvement project to examine historical census and staffing volumes of hospital units to support a more proactive staffing and scheduling model. Research found an increase in use of premium pay, and several external forces, such as the COVID-19 pandemic, impacted outcomes. The staffing ecosystem developed during this project to include clinical nursing leadership, finance personnel, human resources personnel, clinical education experts, and information technology will continue its oversight in making strides at reducing premium pay costs.

Introduction

A high correlation exists between nurse staffing and clinical outcomes safety. If nurse staffing is not addressed, it can lead to nurse burnout, high registered nurse (RN) turnover rates, low employee engagement, patient dissatisfaction, and poor outcomes (American Nurses Association [ANA], 2020). Staffing to 'averages' of hours-per-patient-day (HPPD), census, and acuity often creates under- and over-staffing situations. Nurses at all levels within a healthcare system must have a substantive role in staffing decisions (ANA, 2020). Data have led to the inevitable conclusion that there needs to be a redesign of work and staffing practices to better meet the needs of the changing nurse workforce (Fitzpatrick, 2017). The data-driven nurse staffing project is a transformational approach that meets patient and staff needs by using predictive analytics and real data to create an ideal staffing model. The model is designed to enhance practice outcomes by managing fluctuating inpatient census to staffing ratios, thereby leading to improved patient outcomes, as well as improving nurse-sensitive indicators. The model will change the implementation process of RN staffing and improve nurses' work-life balance by providing consistency and predictability.

1 2 3 4 5 6 7 8

Next Section

Table 1. Data Collection Tool Spreadsheet Data
Units	3- Pay Period Timeframe	Job Code	Pay Code ($) (IC codes) Incentive	Pay Code ($) (>40 hours/week) Overtime	Total Dollars
2S, 4S, 4N, ICU, AR, Women's Health, ER	2/3/19 to 3/16/19	Clinical RN	$65,683.00	$32,841.00	$98,524.00
2S, 4S, 4N, ICU, AR, Women's Health, ER	2/2/20 to 3/14/20	Clinical RN	$52,666.00	$26,333.00	$78,999.00
2S, 4S, 4N, ICU, AR, Women's Health, ER	1/31/21 to 3/13/21	Clinical RN	$181,866.00	$90,933.00	$272,799.00

Appendix B.

Nursing Work Rules

Manual Nursing	Folder Nursing Personnel and Performance
Title Nursing Work Rules	Document Owner Chief Nursing Officer/VP
Document Administrator Chief Nursing Officer/VP
Original Date October 2018	Revision Dates October 2019; January 2020; March 2021
SCOPE: Applies to all nursing staff – RNs, PCAs, unit clerks, and telemetry techs in the Nursing Department. PURPOSE: To standardize nursing work rules across the hospital for all clinical units. Staff are encouraged to work with their colleagues if there is a scheduling conflict. All time off and switches must be approved by the manager or shift NAC and cannot incur overtime. POLICY: I. Weekends A. All staff with a weekend commitment will work according to their unit-specific guidelines or their weekend or per diem agreement (based on unit needs and skill mix). II. Mondays and Fridays A. All staff – full-time, part-time, and per diem – will work a compliment of Sunday, Mondays, and Fridays. • Full-time staff. Day shift: work a minimum of three Mondays and three Fridays in a 6-week schedule. Night shift: work a minimum of three Friday nights or three Sunday nights in a 6-week schedule. • Part-time staff. Day shift: work a minimum of two Mondays and two Fridays in a 6- week schedule. Night shift: work a minimum of two Friday nights or two Sunday nights in a 6-week schedule. • Per diem staff will work based on unit need. III. ETO blackout dates A. The following days will be considered blackout dates for requesting off (no requests will be taken). Staff can address with their manager on a case-to-case basis, or staff can switch with each other for coverage upon manager's approval. 1. President's Day 2. Valentine's Day 3. Good Friday 4. Easter 5. Mother's Day 6. Father's Day 7. Halloween 8. Day after Thanksgiving 9. The week 12/23 to 1/2. IV. Holidays A. All staff will be placed on an A or B template for holidays. Per the HR policy, an employee will not be entitled to holiday pay for the following absences, unless such absences are due to reasons justified in the opinion of the manager; absence when scheduled to work a holiday; absence on the scheduled day before or after the holiday when not scheduled to work the holiday. • A template will include MD, LD, Christmas. • B template will include IH, TH, NY. V. Weekend time off A. Staff will be expected to switch weekends with another staff (based on manager approval) if they need their working weekend off. The only exception is WEPP staff with a benefit of vacation time. Staff working every other weekend may request off one 8-hour shift of their weekend either Saturday or Sunday to complete a full 7-day vacation week. VI. Calling off on scheduled weekend to work A. If a staff member calls off on their scheduled weekend to work, they will be expected to make that time up on another weekend at the manager's discretion within 90 days of the call out. This includes all full time, part-time and per diem staff. VII. Limiting requests off A. Staff will be limited to three single requests in a 6-week schedule that are not in relation to ETO time. VIII. ETO approvals A. The following time frames will be used for ETO approval. Staff should not assume they will be granted their requested ETO time until it is approved. Special circumstances will need to be discussed with the manager. ETO will be limited to two weeks between (either consecutive or total) between Memorial day and Labor Day. • January to April vacations: due no later than 9/1 and will be approved by 9/15. • May to September vacations: due no later than 12/1 and will be approved by 12/15 (limited to 2 weeks during this timeframe). • October to December vacations: due no later than 6/1 and will be approved by 6/15. IX. Absent from scheduled duty A. Employees must call the nursing supervisor if unable to report to work as scheduled and speak to someone directly. Texts and voicemails are not acceptable. Calls would include late for work or absence for any reason. A specific reason must be given for the absence (i.e., personal illness, family illness, work related injury, bereavement). Adequate notice must be given to provide for coverage. Adequate notice is defined as receipt of call two (2) hours before the start of your shift. X. Incentive shifts A. Incentive will be paid per the house-wide policy on incentive. Staff who call out in the week of an incentive shift will not receive incentive pay for the incentive shift.