Bedside Nurses Contribute to Staffing Decisions

Feb 10, 2020

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The HWE standards help us use a common vocabulary and recognize shared goals.

Rebecca McClay

I am a nurse in the critical care unit at Midland Memorial Hospital in Midland, Texas. Our region is subject to constant population changes due to fluctuations in our oil-based economy, which affects nurse staff retention and acuity load.

Within our unit, we identified the need for bedside nurse involvement in addressing staffing concerns and offering potential solutions. Specifically, we wanted to develop a uniform voice to communicate the bedside nurse perspective to unit and hospital leadership.

We had an existing, hospital-level Nurse Staff Advisory Council (NSAC), but after hearing our concerns, leaders and department managers encouraged the formation of our own, unit-based NSAC.

We decided to combine both our Critical Care and Progressive Care units into a single NSAC. This decision was based on the location of the units on the same floor and our close coordination of work for a continuum of patient care. The CCU/PCU NSAC was quickly faced with questions about the role of the committee and what we did to support nurse staffing in our combined units.

Defining Our Voice

To find a guide in our role and responsibilities for both the bedside staff and our managers, the unit-based NSAC officers researched AACN resources for guidance. The AACN Standards for Establishing a Healthy Work Environment (HWE) and the AACN Guiding Principles for Appropriate Staffing were obvious choices for the CCU/PCU NSAC role guidance.

The HWE standards helped us focus on better ways to communicate with members of the hospital-level NSAC. That committee is not run by current bedside nurses, and it is a different work environment. The HWE standards help us use a common vocabulary and recognize shared goals. Using terms that are meaningful to the hospital-level NSAC has strengthened our discussions and allowed us to communicate our goals more clearly across staffing committees. Our conversations are now much more impactful and effective.

In addition, we used AACN’s eight Guiding Principles for Appropriate Staffing to develop a role and responsibility position statement for our unit-level NSAC. We reviewed each guiding principle and drafted a set of parameters based on the unique staffing needs of our unit. It was approved by hospital leadership and accepted into our Policy Tech database.

True Collaboration

As a result of this evidence-based work, our position statement now ensures that our unit-based NSAC, specifically our bedside nurses, has a voice at the table when it comes to staffing concerns and policies. Additionally, it allows our unit to have input when developing effective hospital-wide staffing models.

Meaningful Results

Prior to the creation of the unit-based NSAC, the hospital-level NSAC was looking at staffing by unit, but without direct input from our unit’s bedside nurses. For example, newly hired nurses were placed in our progressive care unit – a telemetry unit – before working in the critical care unit. This became a clarity issue, because the new staff thought they were being hired directly for critical care.

Our unit-based NSAC brought this issue to the hospital-level NSAC. Based on our position statement, we knew we needed diligence in representing our staff roles and developing competencies. This was powerful motivation to directly address with our leadership.

The hospital-level NSAC acknowledged our concern, and we started bringing newly hired nurses directly into their unit of choice. As a result, our staff has nearly doubled, in both units, within the past year.

Additionally, we’ve seen dramatic improvement in our nurse retention.

A Model for Success

Based on the feedback we received from hospital-level committees and other units – combined with our increased unit-NSAC attendance – we believe that implementing the Appropriate Staffing standard has had a significant role in nurse empowerment within the organization.

One of the CCU/PCU NSAC chairs reports to the hospital-level NSAC meetings directly, and they have voiced acclaim and full support for our position statement. The officers of our unit-based NSAC are currently reaching out to other unit-level NSACs within the hospital with the hope that our model will be applied to their work. Our key learning: A healthy workplace is one in which bedside nurses have a committed and professional voice regarding staffing issues and solutions.