Successful Staffing Starts With Culture

Feb 24, 2021

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We have had the highest nursing satisfaction in the hospital on the last two employee surveys.

Beth Humphries

The Beacon Award-receiving Supplemental Staffing Team at VCU Health Systems in Richmond, Virginia, consists of more than 250 healthcare professionals who provide nursing support to nearly every unit in the hospital. As with many other organizations, VCU Health is experiencing unprecedented staffing challenges during the COVID-19 pandemic, but its Supplemental Staffing Department is well equipped to respond. Three nurses from the team, Nurse Manager Beth Humphries, RN, MSN-CNML; Nurse Clinician Mary Raines, MS, RN, NPD-BC; and Staff Nurse Tyson Alburn, RN, BSN-PCCN, described how the department has responded to the crisis.

How has the Supplemental Staffing Team adjusted to meet your hospital’s needs, especially in response to the pandemic?

Beth: In our current environment we need all hands on deck including agency staff. These nurses were difficult to attract even before the pandemic.

Pre-COVID, we created a new pool to meet the needs of the procedural areas in the hospital. Supporting the procedural areas helps to alleviate delays in throughput by allowing more people to get their procedures done in a timely way prior to discharge. We are constantly creating clusters or staffing areas so that we can support the organization as a whole. I do think by having this procedural pool and having a well-established pool otherwise, we were able to jump in and face the challenge of COVID-19.

We opened a Staffing Command Center to support staffing and redeployment of team members to meet the many needs of the organization. We have also implemented rapid onboarding. We began onboarding staff weekly instead of every other week. When school was shut down, the CNRA students couldn’t go back to classes, so we rapid onboarded them. We also rapid onboarded 60 student workers. These workers did not have to be nursing students. They could be pharmacy students, communication students, etc. They were trained to be PPE coaches and door monitors, so you had another resource out the door supporting safety during COVID and freeing up RNs. These workers also assisted with screening visitors when hospital visitation reopened.

Mary: We’ve also decreased the amount of orientation people need, and decreased the HR requirements. A number of these staff are Supplemental employees but are unit based in our heaviest COVID units.

It sounds like your group was ready to respond to the COVID-19 surge.

Tyson: We were there. When it started to surge, our department was already there because, of course, we’re going to get floated to the COVID units. We’re in the ED. We’re in the ICU. We are taking care of these patients from the beginning when there wasn’t that much knowledge. We weren’t just bedside. We were also in the COVID Command Center assisting with calls.

Beth: It’s been a challenging year. I think it’s probably the hardest year of my professional career, and I’ve been a nurse for over 30 years. It’s the challenge of meeting all of the patients’ needs in the organization as well as supporting your staff to make sure they know they're not alone in this fight.

How do you oversee management of the Supplemental Staffing Unit?

Beth: We have a shared governance process within our unit. Our staff have a practice council that meets every other month. We also have staff on all different committees and councils throughout the hospital, because everything affects us, and we affect everyone. For example, if they’re doing a procedure a different way in another unit, we need to know about it because our staff is going to be there in the middle of it.

Are there challenges to creating a healthy work environment when everybody’s not coming to the same place all the time?

Beth: We do not get to see our staff all the time, but we make a great effort to round on them regularly. We have monthly staff meetings. We have our Supplemental Practice Council, and everybody on the Supplemental Practice Council not only sits on all these other hospital committees, but they’re each assigned to be a resource person to a group of other Supplemental nurses. So that gives them another touchstone.

We have had the highest nursing satisfaction in the hospital on the last two employee surveys. The biggest thing our team members say is they feel supported. I think that is a result of being responsive to the staff when they do have a concern. It’s not just rounding. It’s being proactive with them. When they come to us with a safety concern, we actually take that, and we move it up the channel to make sure they get the answers they need.

We also have the highest Safety Star awards in the organization. That’s a program in the hospital where you identify and escalate safety concerns, so they do not reach the patient. For the last five years, we have had more than any other unit in the hospital. I think it's because our nurses don’t have blinders on because they’re not unit-based, and it's not ‘how we always do it.’ They’re always moving around. The neat part about that too is that in addition to identifying problems, they adopt and communicate best practices.

Tyson: We show up to help. We advocate. I’ve brought issues to upper leadership. When there’s an issue, we are the first ones to know about it and we’re like, ‘Hey, this is a system issue that we’re seeing,’ or ‘This is a localized issue in our system that needs to be addressed,’ and then they do something with it.

Mary: On the night shift, there are not as many resources readily available. If there are issues, our night nurses will look to see what other Supplemental nurses are working and utilize them as resources.

Was there another challenge in the hospital that has contributed to upper-level support for the Supplemental Staffing Department?

Beth: One of the challenges we had was meeting the needs of the procedural areas or other unique areas, and we’ve done that. I think another challenge we had is keeping a balanced schedule for the off-shifts. I really think we’ve met that also. We are always hiring and interviewing people and trying to find the best fits, especially for our off-shifts. I think that was our biggest challenge, pre-COVID.

When I started in Supplemental in 2004 and became nurse manager in this department in 2015, one of the biggest things I wanted to do was change the culture of how other units viewed Supplemental staff. I wanted them to look at these people as valued resources that come to you and are a part of your team for that shift. I think we see it now.

Mary: I think some of the things that helped to get this culture where it is, is the nurses really bought into being a part of the team. There are nurses who just want to come to work and do a good job and that’s fine, but I’d say as a whole our nurses are interested in VCU and they’re interested in Supplemental doing well, looking good. When we started having shared governance, I think that made a big difference because people started seeing our staff as the resources that they are in committees with other disciplines and with other areas of the hospital.

How did you know that culture was the place to start?

Beth: Nursing is the foundation of every organization. You cannot be successful without cohesive teams. You can’t build anything without staffing and nursing. That’s what nursing does for the patient population. We provide that safety gap, and I think that’s so important.

To do that you’ve got to have cohesive teams that are focused on what’s best for the patient. When I first started in this role, I was hearing about the negative experiences our nurses were having. It was important to make sure everyone knew that Supplemental represents very skilled, experienced nurses who are team players.

When you mentor and coach your staff and you promote this attitude and behavior toward safety and being patient focused, then you are creating a team that’s going to show up every time with a great attitude and put the patients first. That takes time. It’s not overnight or even a one-year change. It took years to get to the point where now our staff are being asked to chair hospital-wide committees and take on leadership roles.

Our goal is to help our staff reach their greatest potential, such as obtaining certification, challenging the clinical ladder or returning to school. I feel the units now see our staff as experienced resources that add value to each shift they work.

Tyson: The support system is real. Not only that, but Beth ensures that we are not forced into bad situations. It is very much a relationship between our department and another department. For the most part, we can choose where to work in the places there are staffing needs. If you make a balanced assignment, our nurses want to come back to you. It just maintains this culture that we are here to help.

How do you ensure you are leveraging the expertise and skills of your team in the right way?

Beth: I think with the limited resources we have due to our third wave of COVID, team nursing is where we have to go. I think we need to cycle back to team nursing, which was not unheard of 30 years, 40 years ago. That was how we all functioned, but it all seems to come back around. If you face the challenges of not being able to get enough agency staff, having few resources across the nation and the COVID numbers going up, team nursing is a good way to approach this.

I think people need to embrace it because there are nurses who have been practicing in specialty areas where there are fewer staffing needs due to COVID; for example, our perioperative and clinic nurses. These nurses have not been functioning as a typical bedside nurse would, but they still provide significant value by working as part of a team design supporting nurses who are actually assigned to the patients. Team nursing can really help keep patients safe and provide what we need for the organization. We have to start changing the way we’re thinking about staffing. It can’t be just these are my patients. All patients are our patients, and we need to change our approach.

It comes back to valuing your employees, because really nursing is the foundation of every hospital. It’s the nurse at the bedside who is putting the patient first who makes the difference. Our nurses, we like to say, they’re expert generalists. We’re just excellence in motion. It’s our motto here in Supplemental. We want to bring excellence to every place we go.