Even before COVID-19 swept across the country, short staffing in nursing was plaguing health systems. Results from a pre-pandemic 2020 study show that the nurse vacancy rate in the United States is 9% and rising and average turnover of bedside nurses is 17%. As the nursing workforce shrinks, the demands on the healthcare industry are rising. If we stay on the current trajectory, the current regional nursing shortages are projected to become a critical staff shortage across the entire United States by 2030.

While chronic understaffing is a pervasive and ongoing challenge within healthcare, most organizations are still dealing with the issue reactively.  Below are three common mistakes that health systems make when they are consistently short-staffed along with several easy-to-implement tactics that can help you address these issues strategically and proactively.

Don’t operate in staffing silos.

When a hospital has staffing issues, unit leadership can sometimes resort to unit-based staffing and even staff hoarding. Instead of working together to deploy staff based on patient ratios across the organization, each unit works independently to fill the staffing gaps in their unit. This typically happens in a decentralized staffing model, but can also happen in a centralized model when some units are not onboard with sharing staff.

Here are some tips for developing an enterprise-wide approach that leverages all available resources:

  • Create a layer of transparency to foster cooperation between team members so managers don’t feel like they must fend for themselves.
  • Start with giving them a view of the future so they know that they don’t need to hoard staff in fear of the next patient arrival.
  • Leverage the available resources across your enterprise, not just within your facility. Look across your enterprise to identify opportunities to maximize the utilization of the staff across the entire health system, ensuring that your nursing staff is allocated where they are needed most.

Don’t count on premium pay to fill all of the gaps, all of the time.

In the short term, using premium pay alternatives such as overtime, agency and incentive pay to ensure reasonable patient-to-staff ratios can be a viable strategy. In fact, temporary nurses make up between five and 15 percent of hospital nursing staffs in 55% of hospitals.

However, when these short-term fixes become a long-term solution, there are negative consequences. In addition to being an expensive option, the overuse of premium pay options lowers staff morale, puts staff safety at risk and negatively impacts quality of care. Instead of a heavy reliance on premium pay alternatives to address understaffing, here are some strategic alternatives to save money in the long term:

  • Have a clear understanding of your “steady state” staffing situation, including both the number of nurses and skillset, and then create a plan for low and high times of census. This ensures that your health system is only using premium pay as an effective and necessary mitigation strategy for short periods of time.
  • Make sure your, full-time, part-time and per diem are all working to their full commitment.
  • To uncover more potentially untapped staffing capacity, find out if your part-time and per diem staff are willing to go above their commitment.
  • Consider assigning nurses who are almost finished with orientation to patients with lower acuity.

Don’t rely on stretch staffing as a long-term solution.

When hospitals are chronically understaffed, running at a higher than desired nurse-to-patient ratios can become the norm rather than the outlier. When units are constantly stretch-staffed, they are always on the edge of crisis, scrambling to fill critical staffing gaps at the last minute.

That takes a toll on staff morale. Consider this: each additional patient over four per nurse carries a 23% risk of increased burnout and a 15% decrease in job satisfaction.  Short staffing also has a negative impact on patient care. For example, the risk of mortality increases when care is provided to patients by an understaffed team.

Instead of stretching your existing staff day in and day out, try these tactics to fill gaps in the schedule and take some of the burden off the unit nurses by leveraging other resources who can help with either specialized or general tasks:

  • Utilize nurses from other areas who may not have the specific competencies for the unit, but can perform many of the general nursing tasks. When paired with a nurse who has the specialized skills needed in the unit, these extra nurses can help the unit nurses safely and effectively care for more patients.
  • Deploy tasking resources to help with patient care needs that don’t require licensed staff, such as getting water and blankets or helping patients to the restroom. These extra support resources can come from inside or outside the unit.
  • Leverage other professional staff for specialized tasks. For example, pharmacists may be able to distribute meds for a shift.

How to Operationalize These Tactics in Your Health System

The foundation of an effective staffing strategy is precise and complete data. When staffing plans are made proactively based on an accurate census forecast, smart staffing decisions are made days in advance of the shift. Instead of constantly reacting, you have the time and insight needed to align your mitigation strategies with each situation’s unique circumstances.

This forward-focused, data-driven approach eliminates the need for unit managers to spend the start of each shift dealing with emergent staffing crises, allowing them to focus more time and attention on their patients and staff. Also, the staffing office spends less time dealing with daily staffing issues, allowing them to focus on the preemptive resolution of future staffing concerns.

For more information about how your organization can address understaffing issues, check out our new white paper, “7 Strategies for Mitigating Understaffing with Predictive Analytics.”


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