ENGAGING STAFF TO CREATE A BLENDED UNIT AND EFFICIENT STAFFING MATRIX JESSIE BROOKS, RN, BSN, UNIT COORDINATOR KIM HINCK, RN, BSN, STAFF RN, SCHEDULING COMMITTEE MEMBER
OBJECTIVES Demonstrate how engaging staff RNs to create a blended unit and efficient staffing matrix creates a safe, efficient environment for patient care and nursing staff. Describe the new concept of a Blended Unit: Main Pre/Post.
BACKGROUND History (prior to 2012) 2 Units: Same Day Surgery (Pre-Op/Phase 2/Bed Holds) and Post Anesthesia Care Unit (Phase 1) 26 Operating Rooms 12 Surgical Services Growing Operating Room Schedule Congestion in both Pre and Post Op OR Hold and Diversion for the Emergency Department Impending Growth Addition of 6 Operating Rooms, totaling 32 Addition of SDS/PACU bays, totaling 57
CHART OF OR GROWTH
SOLUTION AND PURPOSE Solution Cross-train all incoming and current staff Implement Zone Nursing (3 RNs to 4 Bays) Create a Blended Unit: Main Pre/Post Purpose Ensure patient safety Optimize Patient Flow and Satisfaction Adhere to ASPAN Nurse: Patient ratios KEEP THE OR MOVING!!!!
MAIN PRE/POST South CENTRAL North 54 53 57 56 60 58 31 26 27 19 20 1 3 4 18 17 16 OR Core 5 6 7 36 37 40 39 15 8 14 12 11 10 9
THE DATA The data reveals the average ratio of staff to patient arrivals per hour from April to May 2013. Staff are reflected as the red line Patient arrivals are represented in the blue bars The yellow line represents UC coverage
WHAT DO WE DO NOW???????
CREATION OF SCHEDULING COMMITTEE Committee Members 2 Managers 2 Unit Coordinators 7 Nominated Staff RNs Meeting Committee Members met on a weekend, 8 hours each day.
The committee reviewed the following: WHAT DID THE SCHEDULING COMMITTEE DISCUSS? FTE s available Current Scheduling Guidelines Current Staffing Matrix Trends in staffing vs. Patient arrivals Staff Concerns Current scheduling process ASPAN Guidelines for Patient Care
Pre-Op ASPAN GUIDELINES: PHASES OF CARE 1:2 Nurse to Patient ratio. (Our Goal = 30 minutes or less for each patient.) Phase 1 (PACU or Recovery) 1: 2 Nurse to Patient ratio. (Our Goal = 90 minute Phase 1 recovery.) 1:1 Nurse to Patient ratio upon initial admission for all patients, Unconscious pediatric patients < 8 years of age, until critical elements are met. (Report and Transfer of Care from Anesthesia Provider, stable airway, initial assessment, hemodynamically stable, calm patient ) 2:1 Nurse to Patient ratio for unstable patients. Phase 2 (Post-Op, preparing for discharge or admission) 1:3 Nurse to Patient ratio. Extended Level of Care (Bed Hold, i.e. waiting for a room) 1:3-5 Nurse to Patient ratio.
Ideal Staffing Matrix
SCHEDULING COMMITTEE OUTCOMES Updated Scheduling Committee guidelines, which detailed the self-scheduling process. New shifts were created based on available FTE s, the staffing matrix, and OR volumes. These new shifts were streamlined into 4 start times. Staff members bid for new shifts by seniority, FTE, and by job title (CNE/CN1/CN2).
MAIN PRE/POST SCHEDULE APPROVED/CALL/MOVED/EXTRA SHIFT/HOLIDAY CALL NURSE JOB TITLE days/wk SHIFT SUN MON TUES WED THUR FRI SAT OPTION 1 CN2 0.8 4 0530-1400 1.0 1.0 1.0 1.0 OPTION 2 CN2 0.8 4 0530-1400 1.0 1.0 1.0 1.0 OPTION 3 CN2 0.8 4 0530-1400 1 1 1 1 OPTION 4 CNI 1.0 5 0530-1400 1 1 1 1 1 OPTION 5 CNE 1.0 5 0530-1400 1 1 1 1 1 OPTION 6 CNE 1.0 5 0530-1400 1 1 1 1 1 OPTION 7 CN2 0.5 2 0530-1600 1 1 OPTION 8 CN2 0.5 2 0530-1600 1 1 OPTION 9 CN2 0.5 2 0530-1600 1 1 OPTION 10 CN2 1.0 4 0530-1600 1 1 1 1 OPTION 11 CN2 1.0 4 0530-1600 1 1 1 1 OPTION 12 CN2 1.0 4 0530-1600 1 1 1 1 OPTION 13 CN1 1.0 4 0530-1600 1 1 1 1 OPTION 14 CN2 1.0 4 0530-1600 1 1 1 1 OPTION 15 CN2 0.6 2 0530-1800 1 1 OPTION 16 CN2 0.6 2 0530-1800 1 1 OPTION 17 CN1 1.0 4 0530-1600 1 1 1 1 OPTION 18 CN2 0.9 3 0530-1800 1 1 1 OPTION 19 CN2 0.9 3 0530-1800 1 1 1 OPTION 20 CN2 0.9 3 0530-1800 1 1 1 OPTION 21 CN2 0.9 3 0530-1800 1 1 1 OPTION 22 CN2 0.9 3 0530-1800 1 1 1 OPTION 23 CN1 0.9 3 0530-1800 1 1 1 OPTION 24 CNE 1.0 4 0530-1600 1 1 1 1 OPTION 25 CNE 1.0 4 0530-1600 1 1 1 1 21.50 TOTAL 18 17 17 18 17 MIN. NEEDED 18 17 17 18 17
OUTCOME AND IMPLICATIONS FOR NURSING PRACTICE Competent, cohesive group of staff RNs who are able to take care of patients in any Phase of Care. Safe, efficient patient care. OR Hold due to Main Pre/Post patient saturation nonexistent. Engaged staff who are involved in the growth and development of the unit. Increased staff satisfaction in regards to the self-scheduling process and adequate staffing ratios. National Recognition: Abstract and Poster acceptance, PowerPoint presentation at the 2016 National ASPAN Conference during Successful Practices Session.
QUESTIONS?
REFERENCES Perioperative Leadership Documents Scheduling Committee Documents Aspan. Perianesthesia Nursing 2015-2017: Standards, Practice Recommendations and Interpretive.. S.l.: Amer Soc Perianesthesia, 2015. Print.