What can we do to guarantee our ability to practice nursing the way we were taught in school? How can we take control of our practice and give patients the care they deserve?
SEIU nurses and nursing staff members came together for a conference on February 26 to learn how to use data and evidence to make improvements in staffing.
Medical errors are the seventh leading cause of death in the United States – above car accidents and breast cancer. As nurses, we know that nursing care is directly related to patient safety and preventing medical errors. But frequently we feel like our requests for the nursing staff we need to keep our patients safe go unanswered.
When Mary McNaughton and the nurses at Swedish-Edmonds said they needed more nurses and CNAs on their shifts, they had the data to back it up, and could prove the current staffing plan was not working.
Mary and the nurses sat down and created a form to track how many nurses, CNAs, and unit secretaries were on a shift, and how many patients had needs including MRSA, chemotherapy, and suicide watch. They also tracked discharges, transfers, post-ups, and transfers to ICU, along with missed breaks, overtime, and use of agency nurses and working extra shifts.
The nurses at Swedish-Edmonds presented their data to management, and were able to show that on certain units and shifts, they needed to have additional nurses and CNAs. The form they created is still being used by all the nursing units to collect evidence on how well the staffing plans are working.
“Staffing and patient safety go together. We can’t just complain we don’t have enough staff, we also need to find our own solutions. One of our nurses, Gayle Hansen, worked on this tool to assess staffing needs that we shared with our staff, along with the staff variance report form. Now we’re going to go visit each unit based staffing committee to share it with the nurses, who can review it and see if the staffing plan isn’t working. If they don’t have enough staff they need to fill out staffing variance form, which is presented at the unit based staffing committee. We had one unit that had too many nurses on the weekends, but they were really needed Monday, Tuesday, and Wednesday. So by collecting data, the unit is working on a pilot to change the schedule and see if it improves.”
Cheryl Wallace, RN, Swedish First Hill
“Our safe staffing law says we have to evaluate our staffing plan every six months to make sure it’s working. It’s not enough just to do a staffing plan and say we have it done, we have to know it’s good. We can look at our own data and see if our plan was a success, and we can see if the numbers fall outside what is reasonable, and then we have justification to back up our request to flex our staffing plan up or down. The staffing plan that we recommended had 20% more RNs and cut our use of incentive shift and agency nurses, and hired a lot more CNAs.”
Mary McNaughton, RN, Swedish Edmonds
“I feel empowered, and I can’t wait to get to work and use the same tools and start collecting data on our units. Keeping our patients safe is our top priority, and now we’ve got the tools to show the need for more nurses.”
Susan Tekola, RN, Harborview
Many of us learned Abraham Maslow’s Hierarchy of Inborn Needs as students. The pyramid in the diagram shows various human needs, and Maslow’s theory was that people must first get their needs met at the lower levels before attending to the higher levels. We can apply this model to our nursing practice. When staffing levels are inadequate, we are unable to get breaks; we may work long hours and have little control over our schedules. We cannot guarantee our patients safe care. We are stuck at the lowest level of functioning. We not only have no control over our practice, but are also unlikely to be motivated or empowered to make improvements. Research shows that this is why many nurses leave their jobs and leave the profession.