Case Study #3
Staffing at Sunnyside Hospital
You are the new CNE (you have been at the hospital for 6 months) for 250-bed Sunnyside Hospital located in the state of Illinois. The hospital enjoys a good reputation although recently census has been unpredictable and the competition for patients is fierce in the community. The average age of a nurse at Sunnyside is 50, a bit older than the national average. For the past 10 years the hospital slowly but steadily moved to primarily 12 hour shifts which is attractive to many, if not most of the nursing staff. The hospital is working feverishly to respond to the recent and impending changes in health care (working to reduce health care acquired injuries and infections and to prevent unplanned early readmission to the hospital).
It’s Monday and you review your calendar and move into the first meeting of the day:
Your first meeting is with a small group of seasoned nurses, average age 65, who express concerns about the 12 hour shifts they have to work. They indicate they waited to meet with you for a few months so you could get your feet on the ground. They spoke candidly about the physical challenges they face with 12 hour shifts wondering if you would support a return to 8 hour shifts with some possible options for 4 hour shifts as well. Some are concerned about rumors that a few departments are considering even longer shifts. One nurse earnestly said she could easily imagine working to 75 if there were options available. This nurse is award winning, certified and at the top of the clinical ladder.
Your second meeting is with the manager of the Emergency Department who talks about his interest in moving to a use of mixed shifts with staggered start times to match volume. In the mix he is proposing establishing some 15-hour shifts assuring you that he has nurses who would be more than happy to work them. He wonders if you would support him putting a proposal together and working with finance to cost out the new staffing model. He shares that he feels pressure to pursue this because the competition is offering 15 hour shifts and he is worried he will start losing staff.
Your third meeting is with the CFO for the hospital and the Director for Med/Surg Nursing. The CFO expresses his concern about the productivity and reimbursement for patients cared for on the general medical unit (also caring for oncology patients). The Director states the unit is already understaffed often having the inability to meet staffing numbers generated from the acuity system. The CFO scoffs saying he often wonders if the nurses haven’t figure out how to “work the system”. The Director counters with a comment re: the fact that staffing ratios legislation has been reintroduced at the state level again and indicating this type of situation is what leads some nurses to think it is a good idea.
As you reflect on the meetings you had at the end of your 11 hour day you wonder where to start.
- Please identify the key issues you read in this case
- What does the evidence/rationales in the literature indicate re: staffing?
- What are your beliefs about staffing?
- What regulations must you pay attention to?
- Who will you involve in assisting with investigating and planning solutions to the problems? (Departments, roles, e.g. just list “manager”, or “staff nurse” and expertise)
- What would you hope to have in place by the end of the week? (Potential administrative strategy)
- At a high level, what are your short term goals? What are your potential long term goals? (What are your administrative strategies to go with the goals?)
- For each solution you propose please include a brief summary (bullets) of the intended and possible unintended consequences.