| Principal Investigator: | Louise H. Saladino, RN, BSN, CCRN |
| Co-Principal Investigator/Collaborator: | Earl Dalton, RN, BSN, MHA |
| Organization: | Durham Regional Hospital |
Abstract
Problem
The Critical Care Unit met challenges with negative budget variances for two fiscal years. Unit leadership was charged by hospital administration with finding a solution to the issues causing a failure to meet the unit budget.
Evidence
Evidence used to address the problem was gathered from the Joint Commission Publication, Healthcare at the Crossroads, Strategies for Addressing the Evolving Nursing Crisis. Nurse manager gathered data via 100% retrospective review of daily staffing sheets. Concurrent daily assignments were reviewed to insure staffing effectiveness and delivery of safe, quality care.
Strategy
A review of the literature supported the critical care nurse manager’s use of analytical and problem solving skills to improve operational outcomes. Relationships were formed with the hospital’s finance and performance services departments. Through understanding budget assumptions and labor standards, the management team was able to communicate necessary change to unit charge nurses.
Practice Change
A daily staffing “Productivity Tool” was developed. The charge nurses input data to include: census, nurse-patient ratio and acuity into the tool. The tool quantified the choices in staffing by assigning a dollar amount. Charge nurses received real-time feedback on their staffing decisions.
Evaluation
The staffing model used in the critical care unit had previously not been quantified. The end-users had never been educated to the impact of decisions on the unit budget. The correlating unit fiscal responsibility had never been relayed in terms of accountability and responsibility to the nurses in the unit.
Results
The first positive variance in dollars and full time equivalents (FTE) in three years was realized. More importantly, the charge nurses and staff are openly speaking of fiscal responsibility to their unit and their organization.
Recommendations
Build interdepartmental relationships that will lend to collaboration to meet organizational goals. Communicate change through vision. By incorporating the skills of analytical and critical thinking of critical care charge nurses, the patients receive appropriate care and the organization’s goals can be met.
Recognition
- 1st place poster winner, 2009 Summer Institute on Evidenced-Based Practice
Bibliography
- Aiken, L., Anderson, R. M., Buerhaus, P., Chow, M. P., Clifford, J. C., & Colfack, B., et al. (Nurse Staffing Roundtable Participants). (2001). Safe staffing levels. In Health care at the crossroads, strategies for addressing the evolving nursing crisis (Joint Commission on Accreditation of Healthcare Organizations, pp. 13–16).
- Contino, D. S. (2004). Leadership competencies; knowledge, skills, and aptitudes nurses need to lead organizations effectively. Critical Care Nurse, 24, 52–64.
- Dagrosa, D. (2003). Championing change: Lessons learned from one unit’s struggle. Nursing Economics, 21(6), 302–305.
- Hartigan, R. C. (2000). Establishing criteria for 1:1 staffing ratios. Critical Care Nurse, 20(2).
- Nurse-to-Patient ratios. Retrieved 9, March 2009, from American Association of Critical Care Nurses: www.aacn.org/WD/Practice/Content/nurse-staffing-ratio.pcms?menu=Practice.