Memo To: Tim Herrmann
cc: Chris Berry, Linda Brown, Barb Kessler, Linda Kroeger, Eileen Reynolds, and
Shannon Surber
From: Nurse Representatives from Sacred Heart Nurse Staffing Committee,
Professional Nursing Care Committee and the Sacred Heart ONA Executive Committee
Re:
Request to Address Critical Staffing Crisis
On January 14, 2013, members of the Staffing Committee, PNCC and ONA Executive
Committees met to discuss the increase in both the quantity and the intensity of staffing
concerns being raised by nurses throughout both RiverBend and University District.
In our review we used the Triple Aim Initiative criteria and ONA Principles of Change as
guidelines to evaluate the recent changes that have occurred in staffing. Many changes
were made to unit staffing in July of 2012 based on recommendations from Huron
Consultants. There is substantial evidence that these changes negatively impacted
patient experience or worsened patient outcomes.
The number of Staffing Request and Documentation Forms filed by nurses spiked after
you changed staffing on the units. 88 SRDFs total were filed in the first eight months of
2012. Then in only just 4 months between September 1 and December 31, 132 SRDFs
were filed. With a total of 220 SRDFs in 2012, Sacred Heart once again leads the state
on documented incidences of staffing shortages. This table is a highlighted summary for
September-December 2012.
Most Common Conditions
Not enough/too few staff
Patient acuity too high
Nursing intensity too high
Unintended Consequences
Compromised patient care
No continuity of care
Unable to take rest breaks
Unable to take meal breaks
Voluntary overtime
The staff are stretched to the breaking point and not able to provide the quality patient
care that is important to RNs as the front line advocates for their patients. The changes
you adopted based on the Huron recommendations directly resulted in an increase in
staff working with insufficient resources, missed meals and breaks, overtime.
As leaders in this organization, the PNCC, nurse representatives of the Staffing
Committee and the local ONA Executive Committee recommend the following measures
be taken across units to address a critical staffing situation and ensure the delivery of
quality, safe patient care:
1) Institute, maintain, and post a voluntary on-call list for all units - including
float pool. The law states that the hospital must “maintain and post a list of oncall nursing staff or staffing agencies that may be called to provide qualified
replacement or additional staff in the event of emergencies, sickness, vacations,
vacancies, and other absences of the nursing staff and that provides a sufficient
number of replacement staff for the hospital on a regular basis. The list must be
available to the individual responsible for obtaining replacement staff.” [OAR –
333-510-0045, Nursing Services Staffing, (5-7)]
For all the general nursing units, the hospital fails to do the following:
a. Maintain a current on-call list.
b. Post a list, maintained or not.
c. Make the list available to the staff.
2) Re-calculate Productivity Index (PI) – we understand that the productivity
index for units that determines their staffing is based on paid hours of work. If
that is the case, it includes time that the nurses are on paid rest breaks and
should not be working. The unit PI should be calculated so that it is based on 7.5
hours for each staff member not 8 hours (for 8 hour shift RNs). This results in
under-staffing and needs to be adjusted for the correct amount of work time vs.
paid time.
3) Implement contract language asking nurses to volunteer to be on call if low
censused. We agreed to this language in order to allow for staff to be called in if
staffing needs change after start of shift. This is not being utilized in many units
that are struggling to find available staff.
4) Utilize agency nurses for anticipated absences prior to the start of the shift.
This prevents situations of last minute scrambles and the current staff working
short-handed for the first portion of their shift. (see number 3 on first letter)
5) Bring back CNAs and other ancillary staff to pre-Huron Levels. Per Huron
recommendations, ancillary staff have been cut throughout the hospital. Nurses
have been reporting shortages of ancillary staff on SRDFs and the resulting
comprised patient safety. To fill these gaps, nurses are being asked to float as
CNAs, Ward Clerks, and Mental Health Techs. This is not cost effective and does
not make sense from a staffing perspective. CNAs are an integral part of safe
staffing and there needs to be more CNAs hired to fill this need.
6) Make resources available during the shift. A few suggestions include:
a. Bring back House Float RNs
b. Increase the number of Critical Care House Floats
c. Have a Resource RN per unit/shift
d. Increase the current Float pool staffing - both RNs and CNAs
7)
Ensure that all units are staffed to core at minimum. We’ve heard reports
that some units have lost the “replacement factor” in their core staffing. Also, the
use of voluntary call lists and offering incentive pay under the contract can help
meet this minimum.
8) Review and fix staffing office call process. We’ve experienced situations in
which units are short staffed and the staffing office will tell the unit that they
called all staff to try and find someone to work. The next shift or next day, the
staff report not being called by the staffing office. Likely problems: Out dated
phone lists; staffers not calling down the list in order but calling only those they
believed likely to come in; insufficient staff in the staffing office at any given time
to actually make calls. House Supervisors and Nurse Managers need to be
involved in this process – staffers are stretched too thin and don’t have time to
make all of these calls during a shift and adequately prepare for the next shift.
9) Improve communication between Staff Nurses, Charge Nurses and House
Supervisors. All staff nurses need to know who to report shortages to and have
a clear understanding of what the Charge Nurses and House Supervisors are
able to do in the moment to addresses those shortages.
Thank for your prompt attention to these important staffing concerns. Given the severity
of the situation, please respond by February 4th. We’re obligated to follow through on
these concerns and will have to consider taking these concerns to an outside agency if
we don’t see appropriate action is being taken.