When it comes to finding the most cost-effective resources to cover a shift, most hospitals and health systems will agree that sharing qualified staff across units (or even facilities) is preferable to more expensive alternatives such as OT, contingent labor, or costly shift bonuses.
They also agree that by and large nurses and healthcare staff do not like being told to float to a non-home unit. Especially if there is a lack of understanding for why, or if there’s perceived unfairness regarding which staff members are told to float more than others, etc.
However, we are beginning to observe a shift in attitude about floating among many organizations that utilize a Collaborative Staffing approach, and the reason why is simple: instead of making floating a command, it’s a choice.
We call it self-directed floating, and it happens when employees are given visibility into all of the open shifts they qualify for across a broad number of units.
Essentially, it allows employees to “shop for shifts” and proactively request those that fit their individual preferences, interests and availability. It also allows staff an easy, flexible way to make up for lost income, such as when they take a sick day or are called off due to low census. Additionally, many view it as a chance to further advance their careers by expanding their skills and experience outside of their home unit.
The trend towards self-directed floating was uncovered in a recent study of 182 facilities that use a cloud-based staffing solution, which found that an unintended consequence of implementing a flexible approach to staffing was that nurses were consistently choosing to float1.
Self-directed floating provides autonomy, and research has found that an increased sense of autonomy can reduce turnover and decrease staff burnout2.
How are hospitals making the transition from mandatory floating to self-directed floating? Here are a few common characteristics of a collaborative approach to staffing that are seen in health systems where self-directed floating is more prevalent:
- Organization-wide Visibility: In order for staff to want to float, it needs to be easy to see what shifts are available in the units that they are qualified to work. That requires automation that connects employees with the right skills with open shifts, making it possible for them to engage in self-directed floating. It’s also important for managers to easily view the skills and competencies of the entire workforce, as well as information about the current workload and overtime status, so they can make data-driven and safe staffing decisions.
- Choice: Self-directed floating requires providing employees with the autonomy to choose available shifts in other units. There must be a process for nurses to indicate their interest in working particular shifts outside of their home unit.
- Participation: A positive self-directed floating experience takes committed participation from leadership, management and staff. That starts with tools and systems that make it possible to see and choose open shifts across the enterprise. However, that is just the beginning. Making sure that employees have the tools, information and support they need when working in non-home units is also necessary for a health system that wants to create a culture of floating.
- Consistency: When employees are frequently moving between different units, it makes sense to have standardized staffing policies, especially regarding overtime and incentives. It’s also important for floating staff to feel welcomed wherever they work so they have the desire to come back again. Orientation and equitable staffing assignments can make the experience more positive and productive for both floating and home unit staff.
Over a decade ago, the IOM report “Keeping Patients Safe: Transforming the Work Environment of Nurses” noted that the quality of patient care is directly impacted by the degree to which nurses are active and empowered participants in making decisions about their patient’s plan of care and by the degree to which they have an active and central role in organizational decision-making3. Self-directed floating is one strategy that allows staff to have an instrumental role in decisions that impact the organization and the patients they care for.
To learn more about self-directed floating, check out the 20-minute webinar, “Collaborative Staffing: How Open Shift Management Fulfills Needs.”
1Schulman, Cheryl A., et al. “Self-directed floating: Nurses are accepting its benefits.” Accessed October 2, 2015.http://www.modernmedicine.com/modern-medicine/news/modernmedicine/modern-medicine-feature-articles/self-directed-floating-nurses-a?page=full
2 Weston, Marla. “Strategies for Enhancing Autonomy and Control Over Nursing Practice.” OJIN: The Online Journal of Issues in Nursing. 2010; Vol. 15, No. 1, Manuscript 2.
3Armstrong, Kevin, et al. “Structural Empowerment, Magnet Hospital Characteristics, and Patient Safety Culture.” Journal of Nursing Care Quality. 2005; Vol. 21, No. 2, 124-132.
The creation of staff schedules requires an enormous amount of planning and preparation. Analyzing staff availability, overtime, trends, and census are just a few examples. Fortunately, integrated and robust software solutions can provide tools that can help automate the complete scheduling process.
Creating the schedule is only the beginning. The next step involves creating staff to patient assignments. These assignments are critical, and can have a great impact on both patient satisfaction as well as staff engagement. There are many factors to consider when making staff assignments, including patient acuity, workload distribution and patient location. However, there is one other very important point to be considered: continuity of care.
Patients perceive care to be more personalized when they have the same nurse. This can also lead to improvements in patient engagement. When assignments are made that provide the patient and caregiver the opportunity to establish a relationship it can increase patient safety and satisfaction, as well as help generate a deeper nurse patient relationship, which can lead to better patient care.
When the nurse becomes familiar with a patient’s orders and medications, it can define and resolve patient problems. The nurse can also more effectively identify and communicate changes in the patient’s condition. This continued level of involvement might help improve workforce outcomes, leading to a greater sense of accomplishment for the nurse, and better outcomes for the patient.
Continuity of care also allows nurses to build a rapport with family members and create simplified communication networks from which to provide updates on progress and answer questions. There is also a time-savings factor regarding efficiencies in reporting and chart checks. When nurses are familiar with their patients, communication with physicians and other healthcare providers are streamlined and more effective. Greater involvement and responsibility for the care of an assigned patient can have a positive impact on job enthusiasm and nurse retention.
To learn more about tools to help with creating staff assignments, you can read more about CentricityTM Patient Classification Healthcare’s Patient Classification.