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Battling the Nursing Shortage with IT

November 9, 2007
by Susan Sayari, R.N.
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Staffing applications can ease the nursing crunch by automating the task of scheduling 24-hour shift coverage.

Hospitals rely on staffing and scheduling software systems to overcome the time-consuming inefficiencies of manual processes, as well as to achieve greater consistency in the application of their staffing policies and scheduling rules. Enterprise systems for staffing and scheduling yield productivity improvements in the management of every hospital's most important, and costly, resource: our people.

The most critical, chronic problem that hospitals face when it comes to managing our human resources is the persistent shortage of nurses, who are essential to full and appropriate staff shifts and care for patients, whose average severity is increasing. Hospitals across the country contend with the challenge of filling understaffed shifts. Thus, today, we are seeking innovative applications of staffing and scheduling systems that can help us deal with the problem.

One alternative that many are adopting is shift bidding. This solution enables nurses to view open shifts and to bid the hourly rates at which they are willing to work in order to fill them. In theory, competition among nurses will result in filling shifts at hourly rates that are less than the contracted rates hospitals have to pay to outside nursing agencies. In practice, shift bidding can help decrease the utilization of external registry nurses, which on an hourly basis is typically hospitals' most expensive source of nursing professionals.

But, while use of outside agency nurses goes down, overtime goes up. That is, nurses who are already scheduled for 40 hours per week bid to work at standard time-and-a-half overtime rates (which are often specified in their contracts) for, say, five to 10 additional hours.

Another alternative is self-scheduling. Self-scheduling is designed to fill open shifts at standard hourly pay rates by involving nurses in the scheduling process and, critically, by making that process transparent. Instead of putting nurses in competition, self-scheduling invites cooperation to ensure appropriate staffing.

Self-scheduling is designed to enhance employee job satisfaction by enabling employees to utilize special modules within staffing and scheduling systems to view their department's overall schedules, identify open shifts, and then schedule their own shifts or propose exchanging shifts with colleagues. Unit managers then review the requests and finalize schedules, which are then e-mailed.

At most hospitals, individual nurses now submit their own shift requests on paper without being able to see the overall schedule for their units. If they are not scheduled for the shifts they want, the decision making process can seem arbitrary. With self-scheduling, everyone can see and assess their shift preferences in the context of everyone else's and the overall schedules for their departments. Thus, everyone shares in the responsibility for balancing the schedule and ensuring necessary staff coverage, and they can help one another by swapping shifts.

Competition or cooperation: two very different concepts for using staffing and scheduling software to deal with the problem of chronically understaffed shifts. And they also imply fundamentally different approaches to human resource management in the organizational environment of the hospital.

In the context of the nursing shortage, it is imperative to find ways to make the work environment more satisfying. Giving employees more control over the balance between the demands of work and home is essential to job satisfaction.

Self-scheduling enables hospitals to respond by empowering nurses with greater control over their work schedules — and by inviting them to share responsibility with their unit managers and colleagues for making sure that shifts are appropriately staffed.

At Covenant Health System today, a total of 36 nursing units, including approximately 1,800 nurses, now utilize self-scheduling. Nursing schedules are completed in four-week/one-month blocks, and nurses submit requests of their schedules several weeks in advance. Respiratory therapy and pharmacy staff also self-schedule and case managers will join the list of users in 2007. We are finding that self-scheduling appeals to our employees' sense of professionalism and commitment to collegiality. And these are qualities that all hospitals need to foster.

Susan Sayari, R.N., is director of Nursing, Covenant Health System, Lubbock, Texas.