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Survey: Many Nurses Still Use Manual-Based Staffing, Scheduling Tools

October 13, 2016
by Heather Landi
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Despite facing challenges related to staffing and scheduling in nursing units, 80 percent of nurse managers are not aware of technology-enabled solutions designed to help with managing and solving scheduling and staffing problems, according to a recent survey conducted by AMN Healthcare.

Additionally, when scheduling nurses, about one-fourth (23 percent) of nurse managers report that they don’t use any scheduling tools at all, while 24 percent use paper-based staffing tools and 19 percent use digital spreadsheets. Forty percent of respondents said they used technology-enabled tools. Of those nurse managers with access to automated scheduling software tools, a little less than half (43 percent) still depend on manual scheduling. The survey report did not address why nurse managers with access to these tools still rely on manual scheduling.

Advanced scheduling technology includes predictive analytics, which uses data mining, statistics, modeling, and algorithms; labor management solutions that apply those predictions to healthcare workforce scheduling and staffing; and software that utilizes forecasting in the automation of planning, scheduling, staffing, deployment,  and reporting.

Shortages are nearly all types of healthcare professionals are becoming more pronounced, and the gap of unfilled staff positions is widening. According to the AMN Healthcare report, the challenge is now being felt at the unit-level of care facilities, where difficulties in scheduling and staffing of registered nurses are rising.

In its report, “Predictive analytics in healthcare 2016,” AMN Healthcare, a workforce solutions and staffing services vendor, analyzed the growing challenges in scheduling and staffing of registered nurses and optimizing nurse staffing at a time of workforce shortages. AMN Healthcare surveyed 5,687 nurse managers. The survey also included interviews with 35 nurse managers, finance managers and registered nurses. And the report looks at the state of knowledge about predictive analytics applications in healthcare workforce scheduling and staffing.

The survey found that most nurse managers are not familiar with technology-enabled solutions that enhance scheduling up to 120 days in advance. Nearly 60 percent of nurse managers said advanced scheduling technology that can forecast patient demand and staffing needs would be “very helpful.” However, one-third of respondents said it would be “somewhat helpful.”

Nurse managers face a number of nurse scheduling and staffing problems and many of these problems have a significant impact on daily operations. Nearly half of respondents said that understaffing is a significant problem. And, respondents also cited last-minute schedule changes as a frequent problem, while rescheduling due to day-of sick calls and understaffing are more significant problems.

According to the report, nurse managers often must offset scheduling and staffing problems with short-term fixes that can impact operations. Survey respondents indicated that while diverting patients due to lack of staff rarely occurs, when it does happen, it has a major impact. Cancellations of shifts are the most frequent action taken in response to scheduling and staffing problems, and they also have a significant impact.

Scheduling and staffing issues in nursing units cause serious concerns for nurse managers regarding the impact on staff, patients, and costs. When asked about the effects of scheduling and staffing problems on the nursing unit, nearly all nursing managers (94 percent) agreed that understaffing has a negative impact on staff morale, while 87 percent of respondents agreed with the statement that “nurses feel that nobody cares how hard they work.”

In an interview, one nurse managers stated, “Morale is affected adversely any time there are not sufficient staff to take care of patient needs.”

Additionally, the survey found that a large majority of nurse managers also agree that scheduling and staffing are the hardest parts of their job, “because they must watch the budget, not show favoritism, and often refuse time-off requests from their colleagues” the report authors wrote.

Further, nearly 70 percent of nurse manager respondents said they are very concerned about the impact of these nurse scheduling and staffing problems on patient satisfaction.

More than half say they are very concerned about the effect of these problems on quality of care. One nurse manager said in an interview with the report authors, “When we are understaffed, patients do not get the quality care they deserve. Nurses rarely have time to really connect with patients on a human level, because they have so many patients, tasks, and charting.”

The report authors also interviewed finance managers who voiced frustrations with budget and cost management problems related to workforce shortages. When asked about the most challenging budgeting or cost management problems related to workforce, one finance manager stated, “Variation in productivity metrics and staffing ratios between various nursing units… All have different needs and fixed levels of staffing ratio requirements.”

Another finance manager stated, “Competition for recruiting nurses, especially bachelor-prepared nurses. We have expanded use of advertising to attract nurses and increased our nurse pay scale. But until these actions take hold, we are faced with the prospect of increased agency usage.”

The report authors wrote that while most healthcare organizations implement measures to address scheduling and staffing issues, these measures are often reactive rather than strategic. “Since scheduling and staffing problems are prevalent at patient care facilities, and with most survey respondents reporting that they currently experience these problems, it can be surmised that these usual measures are not broadly successful,” the report authors wrote.

The survey results indicate that organizations have deployed a number of tactics to try to resolve immediate scheduling and staffing issues, with advertising to fill job openings being the single most mentioned item by over 70 percent of nurse managers, followed by cross-training, and enforcing attendance policies including disciplinary actions. “While many of these actions can be part of successful strategic workforce planning, they have not proven themselves to be long-range solutions, considering that healthcare staffing problems are worsening nationwide,” the report authors stated.

The report authors conclude that healthcare enterprises that have adopted predictive analytics and advanced labor management strategies have realized outcomes that include reductions in agency nursing, increased staff satisfaction scores, improved nurse retention, reductions in open shift incentives and bonus pay,  and significant annual savings in labor spending.

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