A New Approach to Managing Nursing Workforce Using Data to Drive Decisions

Background/purpose: Hospital administrators are charged with insuring that needs of acutely ill patients are met by the right caregivers providing the right care at the right time and in the right setting. However, the fluctuations in patient flow, the daily staffing complement, and workload volume pose significant challenges for managing the current workforce in specific departments. Traditional models of position control (PC) have been demonstrated ineffective, time- and labor-intensive, and often inaccurate; most current systems rely on tracking staffing positions by budget rather than individual employee head count. Despite these inefficiencies, the PC continues to be relied upon for hiring decisions because it is the only available tool for many that is somehow aligned with approved budgets. The responsibility for maintaining an accurate, timely PC falls primarily on front-line nurse leaders who are responsible for manually cross-checking and reconciling their department PC to prevent over hiring and errors with job classification. Further, most PCs are not integrated with any other electronic database thereby producing additional errors, redundancies, information gaps, and repetitive workload for nurse leaders. Additional time was wasted in monthly meetings between nurse leaders and staffing resources to review each department’s PC and attempt to best forecast staffing needs or formulate an adequate staffing or hiring plan. The process for maintaining the PC, then, was in desperate need of automation, innovation, and standardization. The purpose of the project was to automate the position control, decrease errors with FTE calculations, standardize position controls, and predict staffing to reduce time to fill.

Description: In 2018, an interprofessional team consisting of nursing, finance, human resources, and information technology departments was formed to integrate the current position control with our human resource personnel data and time and attendance/scheduling system to create an automated process in tracking positions. A new, electronic shared platform was created to replace the traditional paper forms. The new PC is updated in real time, thereby reducing any manual reconciliation or cross-checking. There are various sheets within the application developed for a manager to view: overall budgeted FTE summary which displays budgeted FTE vs. actual, PC detail view, span of control supervisor analysis, hired FTE analysis, scheduled FTE trending for two weeks, schedule details, vacancy rate, and scheduled hours to contracted worked hours. The responsibilities of the nurse manager were streamlined and included only to monitor full-time equivalents by using the electronic position control tool. The new tool is readily available to use for review during hiring process or attrition and can quickly forecast a two-week schedule to identify shortages in staffing, monitor employee hired hours to actual hours, and adjust plans accordingly. Monthly meetings to reconcile the PC are no longer needed.

Outcomes: The interprofessional team was able to integrate, automate, and develop a tool for nurse managers to use. The new analytics tool presented different views to assist with managing the unit workforce. The development of this electronic tool demonstrates innovation and technology that improves organization efficiency and safety of a vital leadership process.

Learning Outcome: After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.