Nurse Staffing Toolkit

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Nurse leaders in New Hampshire are excited about taking another step toward advancing practice in our state through staffing committees. The development of a toolkit to assist executives and staff nurses to establish and effectively run staffing committees is the result of a unique collaborative effort of the New Hampshire Organization of Nurse Leaders (NHONL), the NH Hospital Association (NHHA), the NH Nurses' Association (NHNA) and the Healthcare Human Resources Association of NH.

Taking advantage of an unusual set of circumstances, this forward thinking but uncommon group of allies have launched a process they believe will revolutionize the staffing process in New Hampshire Hospitals with the goal of improving safety and efficiency of care. Like the concept of quality circles long in vogue in manufacturing, staffing committees are the logical outgrowth of the question: “Who is in the best position to problem-solve staffing for best practice?” In quality circle terms, the nurse at the bedside, in conjunction with nurse leadership, is the clear answer.

This toolkit will prepare nurse executives and nurses for effective voluntary implementation of staffing committees. It is the hope of the collaborators that as nursing staffs engage in this process recommendations for improving this toolkit will emerge.

Background
During the 2009 NH Legislative Session proposed legislation to mandate hospital staffing committees was drafted by the New Hampshire Nurses' Association incorporating the American Nurses Association's Principles of Safe Staffing (ANA, 2009). Working in collaboration with other health care groups in the State this proposal was subsequently withdrawn in favor of a voluntary, non-legislative approach to staffing committees. The motivator for legislation, although not an ideal solution, was the desire for nurse staffing to be influenced by legislation rather than dictated by it as it had been in other areas of the country.

NH nurses were concerned about the unintended consequences of legislatively mandated nurse staffing ratios. In California where hard staffing ratios had been legislated significant facility and unit closures were reported. Regardless of the consequences, the mandate of professional practice continues to be significant autonomy and input into practice decisions. Legislation of hard ratios is contrary to these professional precepts.

NH nurses also were becoming aware of significant national nursing union activity directed toward legislating ratios. This national activity became very local when in 2009 a lobbyist hired by the Massachusetts Nursing Association (MNA) became certified to lobby in NH. Because of the budget focus of the NH legislature no legislation was introduced on behalf of MNA but the writing was on the wall. Concern over loss of nurse autonomy spurred a decision to propose the subsequently withdrawn legislation.

The Nurse Staffing Steering Committee (the collaboration of aforementioned organizations was thus formed to:

  • Conduct a survey on existing safe staffing decision making
  • Develop a toolkit for hospital management and staff on nurse staffing committees
  • Strongly encourage hospitals throughout the State to voluntarily charter and employ nurse staffing committees as proposed, as their strategy for safe and effective staffing practice

The following product is a result of those efforts.

Recommendations
After much deliberation the collaborative drafted a set of core principles for staffing committees to serve as the basis for action. The core principles propose key structural elements of staffing committees along with the considerations for staffing decisions. Consistent with the concept that staff nurses in conjunction with nurse leaders are the best arbiters of practice decisions including staffing, staffing committees too, are expected to select from the core principles the pertinent considerations for their practice(s).

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