Children’s Hospital of Philadelphia shared governance solved weekend staffing shortages through an equitable scheduling model and creative nurse satisfaction perks program.
Best Practice: Weekend Journey: Ensuring Appropriate Weekend Staffing While Considering Nurse Satisfaction, Children’s Hospital of Philadelphia, Philadelphia, PA
Katelyn Vogel, BSN, RN and Kaitlyn Cacciola BSN, RN have been staff nurses on the Progressive Care Unit for three years at the Children’s Hospital of Philadelphia. Together they serve as co-chairs for the Supporting Practice Management Shared Governance Council.
Identifying the Weekend Staffing Gap
With an increase in the number of patients and their acuity, the institution noted a hospital-wide shortage of registered nurses during weekend shifts. This shortage had a direct impact on nurse-patient ratios, which research has shown to negatively affect both patient outcomes and nursing staff satisfaction. As a result, each unit was tasked to identify an equitable and effective mechanism to improve weekend staffing.
To evaluate the current state, the Progressive Care Unit formed a unit-based shared governance task force. The team identified the total weekend hours currently staffed per year as 28,704. The task force met several times a month and was open for all staff to attend. Using nurse-patient ratio goals, they determined that 34,944 weekend hours per year were needed.
Developing an Equitable Distribution Model
To equitably distribute weekend hours, unit staff on the shared governance task force determined that every staff nurse needed to work 466 weekend hours per fiscal year. This determination most impacted nurses with longer length of service. However, the unit voted to keep their current weekend pattern. Consequently, the Scheduling Task Force created a unique system for additional weekend signups, requiring all nurses to work between one and three additional weekend shifts per quarter above the previous requirement. After implementing the additional weekend shifts, a survey of nursing staff and anecdotal feedback showed that satisfaction declined.
Boosting Satisfaction Through a Creative Perks Program
To address declining satisfaction, the shared governance Scheduling Task Force, with significant participation from staff, developed a creative and unique “perks” program. This program recognized and rewarded length of service. Specifically, staff with five or more years of service could choose “perks,” such as their choice of winter or summer holiday, no floating, extra vacation time, and many more options.
The unit has recently been recognized in the institution as having a balanced schedule with a low standard deviation. The program was implemented at the beginning of fiscal year 2019 (July, 2018), and nurse satisfaction will be reevaluated three months after implementation of the “perks” program.
The autonomy ensured by shared governance was vital in making this project a success. It allowed staff to come together and solve a problem that would ultimately affect every nurse working in the Progressive Care Unit.