Message to Staff: Staffing for Safe Patient Care

Dear Nursing Colleagues:

This week, UI Health presented its proposed staffing plan to the Illinois Nurses Association (INA) during collective bargaining agreement negotiations. We want you to have the correct facts about our proposal.

Our plan, called Staffing for Safe Patient Care, will focus on obtaining the right nurse at the right time to care for the patient so we can achieve the highest level of safety, quality, service and health outcomes.  This plan includes the following elements:

• Continued use of a patient acuity‐based staffing model with significant enhancements to improve the nursing experience, such as a four Tiered Registry Team and New Technology (iShift).
• An automated, evidenced‐based and reliable tool to measure patient acuity and enable objective, benchmarkable staffing decisions.
• The Nursing Care Committee, co‐chaired by direct patient care nurses, that will make recommendations for changes in unit staffing based upon changes in volume, acuity, complexity of care required, and other relevant data and information. This Nursing Care Committee will also be empowered to seek input and address nurse staffing concerns from direct patient care nurses in each division that will be incorporated into the annual hospital‐wide nurse staffing plan. This shared governance model follows the law and strengthens partnerships between direct patient care nurses and nursing leadership.
• A three‐pronged staffing approach to achieve optimal Staffing for Safe Patient Care (please see chart below for details):
  • Workforce Optimization – Beyond our current practices, we will utilize consultants with a multidisciplinary team to help develop criteria for Level of Care; we will enhance our FLEX/FLOAT Team by increasing  FTE’s; we will also use an incentive‐based four TIERED Registry program.
  • Patient acuity measurement and assignments: Implement a new acuity tool that uses standard documentation for scoring.  We also plan to use our Assignment Despite Objection (ADO) forms allowing direct patient care nurses to have a voice in staffing decisions by way of the Nursing Care Committee.  The Nursing Care Committee will give input on applications for specific patient assignments and thresholds.
  • iShift – Moving away from manual staffing need notification, to technology‐based notification to improve our ability to address unplanned absences and get staff “just in time”. Specifically, we will use an SMS system (text messages) for real‐time notification via mobile device of upcoming available shifts. Staff can accept shifts and be scheduled with one click on their phone. Messages will be based on each nurse’s competency/track, and those participating in the four tiered registry will receive compensation based on their chosen registry tier. Available bonuses for surge staffing will be communicated. Messages will be sent both upon posting of new schedules and with daily unanticipated needs due to changes in patient volumes or staff absences. Nurses can opt out of receiving text messages at any time.

How we will implement patient acuity‐based staffing

• At the unit level, staffing acuity is being calculated every four hours currently using NPAS or through a newly identified acuity model, which would generate an acuity score/percentile (the goal of a balanced workload being close to 100%) and estimates the number of nursing care hours (staffing) required per eight‐hour shift.
• Twice per year, the unit‐level nursing workforce and acuity data will be examined by staff nurses and leadership on the Nursing Care Committee to provide suggestions to address skill mix designs, shift patterns, over‐ and under‐assignments, and acuity‐based hospital staffing plan recommendations for annual budget planning.

Why patient acuity‐based staffing plans are best for patient safety and quality outcomes

• The largest national nursing organizations, the American Nurses Association and American Organization of Nurse Leaders, only support patient acuity‐based staffing models.
• Illinois law—the Nurse Staffing by Patient Acuity Law‐‐actually requires that we staff in this way. The law also establishes a shared governance model, like UI Health’s Nursing Care Committee, to advance partnerships between direct care nurses and hospital leadership to collaborate on staffing decisions.
• Staffing by acuity also recognizes the professionalism of our nurses and takes into account each nurse’s education level, expertise, skills, knowledge and experiences. It means staffing the right nurse to the right type of patient at the right time. This leads to better health outcomes, more consistent and manageable nursing workloads, higher staff satisfaction and better patient experiences.
• Staffing by patient acuity supports our ongoing efforts to achieve Magnet status.

Why UI Health does not support staffing ratios

• One‐size‐fits all staffing ratios are too rigid and remove flexibility. They ignore fair workload distribution among peers on a shift‐to‐shift basis.
• Nurse staffing ratios also result in longer ED wait times, increased ambulance diversion hours, reduced patient services and higher operating costs.
• Since 2004, no hospital in any state other than California has adopted this method of staffing (since 2004). Importantly, Illinois performs better than California on many patient quality outcomes (CLABSI, CAUTI, HAPI, falls, LOS).

We hope this information helps you understand our proposal and why our staffing model is in the best interest of UI Health nurses, our patients and the communities we serve.

Patient safety and high‐quality care are the heart of everything we do. Staffing decisions based on acuity allow us to put patient safety first and foremost in our decisions, and the flexibility to continue to adjust based on changing patient needs.

If you have questions, please feel free to contact your Senior Director or ACNO.

Sincerely,

Sheila Cook, MS, RN, ACNS‐BC
Associate Chief Nursing Officer, Patient Experience

Ruby Darlene Evans, MSN, RN, MT, CPHQ
Associate Chief Nursing Officer, Nursing Quality & Clinical Professional Practice Development

Robin Garrett, BSN, RN, CNOR
Senior Director, Perioperative Services

Phyllis Grice, MSN, RN 4
Senior Director of Operations

Tiesa Hughes‐Dillard, DNP, MBA, RN, NEA‐BC
Associate Chief Nursing Officer, Division of Med‐Surg, Dialysis & Pastoral Care

DeLisa Jeffries, MS, MPH, BSN, RN
Associate Chief Nursing Officer, Ambulatory Services

Rani Morrison, MS, MSW, LCSW, ACM, FACHE
Senior Director, Care Continuum

Doreen Norris‐Stojak, MS, RN, NEA‐BC
Associate Chief Nursing Officer, Women & Children’s health & Psychiatry

Lisa Potts, DNP, RN
Associate Chief Nursing Officer, Nursing Resource Office & Patient Logistics

Jill Stemmerman, DNP, RN, CENP
Associate Chief Nursing Officer, Division of Critical Care, Emergency Services, CDU & Diagnostics

Jacquelyn Whitten, DNP, RN
Associate Chief Nursing Officer, Emergency Services & Patient Logistics

Shelly Major, PhD, RN, NEA‐BC, FACHE
Chief Nursing Officer