Trend: Controlling Overtime

Today we have this new world, where organizations are developing systems that extend beyond the hospital to span the entire continuum of care. With that comes an enormous opportunity to improve our staffing and scheduling methods to leverage talent at all points along the continuum. However, many organizations are neglecting to take advantage of this opportunity and remain stagnant in old patterns of staffing in silos.

When we operate in silos it is easy to miss simple opportunities to optimize the workforce. Overtime is a common challenge for everyone. When scheduling happens within silos, avoidable overtime happens more frequently.  That can be harmful to an organization on many levels. The most obvious impact is cost. Labor is expensive. Premium labor stretches budgets, and across large organizations, the cost can easily amount to millions of additional dollars per year.

Just as important is the human cost. For RNs, fatigue is a very dangerous and very real problem. Studies have shown that fatigue directly impacts quality. Patient mortality rates are higher when nurses are consistently forced into working more hours than what is considered safe[i]. Fatigue also impacts patient engagement. If a nurse is too tired or burned out to provide a patient with proper instructions upon discharge, that patient will have issues managing their care when they return home, which could ultimately lead to having them land right back in the hospital as a readmission[ii]. Overworked nurses also tend to be dissatisfied with their jobs, which impacts retention rates[iii]. Replacing a single nurse can cost upwards of $80,000[iv]. When developing a staffing plan it is important to look at all of these factors and the specific evidence as it relates to an organization, or run the risk of the plan creating negative outcomes for patients, the nursing staff and the organization’s financial outcomes.

Reducing overtime doesn’t just happen simply by putting an end to staffing in silos. While this is an important first step, we really have to change the way we think about staffing from the inside out. We need to take a more holistic approach and look at the analytics to determine where the problem is and then identify how to fix it. However, it’s not okay to just look at it on a unit level. It works most effectively if you look at it across the hospital, across the system, across the entire enterprise and continuum. This ensures that you are seeing the full picture and fixing the right things. Successful reduction of overtime requires a systematic approach that takes into account evidence from all angles and leverages predictive analysis.

 

[i] Collins, Beth A., et al. AHRQ Commentary: Limiting Nurse Overtime, and Promoting Other Good Working Conditions, Influences Patient Safety. Journal of Nursing Care Quality, Vol23 no.2 (June 2008): 97-100.

[ii] Weiss, Marianne, et al. Examining the Impact and Value of Nursing Practices to Reduce Re-Hospitalizations. Robert Wood Johnson Foundation Nursing Research Network. Accessed May 5, 2015 http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2013/rwjf407339

[iii] Stimpfel, Amy, et al.  The Longer The Shifts For Hospital Nurses, The Higher The Levels Of Burnout And Patient Dissatisfaction. Health Affairs, 31, no.11 (2012):2501-2509.

[iv] Jones, CB.  Revisiting Nurse Turnover Costs: Adjusting for Inflation. Journal of Nursing Administration, 38, no 1 (2008): 11-18.

 

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