Katheren Koehn, MA, RN, AJN editorial board member and executive director of MNORN (Minnesota Organization of Registered Nurses), reports from last week’s ANA conference on staffing held in Washington, DC.
The ANA Safe Staffing Conference ended on Saturday. There were almost 700 registered nurses from all over the country in attendance—nurses in management, direct care, and leadership—all gathered to try to discover new strategies for how to solve the most challenging issue in nursing: safe staffing.
Not a new issue. This has long been the most challenging issue for nursing. Teresa Stone, editor of Poems from the Heart of Nursing: Selected Poems from the American Journal of Nursing, told me that, as she was searching the archives of 113 years of AJN issues for her book, she found that staffing issues were a frequent theme. Today, as the work of nurses has become more complex, the need to create sustainable solutions to ensuring appropriate staffing is our most critical issue—hence the ANA Staffing Conference.
The body of evidence supporting the idea that appropriate nurse staffing makes a difference in saving patients’ lives has grown exponentially in the past 20 years. This evidence—paired with the new federal financial incentives for hospitals to improve patient outcomes and experiences—makes it seem inevitable that increasing nurse staffing would be the next step. But decreases in Medicare reimbursement rates, along with caution about future finances related to some aspects of health care reform, are in fact making hospital purse strings tighter than ever. Nurses continue to beg to be taken out of the “room and board” costs and to be seen as an asset. But instead, they are often seen as a major expense that can be reduced for the sake of the bottom line. If this impasse is to be brokered, it will demand new thinking and new communication.
A focus on innovation. Past ANA president Barbara Blakeney, now innovations specialist at the Center for Innovation in Care Delivery in the Institute for Patient Care at Massachusetts General Hospital in Boston, asked attendees to be innovative in our solutions to the problems of staffing. She taught us about the five “discovery skills” of innovators: associating, observing, experimenting, questioning, and networking. For example, innovators are extremely good at networking with smart people with whom they have little in common but from whom they can learn.
Blakeney also reminded us that in this time of wanting everything to be based on evidence, we also have to allow for discovery and creation of new practices. One of the processes she recommends for innovation at the hospital unit level is the rapid-cycle improvement process used by the Transforming Care at the Bedside (TCAB) initiative. In addition, she emphasized that anyone at the unit level can potentially lead change. Leadership’s role is to make the environment safe for trying new things—for innovation.
Conference attendees learned anew about the body of research on the relationship of nurse staffing to patient outcomes from leaders including Jack Needleman, Matt McHugh, and Jeannie Cimiotti. Care delivery models were explored by Jennifer Mensik. Karen Tomajan, and Sue Davidson, and Kathy Malloch presented case studies. Sean Clarke provided information about how organizational climate impacts nurse staffing and patient outcomes. LuAnn Joy and Karlene Kerfoot spoke about some of the tools and concepts that can help to optimize staffing. And, finally, Jack Needleman, Joanne Spetz, and Robert Dent, with the help of moderator Donna Nickitas, helped us make the business case for staffing.
The conference room was filled with data and information, discussion, questions, and answers. We learned how to talk about staffing within the context of organizational and unit culture. We learned that staffing is not merely a numbers game—we need to think about all elements of the work environment. And we learned that being innovators for solutions to staffing is not going to be easy, but it may be the most important work we can do—for the good of our patients and for our profession. ANA has promised that there will be a future staffing conference to continue these efforts.