Staffing

In this episode, I will be speaking with Sam McGowan and Kristie Butterworth about our new staffing office, staffing concerns, scheduling, and float pool.

Transcript

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Welcome to Nursing Together. I'm Michelle Hohen, Tanner's Chief Nursing Executive, and your host. Today, I'm excited to have two incredible guests with me, Ms. Sam McGowan, our Hub Director, and Ms. Christy Butterworth, our Manager for Bed Management and Staffing Office. We're here to shed some light on how our Staffing Office operates. So thank you both for joining me today. Thank you for having us. Yeah, super excited to be here. So before we get started, I would like for you guys to do just a little bit of an introduction so everybody truly knows what your roles are and everything that happens to encompass up underneath you. Sure. Do you want me to go first? Yeah. Hi, I'm Samantha McGowan. I'm the Director of Care Coordination at Tanner. May will be 10 years at Tanner. My background is med surg and critical care. I was also a nursing supervisor in Villa Rica. And then transitioned into a nurse manager role. Also had a brief stint in case management and utilization review, and I have been in this role since November of 2023. My scope now currently includes bed management or our hub which includes our staffing coordinators, our bed placement nurses, our transfer nurse, as well as the upcoming role of service coordinators. And I also am the director for the float pool and our care progression leaders. I'm Christy Butterworth. I am the manager of bed management and staffing and also our upcoming service coordinators. A little bit of my background. I have been with Tanner for May, or I'm sorry, April will be six years. I started as a med surg nurse, and I have done a couple years on that floor. I also have done nursing supervisor and then came over here to bed management. My scope now is just managing bed management. Staffing office, the service coordinators, and I've done a little bit with care logistics. So let's go ahead and get started. And I want to just ask you guys just a few questions in regards to the areas that you're in. This is just to hopefully get a better light on exactly the functions within your departments. I think sometimes there's some confusion with our staff of how we're trying to go to the next level in regards to, not only the staffing office, but bed management and our throughput. Let's go ahead and get started with Sam. Why don't you go ahead and give us just a little bit of an overview in regards to what the staffing office really is and what the importance is. Okay. So the intent, we went live with the staffing office in June of 24 with our go live of smart square. The intent behind centralized staffing is first to ensure our nursing supervisors are functioning at the top of their license and are able to provide support to our bedside staff and really assist with operations of our hospital facilities. So that was the first reason behind this. And then the second, I think, is to ensure fair and equal staffing at all of our facilities and make sure that we're being safe and supporting the needs across our healthcare system. It's not uncommon to have a facility have an unexpected shortage and no resources to provide that facility. And so we really wanted to correct that and ensure that Everyone in our community is receiving the same level of care and that also that our nurses are being supported as fair and equally as possible. Makes a lot of sense. But Christy, as the manager of both bed management and the staffing office, how do you ensure that we have some smooth coordination between the two, but also as Sam said, elaborate just a little bit more on the reasonings why it's so important to even out our staffing across the system. I think when we first started this one of our goals where we have our bed management staff and our staffing office in the same area and room, because I think a lot of this falls back to communication. They need to be able to communicate if there is a rise in patients or an influx in patients, if we do not have enough staff in a certain area. So I think it's important that they continue to communicate and keep that open line so they know what's going on across all of our facilities. And then also to elaborate on the staffing. Across the Tanner facilities. We have Philly Rico and we have Carrollton that work closely together. I think it's important that we are keeping that as equal and fair as possible. If one facility is really struggling with an influx of patients and we need to pull some staff to that facility to help offset that, we are able to do that now with our staffing office because they are here to look at the system as a whole and not just one unit or one department. Yeah, I'd like to just echo off of that. I think historically also our smaller facilities and even our behavioral health facility, Willowbrook maybe hasn't been able to be supported when there is a staffing need. And so we've worked really hard with Jennifer Connor, the manager of the float pool, and also with Misty and Michelle to ensure that our float pool staff are receiving cross training to all facilities and so that we have a little bit more flexibility. to support all five facilities. So we have a lot of new things that have happened probably in the last six months to a year in regards to both bed management and the staffing office. But in your mind, tell me what the biggest challenge was for you guys to transfer or Incorporate not only SmartSquare, but the staffing office into our daily lives........ I think probably the biggest challenge is just the change and how quickly we are trying to push this through. I think it's a good change and I think as humans we are all resistant to change. So I think just getting everybody on the same page and showing them, what we're trying to accomplish and keeping our patients, first and foremost, I think that was probably the biggest challenge on our end is just getting everybody on the same page. Yeah, I would echo that. I think that we definitely have, there's been some learning curves, learning a new software and launching a new program, a division of the hub at the same time. It was definitely challenging. Christie and I were very intentional with our hiring selections. While they don't, they weren't nurses, they do have a background in healthcare and staffing and or staffing. They all spent time with the nursing supervisors shadowing to learn the unique nuances of each individual floor and facility. And adopting, getting comfortable, being confident in their decisions, and also, I think, just learning to share the why and transparent about why they're making the decisions that they're making. On that same note, I have noticed myself staff sometimes want to complain that the staffing office aren't clinical. Or they're not a nurse and they don't understand the acuity. What pieces and parts do we have in place within our staffing department that really helps us ensure that we are guiding our practices the right way? We do staff based on staffing grids which are available for distribution and are We really did our best to make sure that they're fair and equal. Beyond that, we do have things built into SmartSquare. For instance, we can make adjustments to staffing if there is an acuity change or a sitter need, is probably the most common example, where we provide additional staff. In addition to that, we do our staffing office does have a daily huddle at 4. 30 a. m. and 4. 30 p. m. with all facility nursing supervisors to review any needs. And to come in alignment on staffing and if there is a shortage in an area that nursing supervisor can provide additional support to that area. And I think that falls back to what I had mentioned earlier to communication throughout the day with staffing. Things change all the time. So if there is a staffing need that arises throughout the day that they can utilize their nursing supervisor to help relay that message or the A& M's on the floor. So I appreciate that guys because ultimately it is super important for us to ensure that we are giving safe care across the system. But with that being said, how is SmartSquare helping us determine whether or not safe care is happening across not only each unit but each hospital? I think we're able to manage it more and see it as a whole. Where before we would have to call and rely on communication just with different departments. Now we can use, utilize SmartSquare and see all the departments and all the facilities and see exactly it will pull over how many patients they have. We can look at how many nurses they have. We can look at their ratios. We can look at how many techs are on each floor. How many sitter needs. It gives us a clear view of everything that's going on with each department and each facility. SmartSquare does also have predictive analytics embedded in the program. So it does look at our historical census across all of our units and it makes a prediction for the next shift. You can actually look ahead and it will predict even out through the week. So that's been very helpful to look ahead. Our staffing office has been very good about Wednesday nights. They review the staffing for the weekends, I think, historically. Weekends have been our biggest struggle with staffing. And they actually are able to predict the census of each unit. And they do send out, they send us the breakdown of each unit, including float pool, of who's working on the weekend shifts. And we do send that out to the managers on Thursday mornings so that they can assist in recruiting additional staff for our weekends. Excellent. Thank you guys. The next three questions, I'm going to say, are going to be more about debunking per se some of the rumors that we hear across the system. Rumor number one is, you always pull from my units. It's unfair and we aren't staffed properly for our units. What's the reason sometimes we need to pull in certain areas? for our staffing. I'll start with one of the biggest things that we've seen recently is the influx of patients in our ERs. Currently we have our staff in place, but I think it's hard to staff and prepare when you have 40, 50, sometimes 60 patients in the ER and needing beds. So obviously you're gonna need extra staff down there in ER overflow to help offset that. And so that would be one of the biggest issues we've seen over the last few months. So we're pulling from floors. Just to give that ER those extra cares. We gotta, we have to make sure, I think we forget that those patients are being held down in the ER area. We have to remember that they are, the ER there is there to take trauma and to take those emergency patients. So if we are using up all of their areas in their room, that puts the ER in a bind. We have to ensure that we are staffing that floor appropriately and that we're able to move those patients as quickly as we can. Yeah, I think anybody that's ever worked in any of our er overflow areas and both Christie and I have personally worked those areas. Those are our most vulnerable patients. We do set ourselves apart at Tanner by care, choosing to care for those patients using inpatient nurses. And I think that's excellent. I think that's what sets us apart from other hospitals across the nation is that we're not. using emergency department nurses to care for those patients. We chose to give them the appropriate level of care in an unfamiliar environment. So we do want to make sure that those areas are supported with as much staff as possible while still meeting the needs of our traditional Floors and units. Unfortunately, when we're talking about an additional 60 patients across the system that need care from inpatient staff that has stretched us thin our vacancy rate across the system does remain lower than the average. But I think the biggest, with this recent respiratory surge that we've had we know that our staff across the system have felt that. I am so glad you guys brought that up because our vacancy rate is low. It currently right now is at 6. 4 percent and nationwide right now it is at an 11 percent and trending down. But then also in Georgia, they're currently at 18%. Wow. I too just recently have gone to a GNA summit. And they talked about what those rates look like here in Georgia and how they're only going to get worse. But we still get complaints. And this is rumor number two. That if our vacancy rate is so low, why are we pulling from our units? Besides, we've already talked about the increase in the number of patients that we're seeing that need to be inpatient. What is our other real reason why we're feeling such a pressure even though we have a vacancy? An excellent vacancy rate. Yeah, I'll go ahead and answer that one. Call outs. We definitely see a higher than average number of call outs. Christy and I do track that and report that to all units at the end of the month. Just for transparency. But it's not uncommon to see upwards of four to five hundred call outs in a thirty day period. That definitely impacts. Our ability to safely distribute staff. Particularly having late call outs causes a pretty significant burden. Because the staffing office our call out time is the cutoff is three hours before the shift. And so they use that remaining hour to ensure that the staffing is fair and equitable. Unfortunately, a lot of times they finalize staffing two hours before the shift and then those late call outs come in and kind of mess everything up. And that does contribute to, unexpected shortages, but it also contributes to double pulls. It's really easy to pull somebody and then send somebody from another unit when you're trying to cross cover unexpectedly. Yes, and the late pulls. I hear a lot about that where you're pulling, at the beginning of the shift and a lot of that has to do with those late call outs because we get those late. So obviously staff has already been distributed as even as possible and then you have a late call out so you're having to redistribute all that staff and unfortunately it's right at shift change or right when the shift is beginning so it does cause a lot of chaos and confusion and A lot of frustration. And then the final rumor I've heard is that Float Pool isn't evenly distributed and that Float Pool doesn't have to work certain shifts. So I know that Float Pool is not under you, Christy, but you still do have the staffing office and you do see within Smart Square who's signed up and who's not. Who's not summed up. So just looking on a day by day basis, do you see that we probably have some issues or some opportunities with float pool? Or are we fairly distributing their time throughout the whole week? I think we are doing a good job, barely distributing their time throughout the week. Again, going back to the influx of patients, if you have an abundance of patients down in the ER, obviously most of your float pool is going to be going, or assigned to the ER, to try to offset those patients and to prevent pools from the regular floors. So a lot of times during the influx, you're going to see most of those float pool down overflow. I can say one thing that we, Sam and I, have been talking, because we're always talking and trying to improve and see which ways we can. What we can do better. And I think one of the things we had decided to do was one of the weekend, or on the weekend vacancy rate that we send out every week that our staffing does is to separate that out, cause right now we have it combined with each floor and we have the float pool nurses in that census that we send out in the vacancy rate, so I think we were looking at possibly altering that vacancy rate that we send out and Separating the float pool so that you can see exactly how many float pool staff are scheduled for those shifts versus how many of our core staff are scheduled. Thank you both, Sam and Kirstie, for joining us today and sharing these valuable insights on our staffing office. We will talk about our clinical progression leaders and have both Sam and Kirstie back for that. And thank you to our listeners for tuning in to Nursing Together. Stay connected, stay informed, and always thank you for all that you do.