Marie Manthey: Staffing

Remembering the Simple Truths

Tue, 19 Jun 2007 16:07:24 GMT

John Nelson --- nurse researcher, president of Healthcare Environments and CHCM adjunct faculty ---frequently shares data with us about the outcomes of our work with our clients. One hospital implementing Relationship-Based Care found that a richer skill mix decreased the dollars per Adjusted Patient Day, decreased ventilator-associated pneumonia and decreased patient falls with injury. John would hasten to add that this is a statistical correlation that does not indicate causality, but only a relationship between variables. I think the more we learn how to interpret and correctly discuss this kind of statistic, the better able we are to explain the importance of adequate staffing.

After the "reengineering" of nursing in the nineties (which had nothing to do with nursing, and everything to do with changing skill mix to save money), we lost sight of simple truths and replaced our authentic experience with "grids" which supposedly save money but which in reality wreak havoc with common sense.

Primary Nursing and the 12-hour Shift

Tue, 05 Sep 2006 15:44:01 GMT

I get a lot of questions about how Primary Nursing can work with 12-hour shifts. This is a complex question and deserves thoughtful discussion.

My short answer: Primary Nursing CAN work with 12-hour shifts. And both Primary Nursing and 12-hour shifts can meet the need short term patients have for a therapeutic relationship with a nurse (or nurses).

My long answer, it takes changing how we think about staffing and relationships.

Using licensure to create role clarity

Fri, 04 Aug 2006 16:52:31 GMT

Jean Harry feels that the term "ratios" is troublesome:

I agree that the "ratios" is misleading....and that the variety of entry points into practice is increasingly confusing. We need to analyze work complexity in terms of knowledge and skills needed for safe Nursing Interventions in a particular patient population that are sophisticated enough that also take into account the workplace relationships that impact utilization of support staff. I think that by going back to the basics over and over again (knowledge and skills coupled with effective interpersonal relations)....rather than trying to differentiate by broad credentialing, we will be able to see the forest for the trees.

Getting Smart about workload issues

Fri, 21 Jul 2006 19:40:03 GMT

I've been thinking a lot about this issue of staffing and time use, and I think we need to develop new terms to express a new way of thinking about staffing and time use. We need to be able to pragmatically talk about various workload issues. A set of differentiated situations with clear criteria or standards will make it easier to do this

Nurses have an amazing capacity to do more!

Fri, 24 Mar 2006 17:56:44 GMT

I know if I said this in a speech before an audience of nurses, many would get angry, and some would probably walk out. And yet, it is a statement I believe to be true. Not all nurses. Not in all work situations. Not all the time.

The Role of LPNs

Mon, 16 Jan 2006 18:44:30 GMT

Here's my two cents worth on the subject of LPNs.

Strategic Problem Solving at the Staff Nurse Level

Tue, 13 Dec 2005 15:00:17 GMT

What is Wrong with this Picture?

Several times a week, in hospitals all over, system or another breaks down...requiring a staff nurse to 'fix' the problem so a 'patient won't suffer' from the breakdown. Maybe it’s pharmacy sending the wrong drug....or not sending it on time....or a late tray that never arrives for a hungry patient....or the transporter arriving without a wheelchair to take a patient for a test.....you know the situations.

Time after time, nurses stop what they are doing to 'fix' the problem. Eventually their frustration mounts to the point they tell their nurse manager that something needs to be done.

What would Nightingale do?