Linking Nursing Outcomes, Workload and Staffing Decisions in the Workplace

Ontario

Research shows that nurses want to provide more input on assessing patient acuity, changes in patient needs and staffing requirements. Nurse autonomy and participation in decision-making are key factors in contributing to a healthy workplace and to nurse retention and recruitment.

When healthy workplaces thrive, nurses who work there want to stay and are unlikely to seek early retirement. New nurses are drawn to these workplaces and stay because of the positive nursing experience.

Hamilton Health Sciences (HHS), the Ontario Nurses’ Association and the Ontario Ministry of Health and Long Term Care developed a project that complemented a series of Ontario government studies and initiatives. The project involved the enhanced development and application of a “Nursing Dashboard,” a single source of nursing, patient and organizational information for data-driven decisions about the appropriate staffing for nursing care. Original work on the tool had begun in 2007 and 2008 as one of several pilot project funded by the Nursing Secretariat.

Project Objectives: 
  • Determine which indicators capture important changes within the unit and organization
  • Determine which indicators were needed and useful to effectively assess the level of staffing on an individual unit
  • Determine how indicators can best be  collected so that they are accessible to nurse leaders in decision making processes
  • Test and modify the Nursing Dashboard so that nurse leaders, consulting with staff nurses, can make more informed workload and staffing decisions
  • Provide opportunities for RNs to be involved in assessing their workloads
  • Assess how the Dashboard could be applied to other sites
Project Implementation: 
The Dashboard was implemented on eight pilot units in four sites at HHS. Nursing staff representatives from the eight units were integrated into Unit Committees comprising a unit manager, staff nurses, a financial controller, and an information controller.A catalogue of definitions for the indicators was created. The Dashboard was developed based on input/throughput/output indicators, including information from safety occurrence reports, payroll, workload and other sources. Outcomes measured included resource utilization, observations by nurses, and patient outcomes. The Dashboard could be accessed from any computer on the unit, providing managers and nurses with an overall picture of their ward’s situation, and helping them determine how to utilize available resources most effectively.Staff nurses were educated about the Dashboard, and met regularly with managers, financial controllers, and information controllers to assess unit staffing based on patient requirements, unit activity and staff demographics. Nurses and managers on the pilot units reviewed the Dashboard to ensure that the indicators were representative, to discuss changes occurring within the clinical unit and to determine if the Dashboard could be made more helpful or accessible.
Project Outcomes: 
• The Dashboard was found to be helpful in describing the elements in a patient care system, from inputs to throughput factors, and patient, nurse and organizational outcomes• The Dashboard helped determine the factors that usefully characterize the work environment, and the salient outcomes for tracking, trending, projecting and making data-driven decisions• The Dashboard was viewed as a one-stop shop that captured generic, relevant and useful indicators and outcomes• The Dashboard demonstrated the importance and value of collaborative decision making• Participants saw the value of the Dashboard information and gained an appreciation for the depth of knowledge needed to determine the appropriate numbers of staff for nursing units• Staff nurses valued the opportunity to participate and be heard• The project encouraged mutual respect, understanding, engagement, and interprofessional collaboration• The Dashboard will be revised based on suggestions from project participants and will be tested across HHS• Partners will investigate the Dashboard’s applicability to long-term care, public health and other areas• Partners will investigate the merits of using the Dashboard as a learning tool for new managers, staff and students