Academic journal article Creative Nursing

Shared Governance and the Delivery of Labor Resources in a 24/7/365 World

Academic journal article Creative Nursing

Shared Governance and the Delivery of Labor Resources in a 24/7/365 World

Article excerpt

This article explores how shared governance and unit-based scheduling/staffing/resource management (SSRM) committees can impact the delivery of labor resources 24/7/365 through knowledgeable workforce budgeting and employee scheduling and daily staffing best practices. Two case study examples are included.

Organizations are responding to unprecedented demands to adapt to health care changes and shrinking reimbursement dollars. Labor resources make up the lion's share of hospital expenses and are central to the balance of hospitals' costs and performance. More labor resources are required to meet increasing admissions and patient complexities, requiring increasing numbers of highly specialized clinical workers (American Hospital Association, 2011; Labor Management Institute [LMI], 2012).

Shared governance is an organizational structure in which staffnurses have a voice in determining nursing practice, standards, and quality of care. Shared governance models create decentralized systems in which decision making lies with bedside staffnurses whose role becomes the source of innovative solutions; the manager's role is one of facilitation and support to assist staffnurses in changing practice to better care for the needs of the patient (Forum for Shared Governance, 2012).

One of the best ways for staffnurses to have a voice in the delivery of labor resources 24/7/365 is by serving on the unit's scheduling/staffing/resource management (SSRM) committee. The SSRM committee is tasked with addressing the planned delivery of labor resources through the unit's workforce plan or budget, achieving autonomous and participative self-scheduling, and benchmarking unit performance for ongoing improvements.


As labor resources are planned to meet patient care needs, it is a management imperative that nursing leadership work closely with finance to define components of the workforce plan: the unit type (e.g., intensive care unit [ICU], medical/surgical) for benchmarking purposes; the nursing care delivery model; the defined direct and indirect caregivers; and the target direct, indirect, and total worked hours per unit of service-for example, hours per patient day (HPPD) or hours per visit. This information helps inform staffnurses about the logic behind the staffing decisions.

Unit Type for Benchmarking Comparisons

Many units are blended units comprising different specialty patient populations (e.g., medical and telemetry). The patient population mix cannot be predicted accurately at any given time, which often contributes to fluctuating increases in hours per unit of service. In the 2011 Perspectives on Staffing and Scheduling (PSS) Annual Survey of Hours Report, LMI reported small but continued increases in direct care (57% of 63 reporting unit types), which may be due to increased patient acuity and/or due to the unpredictability of patient population mix in blended units. LMI also reported small but continued decreases in total worked hours/unit of service (41% of 63 reporting unit types) because of reductions in indirect support staff(clerks, educators, clinical nurse specialists, etc.). Findings were based on responses from 429 hospitals (LMI, 2012).

Nursing Care Delivery Model and Labor Resources

The nursing care delivery model broadly defines the way health services are delivered in a unit, service line, or department.

Case Example. This case study is from a neurology step-down unit at a teaching hospital that had adopted a registered nurse (RN)-only care delivery model. As part of a Workforce Assessment Project by LMI, we looked at the direct, indirect, and total worked hours of care, which were rising from 12.5 to 16.5 total worked HPPD, and the RN-to-patient ratios, which were supposed to be 1:3, but RNs reported that ratios were often as high as 1:6.

The unit had two part-time licensed practical nurses (LPNs) who had both been in the unit for more than 20 years as it evolved from medical/surgical to general neurology and then to the neurology step-down unit. …

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