 Western Maryland Health System: Self
Scheduling + Closed Units = Happier Nurses
In the space of one year, patient satisfaction scores for
inpatient care at Western Maryland Health System have increased from the
49th percentile to the 85th percentile. Over a slightly
longer period, RN turnover has decreased by roughly half, from 11.9 percent to
4.7 percent.
What has made such a dramatic difference? “Happier and
more satisfied nurses,” says Nancy Adams, the system’s senior vice
president/chief nurse executive. A major contributor to that satisfaction, she
says, is self scheduling for nursing units, an initiative supported in part by
a $138,000 grant from the state’s Nurse Support Program.
Adams says that while the health system had previously
allowed self-scheduling for units that took on the responsibility themselves,
the informal approach was not very successful. The current effort works well,
she says, because it is grounded in a system-wide process with broad support.
The launch also benefited from good support from a consultant, says Adams,
noting that all of the nursing units have adopted it.
Accommodating School Bus Schedules
Individual units have considerable flexibility in shaping
scheduling guidelines to accommodate the particular needs and preferences of
their staff—for example, a nurse with a child whose school bus comes a
half hour after the day shift begins, or one who prefers to work three 12-hour
shifts. Unit-specific scheduling guidelines must, however, fit within two
over-arching sets of guidelines: health system policies, which include budget
parameters for overtime, and unit staffing guidelines (developed by the nurse
manager), which specify the level of staff required for patient census. The
unit-specific guidelines are developed by a Unit-Based Scheduling Council, made
up of at least three members—one each from the day, evening, and night
shifts—and based on staff input.
The on-going task of constructing the unit’s four-week
schedule belongs to a Unit Scheduling Coordinator; unit RNs rotate in the
position. In addition to considering health system policies and unit staffing
guidelines, the coordinator incorporates staff scheduling preferences and
time-off requests. The nurse manager approves the schedule and arbitrates any
conflicts.
The Appeal of Closed Units
Adams cites another contributor to nurse satisfaction at the
health system: the opportunity to adopt the closed unit concept. Under this
arrangement, nurses agree to staff the unit from within, rather than seek help
from nurses on other units who “float” or are “pulled” from
their own units to provide extra help. By committing to meet unit needs under
all circumstances (either working overtime if needed or not working if not
needed), unit nurses cannot be pulled to another unit. “When you talk to
nurses,” notes Adams,” being pulled from one unit to another is one
of the things they dislike the most.”
Adams says that while arranging coverage under the concept
is easier in a large unit, Western Maryland has a 10-bed ICU where it is
working well. She cites a flexible and cohesive staff as a requirement for
success.
While the closed unit approach is not part of the health
system’s state grant, it does dovetail with grant goals. “Our number
one goal is nurse satisfaction,” says Adams. “The happier and more
satisfied the nurses are, the more satisfied patients are. Since we’re
here to give patient care, the focus of these programs is on nurses.”
Contact:
Theresa Hershberger, RN, MS
System
Director, Education & Project Management
Western Maryland Health System
P. O. Box 539
Cumberland, MD 21501-0539
Phone: (301) 723 1431
thershberger@wmhs.com Text
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