Following up from my last post regarding staffing and litigation risks, this post concentrates on “what we know” and “what we can control”. For example, what we know is that there simply is not enough staff (clinical and even non-clinical) to fill a provider’s vacant positions. The world in general knows this and the press, is oft to repeat a narrative where staff shortages cause negative outcomes, long service waiting times, delayed or deferred admissions, etc. Not a week goes by where I don’t see a news story, on-line, in-print, or on television focused on a health care staffing concern of one level or another.
As I mentioned in the prior post, the heightened alarmism and focus is not helpful, for the most part. For example, I’ve watched Union organizing activity in a number of markets, seeking to organize nurses, based on the staffing issue – not enough and thus, unsafe for nurses and patients. I get the issue, but I don’t see a solution. Raising the issue to a fever pitch, demanding that providers hire more staff that don’t exist, pay more for staff that does exist, etc., isn’t solving the problem. I get that management may even seem callous to the issues and some may be but most senior leaders I talk with are truly trying to do everything they can to improve bedside/patient-centric staffing levels. The simple reality is that there are more openings than bodies capable and willing to fill the positions.
A case in point is recent organizing activity in Wichita, KS (Sedgwick County). Union activity in health care in this area/community has been historically, very low. For professional nurses, it’s been virtually non-existent. At two Ascension hospitals (national Catholic health system) nurses voted within the last nine months, to organize. Here’s a short quote from the Union regarding the push for organization: “We need better staffing, we need Ascension to get serious about recruiting and retaining nurses and we need to have a better safety workplace violence program,” said registered nurse Sara Wilson. “Nurses are in danger when we go to work and Ascension needs to take care of their nurses.” As one would expect, there is truth within that statement but also, to be frank, very little that Ascension can do to create more staff. Provider resources are simply not robust enough to just see the staffing issues as economic. More money isn’t the answer. Ascension closed 2022 with a negative 3.1% margin on losses of $1.8 billion. Among the major health care bankruptcies, one quarter were senior care providers (last several years).
Knowing what we know regarding staff supply, the concern is can some things be done and what can we control. We know money won’t solve the staffing problem as this too, is of finite quantity. Likewise, we also know that money is a substitute concern for the real core issue of simply, not enough bodies for the tasks demanded in patient care. In other words, money becomes the tangible point, but we also know, that money won’t employ more bodies or staff. I know many providers that have RN openings that offer $100K in wage opportunities plus sign-on bonuses and benefits with no takers for these opportunities. A quick Indeed search of Chicago, IL using the job title “nurse” produced 9,133 positions within a 25-mile radius. Similarly, Google searches for nursing positions provide multiple, big dollar references, for travel positions ($5,500 to $7,850 per week). And, according to the Bureau of Labor Statistics, over 203,000 openings will occur every year for at least, the next decade (https://www.bls.gov/ooh/healthcare/registered-nurses.htm).
What can be done primarily, for any provider, is first and foremost, a concentration on retention. The second thing is to listen to staff, not as a show, but as a real effort in understanding what their concerns truly are. Some are fixable, some are not but all providers should be honest. Open the books so to speak and share the economics. The third, as I have discussed repeatedly, is improve management and reduce bureaucracy wherever possible. An organization can significantly improve its bedside hours (actual) by reducing as many tasks as possible, that have nothing to do with patient care. Trust me, there are many things that health systems and providers require staff to do that has nothing to do with patient care or regulatory requirements. Fourth, analyze the work-flow and make sure that proper duties are assigned to proper staff. I have seen all to many environments where RNs are doing work that could and should be handled by techs, social workers, chaplains, therapists, etc. For example, I can’t even begin to count how many times I have heard about therapists dropping a patient back into his/her room and putting on the call light for nursing to come and toilet the patient or have other care needs met. Crazy. Unless the need was a medication administration, the therapist can and is qualified to assist the patient with a toileting need to get fresh water, transition the patient to bed, etc.
When I see litigation and I see a lot as my firm (H2 healthcare) has an active compliance practice and a nationally known expert in litigation support (defense, not plaintiff), the focus is nearly always on “nursing” not doing something or being somehow, the causation for the bad outcome. Now, with staffing coming to the surface as a root cause (not enough bodies), the question begs, what kind of staff and in what amount. No doubt the focus will be on nursing but perhaps, that focus is rather shallow. As I pointed out in the paragraph above, maybe the staff numbers are better than thought just poorly organized and used (health care is notorious for “silos”) and layers of management.
What a provider can control, aside from numbers of staff which, we know is difficult to totally control, is how staff are allocated especially in relationship to patients and their needs. Below are my top six things providers can control/do with regard to staffing and to reduce litigation risk.
- Make sure staff in number and capability, match the generalize facility census trend. This means in number (patients) and care needs. I know providers like full beds with patients that garner high reimbursement but, there is a balance. Strike the balance as much as possible and let staff know it.
- Work as teams – not just as nursing, and therapy, and social work, etc.
- Stop employing managers that were the “best” clinicians. Employ managers that actually know how to manage, Likewise, give these managers true accountability and authority. They must be able to do their job and not have to “punch up” to get things done. Good management reduces litigation risk.
- Put staff in positions where decisions are made and give them real results and a “piece of the pie”. Gain share for reduced call-ins, turnover, staff referrals (new).
- Keep staff apprised of staffing levels and make sure they know how staffing decisions are made, etc. Don’t whitewash the issues. Staff complain about being short-staffed which is the “killer” when it comes to litigation. Too many depositions of nursing staff start with staffing level discussions. Focus on real conversations, daily, about team and everyone being engaged not just “CNAs and Nurses”.
In my next post, I’ll dig a bit deeper into this concept (risk and what can be done), especially concerning the evolving and expanding trend of litigation in Assited Living Facilities.