IMPROVING A STAFF STRATEGIC PLAN : Case: A Plastic Surgery Ward, Töölö Hospital

Abstract

Background: Nurses' utilization of their working hours has been subject to discussion and criticism. Nurses are at times accused of spending limited time with their patients and too much time at their desks. As health care needs increase and budgets decrease, there is less flexibility in staffing and a greater importance is put in determining staffing needs. Care indicators are increasingly needed in nursing to ensure the quality of care, to help quantify the number of staff required to provide care that is safe for both the patients and the health professionals.

This study was carried out in the Plastic Surgery Ward in Töölö Hospital. The need for this study arose from the staff dimensioning challenges faced in the ward. The study was initiated by the Ward Manager of the Plastic Surgery Ward, but also because of the staff requests.

Objective and Aim: The purpose of this study was to improve the staff strategic plan in the Plastic Surgery Ward. The objective of the current state analysis was to receive data regarding nurses’ use of time. The analysis of the data suggested that the aim should be to adevelop functional and efficient staffing strategy for the ward.

Method: An action research was conducted for this study. Quantitative method was used to collect the data. The Self-Assessment Form, based on The Nursing Activities Score Classification was used to estimate the time usage on direct nursing, indirect nursing, departmental work and personal time. The data was provided by Registered Nurses (RN) and Practical Nurses (PN), who were working at the ward in patient care, in the field. There were a total of 188 forms that were filled and returned, with a response rate of 94%.

Results: It turned out that RNs generally use 55 % of their time for direct nursing and 30 % for indirect nursing. PNs use 62 % of their time for direct nursing, and for indirect nursing they use 22 %. Of all nursing activities, the RNs use most of their time in preparation and administration of medications (11.4 %), while the PNs use their time mostly in toileting and hygiene care of patients (12.3 %). Communication and nursing documentation together were also nursing activities where nurses use much of their time, with RNs’ 20% and PNs’ 17.3% respectively. RNs and PNs use a lot of time in cleaning and household management (23 min), equipment stocking and inventory (10 min), transferring patients (33 min), office work (11 min), waiting and searching things (12 min) and other activities that are not patient-specific or related to the patient care.

Discussion: Nurses use much of their time on activities that are not related to nursing care, especially RNs. These activities should be decreased or even cut out totally by redelegating and by finding departmental efficiencies in uses of technology and improved workflow. Nurses should use more time with their patients to make sure the patient care is patient-oriented and high-quality.

Conclusion: Special attention should be paid to Registered Nurses' job descriptions, as well as, well-assigned work tasks, targeting professional skills, hiring necessary staff and utilizing technology. These approaches can help the Ward improve its strategic goals so that it will be more efficient and effective.

Implications for nursing management: This study presents suggestions how to improve staff strategic planning and staffing structure in a Plastic Surgery Ward. These proposed collaborative solutions can improve the quality of patient care and safety, a reduction in errors, cost-effectiveness, and patients’ and nurses’ satisfaction.