Among those outside-the-box-ideas: Nurse leaders really do have control over the highs and lows of patient flow and the staffing problems that arise from them.
"Those peaks and valleys don't actually have to exist," she insists. Instead, nurse leaders should ask themselves, "How can we staff differently to make an impact to smooth out variability?"
Mensik concedes that when she tells nurses to find ways to control variability, "They snicker and they laugh a little bit." We can't do it, they say. You don't know my hospital.
But it can be done, Mensik says; all it takes is some new thinking and a willingness to deviate from the status quo. Of course there are some things that nurse leaders can't control, such as who comes into the ED. But there are things that they can control—and therefore, change for the better. Here are three strategies:
1.Schedule discharges: Mensik recalls the staffing issues in her hospital's obstetrics unit. "We had a ton of discharges in the afternoon, and it was really hard. When the census dropped in the evening we had too many nurses," she says. So the unit took control over this problem by scheduling discharges during admissions and scheduling accordingly.
By using a pre-arranged discharge schedule, discharges aren't lumped into the same small window of time, Mensik says. In addition, nurses know upfront who they're discharging and when, allowing them to organize their care and spend a generous amount of time with each patient.