HealthMarch 14, 2022

Nurse leaders speak out: It’s time for competency-informed staffing

Staffing a healthcare institution daily and ensuring the right mix of staff on each unit to meet patient care needs, is one of our most challenging responsibilities. The pandemic revealed the disconnect with staffing based on hours per patient day, beds alone, or average daily census.

Basing staffing on numbers just doesn’t work anymore. Patients are sicker than ever and with high patient acuities, the skills and clinical judgement needed to care for patients is much higher and complex. We’ve always known it, but during the past two years of the pandemic, we’ve recognized that a nurse can't move from one unit to another without cross-training to ensure they have the necessary competencies. When it comes to quality care, competency and acuity matter and they need to inform how we schedule and staff.

It’s time for a change - nurse staffing based on numbers just doesn’t work anymore

Competency is defined by the American Nurses Association as an expected level of performance that integrates, knowledge, skills, abilities, and judgements (ANA, 2014). Competency-informed staffing considers the competency of the nurse, patient acuity/severity of illness and not just numbers. In a recent nurse leader survey by UKG and Wolters Kluwer (2022), up to 81% of respondents indicated that having competency inform their staffing and scheduling patterns during the next 18 months will be important/very important and up to 79% believe they will need to implement competency-informed shift coverage.

It’s time for competency and workforce management software to be interoperable

Right now, many of us struggle with just keeping track of nurse competency in the learning management system (LMS) and most of the time, the LMS does not communicate with the workforce management solutions software we’re using to staff on a daily basis. Many leaders use a manual system for daily staffing and resort to paper and pencil to staff shift to shift.

We have additional challenges with experienced nurses retiring, joining agencies, or moving to areas with better hours (such as clinics, outpatient surgery centers, and offices). We also have nurses and unlicensed assistive personnel who are burned out and leaving the profession all together. To complicate matters, graduate nurses are joining the workforce ranks lacking mastery of key skills and competencies and we don’t have enough experienced preceptors to train them.

Here’s the bottom line: the LMS must be interoperable with workforce management software to ensure the right mix of nurses and unlicensed assistive personnel are available to care for patients at any given moment. Staffing for average daily census is no longer sufficient. Healthcare systems need to invest in and cross-train their float pool workforce to work across adjacent specialties so they can be used to fill vacancies. Healthcare industry partners must work together to build interoperable solutions that foster safe, quality patient care by insuring there are adequate numbers of competent staff.

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Anne Dabrow Woods
Chief Nurse of Health Learning, Research & Practice, Wolters Kluwer
Dr. Anne Dabrow Woods is the Chief Nurse of Wolters Kluwer, Health, Learning, Research and Practice business at Wolters Kluwer where she drives the strategic development of evidence-based solutions for nurses and nursing institutions.
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