Senior Vice President of Patient Care Services and Chief Nursing Officer, Lutheran Medical Center, Brooklyn, N.Y.
Q Our education department doesn't meet my unit's needs. I think our nurse educator should report to me, not the director of nursing education. To whom do you think nurse educators should report?
There's no right answer to your question because needs can be met, or not met, in both reporting relationships.
In my organization, we use a hybrid model with primarily specialty educators reporting to their clinical division and a core of centralized instructors reporting to the director of education. I've been an educator in each scenario and they both work. The key is a mutual respect for defined goals and a working relationship of stakeholders both at the unit level and the next level up the chain.
Meet with the educator, your boss, and your educator's boss to define needs, set goals, develop a plan with target dates, and agree to an evaluation process. Be specific. Look to needed skill sets, program expansion, quality improvement findings, and staff competencies or lack thereof. Agree to the time frames you can devote to staff education, whether in the classroom, at short huddles, or during bedside coaching. Define the hours per day you can expect to see the educator visible on the unit, accepting that the time may vary depending on other responsibilities such as a new orientation class just commenced or an annual education fair in progress.
Keep in mind that there's some global risk with a totally decentralized educational model, such as losing sight of overall educational goals, fragmentation, duplication, and even insufficient record keeping for regulatory purposes.
You know the "why." Negotiate the "who, when, how, and where" and then be persistent with the plan and its evaluation. If the root cause is a lack of resources, then the problem runs deeper and may be out of your sphere of direct influence. Defining your needs will help make the case for a change in structure, process, or even levels of educational resources.
Q We're currently investigating the purchase of a commercial patient acuity system, but I'm not sure it's worth the money. Do you believe I'll get the information necessary to make better financial decisions?
You should involve your finance department in the decision because you need their support in using the data to make financial decisions. Of course, the key issues are whether the data are valid, reliable, and reflective of nursing workload; if the data collection task is value-added for your staff; and if you actually use the data in a meaningful way.
We know that acuity-based staffing is far better than ratio-based staffing; for example, a six patient assignment can be totally manageable one day and unrealistic the next. Traditionally, we make acuity-based staffing assignments based on at-the-moment charge nurse/supervisor assessments on a particular unit. We also make acuity-based staffing budgets based on several factors, such as expected patient population on a unit, regulatory or contracted minimums, and industry standards. Critical care, step-down, oncology, pediatric, recovery, medical, or surgical units are obviously staffed differently. Is that enough?
It has been reported that standardizing acuity data optimizes staffing effectiveness, especially when combined with workforce management software to closely monitor staffing and productivity goals.1 Established vendors offer well-studied methodologies, useful reports, consultant expertise, integrated software, and more. Hospitals with full electronic health records can look at acuity systems that use documentation data to automatically produce patient acuity data without it being a separate task.
If you aren't prepared to put the time and resources into thoroughly researching systems, engaging stakeholders, and planning your implementation/evaluation strategy, then you won't see the outcomes you seek. The evidence on return on investment is limited. Check references carefully. Making data-based financial decisions is sound management; commercial acuity systems may or may not get you there.
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