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Survey focuses on nursing shortage, staffing effectiveness

Nurse Leader Weekly, January 7, 2005

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If a candidate for a nursing position walked in the front door to apply, could he or she get an interview that same day?

A Joint Commission on Accreditation of Healthcare Organizations (JCAHO) surveyor posed this question to the nurse recruitment coordinator during Southern New Hampshire Medical Center's (SNHMC) triennial survey in March 2004. Ensuring that the hospital is responding to the nursing shortage was a major focus for surveyors during the competence assessment process meeting, as were staffing effectiveness and credentialing, says Karen Reed, MS, director of quality management at the Nashua-based hospital.

The recruiter's answer satisfied surveyors-she has granted same-day interviews many times in the past to accommodate nursing candidates. Scheduling a same-day interview would only be problematic if the director were out for the day, says Reed.

Standard HR.1.30 states that hospitals must assess staffing effectiveness by using data on clinical and service screening indicators and human resource screening indicators. "We had 90% of what [the surveyor] was looking for," says Reed.

The hospital's plan did not include follow-up actions taken as a result of the data analysis-the one thing the surveyor said was missing. SNHMC has since updated the plan to include benchmarking, Reed says, although it is not a standards requirement.

The surveyor liked that the hospital presented data in graphs and tables, which is a standards requirement.

The hospital spent time creating the appropriate measures for behavioral health and birthing to ensure that data analysis is specific to staff in these units, according to Reed, although it is not a standards requirement. For example, the birthing unit does not have many patient falls, so its measures were different than those of other units.

In addition, the plan includes the initiatives and actions the hospital will take as a result of the study, says Reed. SNHMC's studies showed that staffing was not related to falls or to other areas the hospital examined.

Reed and her team had predicted that per diem staff would document taking fewer comfort measures, such as rocking or supplying pacifiers, for newborns than would employed staff. "This turned out not to be the case and was the only surprising result," she says. Whatever the findings, it's important to document the results and your action plan."

Source: Adapted from Briefings on JCAHO (January 2005), published by HCPro, Inc.

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