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Consensus staffing guidelines.

In 2004 New Mexico Nurses Association brought together key people from the NM Board of Nursing, NM Organization of Nurse Executives, NM Center for Nursing Excellence, nursing programs and others to inform them of recent research on fatigue from long shifts, overtime, on-call time, that that fatigue's impact on quality of patient care. The following year the legislature passed a memorial directing the NM Health Policy Commission to look into issues of fatigue and staffing patterns and their effects on patient safety and nurse retention.

From that memorial and our ongoing efforts to keep the issue alive, the NM Organization of Nurse Executives has developed Consensus Guidelines: Nurse Staffing. It has been endorsed by NMNA, NM Organization of Nurse Executives, NM Center for Nursing Excellence, and NMHHSA. It has been presented to the NM Board of Nursing.

These guidelines are written to encourage hospitals in NM to work with their staff nurses, administrators and nursing management staff to develop staffing plans that should improve the care given to all patients and improve retention of nursing staff (and decrease turnover).

Definitions:

Regularly Scheduled Hour: Based on 40 hours per week/80 hours per pay period.

Mandatory Overtime: Work scheduled by the employer that exceeds regularly scheduled hours.

Voluntary Overtime: The employee voluntarily works hours that exceeds regularly scheduled hours.

Total Work Hours: Regularly scheduled hours plus overtime hours (mandatory and voluntary).

Guidelines for Scheduling Work:

Shift length: The literature strongly indicates that errors and near misses dramatically increase after 12 hours of work. NMONE recommends a goal of shifts not extending beyond 12 hours.

Flexible Shift lengths: Though 12-hour shifts are the norm, they may not be the best option for all nurses, particularly for mature nurses. With 45% of NM nurses over age 50, flexible shift length may offer retention options. Flexible scheduling options provide an opportunity for all nurses to balance the demands of their professional and personal obligations.

Rest Between Shifts: NMONE recommends a minimum of 8 hours of rest between shifts.

On Call: On call is to cover acute, emergent influxes in patient care needs. When called in to work, the on call hours worked are not overtime if they are within the guidelines of regular work hours. If the on call hours cause the nurse to exceed the regular work hours guideline, these worked on call hours are considered overtime. When called in to work, principles of staffing such as shift length limitations, rest between shifts, and total hours worked should apply.

Scheduled On Call: Some units, based on their patient population and type of' service, have unpredictable and highly variable work loads (operating room and Labor and Delivery are examples of these types of units). Scheduled on call is used to manage the variable workload, and is clearly articulated as the expectation of the job by the unit/department written guidelines. Scheduled on call may result in overtime, but would not be considered mandatory overtime. Principles of staffing such as shift length limitation, rest between shifts, and total hours worked should apply.

Overtime:

Mandatory Overtime: NMONE recognizes that occasional mandatory overtime may be necessary to manage immediate, short-term emergencies. It should not be used routinely as a staffing tool.

Voluntary Overtime: NMONE recognizes that nurses may volunteer to work additional shifts or work at more than one facility for financial reasons.

Total Hours Worked: NMONE does not have a recommendation for total number of hours worked in a given time period, however NMONE does suggest that organizations establish total work hour guidelines, and be accountable that total hours worked at their facility are within that guideline. Nurses who work at more than one facility have personal accountability to ensure they receive rest periods between shifts to ensure their ability to provide safe patient care.

States of Emergency: Scheduling policies may not apply to states of emergency as declared by municipal, county, state, or federal officials. In these extreme situations, nurse leaders, in collaboration with the nursing staff, establish a plan that ensures safe, quality patient care as well as the safety of the nursing staff. Organization executives, managers, and staff must consider the total number of hours worked, the conditions of work, and the effects of fatigue and stress on human performance when making decisions and assignments.

Education: NMONE strongly encourages that all nurses, during orientation, review the NM Nursing Practice Act and be provided evidence of the impact of fatigue and excessive work hours on safe, quality patient care. All nurses are urged to monitor their own personal work schedule, to include their primary employer and other employment, to ensure they are capable of providing safe patient care.

The New Mexico Nurses Association board of directors expects that over the next year most hospital administrators and nursing managers will begin to discuss with their staff nurses their staffing plans, reviewing what the plan currently addresses and based on input from unit staff, begin developing staffing plans that allow for flexibility in scheduling for those who need or want shorter shifts. This will allow the mature, expert nurse to work shorter shifts, while providing expertise and mentoring of knowledge and skills to the novice; will allow the nurse with young children to schedule days off for parent-teacher conferences, school trip or in-class volunteer time. We believe that nurses will soon no longer be scheduled to work M-F, be on call and have to work the entire weekend, and come back and work M-F the following week. Although NMONE did not recommend Total Hours Worked limits, they acknowledge in their background materials that the 2004 Institute of Medicine Report Keeping Patients Safe: Transforming the Work Environment of Nurses recommends that nurses not provide patient care in any combination of scheduled shifts or mandatory of voluntary overtime in excess of 12 hours in any given 24 hour period and in excess of 60 hours in a seven day period. For your information, Oregon passed a staffing bill in their legislature that limited time worked to not more than 48 hours in a seven day period.

Having watched the unfolding of consequences from California's rigid nurse-patient ratios law, NMNA is NOT interested in nurse-patient ratios here. We think that the NMONE nurse staffing consensus guidelines, supported by the hospital association, is a good beginning to addressing the issues of fatigue in nurses due to staffing patterns, patient safety issues related to tired nurses, and retention of staff nurses by facilities. If you are interested in working with your facility's administration, copy this article, give it to your nurse manager, tell the manager you want to volunteer to serve on the committee that will be developed to work on staffing issues/planning.

We will be watching for changes in staffing patterns over the next eighteen months. NMNA would appreciate feedback, both positive and negative from nurses in New Mexico on how these patterns change, and whether the guidelines are being followed in your facilities. Please, give us your feedback by writing to carrie@nmna.org. We will compile the information and look again at the issue no later than August, 2008, so that we can determine if other steps need to be taken to keep our patients safe and our nurses working in our facilities.
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No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2007 Gale, Cengage Learning. All rights reserved.

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Title Annotation:New Mexico Nurses Association
Publication:New Mexico Nurse
Geographic Code:1U8NM
Date:Apr 1, 2007
Words:1206
Next Article:Legislative report.
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