Self Scheduling Pdsa Self-Scheduling With Hospital Nurses:

Self Scheduling

PDSA

Self-scheduling with hospital nurses:

A literature review and proposal for change

Recently, there has been a great deal of frustration amongst both nurses and patients about the strict, inflexible, and counterproductive schedules nurses are forced to adhere to regarding the planning of their shifts. As a counterweight to this trend, there has been a movement which advocates the practice of nurses self-scheduling their hours, versus adhering to a predetermined, set formula. Frustration with scheduling, including back-to-back shifts and frequent night shifts has been linked to nursing burnout and a higher risk of medical errors. That is why determining solutions to the problem is such a critical component of alleviating the nursing shortage and creating a wholesome and more sustainable environment for nurses on the front lines of care.

One institution which has had notable success with self-scheduling is St. Francis Hospital in Columbus, Georgia. "St. Francis was having staffing problems that forced their own nurses to float between units when they didn't want to. The hospital also had to pay a lot in incentive payments to cover extra shifts and rely on expensive agency nurses to fill in the gaps" (Pecci 2012:1). Self-scheduling has reduced the need for 'floating' nurses and reduced costs as there is no need to support the wages of expensive temporary workers. The system used by St. Francis is not unique, and it could be adopted by a wide variety of institutions. Software is used to give nurses greater autonomy and agency over their actions yet still coordinate their shifts with the needs of patients in an efficient manner. "There are several different self-scheduling software options for hospitals to choose from -- St. Francis uses one that not only allows for self-scheduling, but also includes a system where nurses earn points for picking up extra shifts. Nurses can accumulate points and cash them in to earn rewards" (Pecci 2012:2). This is a method that uses 'carrots' rather than 'sticks' to encourage nurses to take potentially less desirable shifts or to work more hours. Because it is chosen, nurses are less resistant to doing so. Nurses can also schedule remotely via a computer system, which ensures scheduling is both convenient and can also be updated immediately, if there is a vacancy, further reducing the need for floating or temporary help.

Flexible work schedules have been cited as the reason older nurses or nurses with children can remain in the workforce for longer. This allows more experienced nurses to remain active and reduces the pressures created by the current nursing shortage. But even younger nurses can benefit from flexible schedules. "Many nurses like having the ability to choose a schedule that does allows them to easily continue their educations or spend more time with their families or tending to other pursuits" (Larson 2009). Nurses can also more easily add to their credentials with flexible scheduling, yet another win-win for the healthcare system. There has been a growing acknowledgement about the need for more master's level-prepared nurses. Nurses at institutions with flexible scheduling can work and go to school, planning their coursework and their scheduling in tandem rather than being held hostage to the needs of a rigid, fixed schedule. At one institution, "the hospital allows nurses to choose between eight-hour shifts or 12-hour shifts, and a weekend option program exists for nurses who are willing to work 24 hours on the weekend but still receive full-time pay" (Larson 2009). Nurses can also phase into part-time employment more easily if the entire schedule is flexible, easily allowing nurses to opt in and opt out, depending on their financial needs and the needs of their families.

A pilot study by Bailyn, Collins & Song (2007) which involved implementing self-scheduling on a nursing floor for an entire year found a noticeable increase in morale amongst nurses, as measured by an informal questionnaire and "its effect on the nurse manager was gauged by counting change requests and sick calls, as well as her time spent on scheduling and her perceived annoyance in doing it" (Bailyn, Collins, & Song 2007). Nurses involved in the study reported that they benefited having more control over their time and were able to give more effective patient care as a result of feeling more empowered and relaxed. As well as subjective reports of improvement, "change requests decreased, as did the time spent by the nurse manager and her sense of annoyance" (Bailyn, Collins, & Song 2007). However, it was found that "since the nurses did not adhere to the rules of the programme, despite repeated efforts by the nurse manager, the attempt floundered" (Bailyn, Collins, & Song 2007). The study designers still recommended the format but stressed the need for careful monitoring to ensure that all participants understood the rules of the system. What was particularly troublesome was that the nurse participants did not seem to know why the self-scheduling system was problematic. "Some believed the only reason that self- scheduling did not work was because it created too much work for the nurse manager. Others believed that a few nurses were ruining self-scheduling for everyone, that is, a few nurses did not follow the rules as they were supposed to" (Bailyn, Collins, & Song 2007: 6). Nurses who broke the rules regarding the rules for flexible scheduling, however, created a spiraling effect, causing more nurses to ignore them.

Flexible scheduling can work if carefully monitored and if useful planning tools are deployed, such as the use of software to ensure that all nurses have equal opportunities to book shifts and there is no rearranging of schedules due to favoritism. When implemented correctly, it can save costs and encourage retention of nurses who might otherwise leave the profession or who could not advance their educations. But merely because it is flexible does not mean it can be a free-for-all.