Willow Springs Center 2014 Staffing Committee Report Address: 690 Edison Way
City: Reno State: Nevada Zip Code: 89523 Title of Individual responsible for committee meetings: Chief Nursing Officer. Staffing Committee established: Yes, 12-02-2009
Committee composition: Total of 14 members.
Administration represented by: CNO/Interim CEO, Staffing coordinator, MHT Milieu specialist, RN house Supervisor. Direct care represented by: Four MHTs and two lead MHTs, Four RNs.
Direct care members represent every unit and every shift. Ratio of Direct Care staff to Administration staff is 3:1.
Committee Meeting frequency: Meets quarterly on the 4th Wednesday at 07:30. Additional meetings held to work on special projects. Total of 6 meetings held in 2014.
Committee Activities:
Improvements in communication between RNs and MHTs on the units. Improvements in communication between units in hospital
Address any ADOs or RWAs submitted since last committee meeting.
Review Employee engagement survey and implement changes respective to feedback. Recruitment and retention strategies (staffing committee mentors)
Managing consistent breaks
Educating front line staff of committee members, their activities and access to meetings. Address staff tardiness and frequency of call offs
Revise RN schedules to 8s and 12s. Review and update Staffing Policy.
Assessed impact of new Q shift patient Self Inventory Assessments. Committee Efficacy:
The most significant accomplishment in 2014 was the result of the committee initial focus on staffs care responsibilities that were unique to the MHTs and RNs that placed a barrier of communication and teamwork during milieu management responsibilities. The committee concluded that the challenged communications led to poor teamwork in managing acute milieus and had an additional impact creating poor morale with RNs and MHTs on the pm shift in particular. Poor retention of new staff on the PM shift was also an outcome and the only RWA of 2014 was submitted by an RN on this shift. The RWA was
resolved by changing the RNs work assignment temporarily and providing more time, training and experience on charge RN duties. From a systems perspective there was a clear need to get the RN into the milieu with the MHTs and not in the nursing station managing obligatory paperwork. In addition it was agreed that getting the RN out on the unit would provide more rewarding direct contact with the patients and not paperwork i.e., improved morale and retention. A new schedule was proposed to have an additional RN overlapping on the PM shift with the specific role of being in the milieu. The CNO developed a new schedule with overlaps at known times of high acuity with 12 and 8 hour shifts. It was reviewed/modified by the committee then presented to the CEO for approval. It was implemented in July 2014. Staff retention, RN engagement in milieu intervention and documentation has all improved since implementation.
Other accomplishments included:
Review of staff breaks protocol and introduction of new tool that has decreased missed breaks significantly. Communication practices/expectations between units enhanced when patients sent to other units to de-escalate.
Administration night shift rounds to 1:1 with night staff ensuring their ideas regarding staff are heard and addressed. This led to AM scheduling changes. Staff tardiness addressed through supervisors monitoring and counseling specific offenders leading to an overall decrease in events.
Established Staffing committee mentor program to increase retention of new employees.
Increased staff awareness of staffing committee members, activities and access via posted fliers, memos and committee representation by all disciplines, units and shifts.
Approved 2014 staffing policy that included specific actions for staffing committee. Activities of committee now reported in PI/Ethics Committee monthly as warranted. Goals for January 2015 meeting include:
Implementation of staffing software.
Review potential of “On Call Schedule” for immediate coverage on shifts difficult to cover call offs. New staff retention activities.
Review and make staffing recommendations related to 2015 DBT unit relocation and expansion.
Responsible Staff for committee report:
__________________________________________________ CNO/Interim CEO Date___________ Samuel B. McCord RN BSN
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Willow Springs Center
Provision of Care
Title
Nursing Staffing Plan
Policy #POC. 1000.100
Category
Staffing
Supersedes:POC. 1000.100
Author
Chief Nursing Officer
Creation Date: 10/09
Next Review Date 9/2016 Revision History 10/09; 5/2010; 7/2010; 10/2010; 11/2011; 3/2012 9/2013; 10/2013; 9/24/14 Page 1 of 9 PURPOSE:
The purpose of this policy is to ensure compliance with all relevant statutes and regulations regarding staffing in a licensed facility. This would include the creation and maintenance of a comprehensive staffing plan that includes the circumstances under which a licensed nurse or Mental Health Techs may refuse or object to a work assignment, the coordination and facilitation of a staffing committee and a systematic plan to schedule and administer work assignments.
POLICY:
It is the policy of Willow Springs Center to comply with all regulations and statutes in regard to establishing a comprehensive staffing plan that includes a plan to allow a licensed nurse or certified nursing assistant to refuse a work assignment. It is also the policy of the Willow Springs Center to recognize the importance of adequate staffing and to that end facilitate a staffing committee and an orderly plan to administer work assignments and scheduling.
PROCEDURE
I. Comprehensive Staffing Plan
A. The Chief Nursing Officer or designee will be responsible for assessing and evaluating the nursing staffing needs of each unit. The Chief Nursing Officer or designee will receive recommendation, input and feedback on Staffing Plans from the Staffing committee
B. Number, Skill Mix and Classification of Licensed Nurses Required by Each Unit
i. A minimum of one currently Nevada Licensed Registered Nurse will be assigned to each unit on all shifts. A Charge Nurse is designated on each unit.
ii. A medication nurse which may be either a currently Nevada Licensed Registered Nurse or Licensed Practical Nurse..
iii. Adequate supportive staff Mental Health Techs will be assigned to each unit as to assure the highest quality patient care and patient safety.
iv. Staffing may increase or decrease based on assessed acuity of the unit, and changes in census as assessed by the Chief Nursing Officer or designee.
2 i. All patients treated at Willow Springs Center are between 5 and 17 years of age and have a
primary diagnosis of a psychiatric disorder.
ii. Patients may also present with a co-occurring disorder.
iii. Willow Springs Center has three distinctive units, Adolescent 1, Adolescent 2 and a Pediatric Unit
D. Activities in Each Unit: The Chief Nursing Offer will assess additional workloads which may include but are not limited to:
i. Provision of care, oversight and education for medically compromised patients or those with unstable psychopathology
ii. Over sight of Q-15 minutes Patient Observation Rounds to assure patient safety iii. Oversight and direction of supportive staff
iv. Interdisciplinary collaboration
v. Oversight of Conducting patient body and belonging searches (Contraband) vi. Discharges and/or admissions on any shifts
vii. De-escalation of assaultive or hostile behaviors on any unit viii. Oversight of seclusion and/or restraints
ix. Medication management of psychotic patients x. Oversight of medically compromised patients xi. Special programs and/or interventions
xii. Prevention of elopement and management of unpredictable changes xiii. Oversight of patients at Risk for Suicide
xiv. Oversight of patients at risk for Sexual aggression and / or victimization xv. Oversight of patients for assault/homicide
xvi. Documentation of interactions and interventions
xvii. Respond to other situations identified high-risk behaviors as required within Nursing Practice
E. Size and Geography of Each Unit: Patients may be transferred between units and programs based on clinical assessment by physician and therapist.
UNIT # OF BEDS GENDER AGE RANGE Adolescent 1 40 Beds Latency Male/Female
DBT Unit: Male/Female
Latency-9-13 years
Other 14-17 years Adolescent 2 62 Beds Male/Female separated
into two halls
14-17 years
Pediatric Unit 14 Beds Male/Female 5-9 or 10 years F. Specialized Equipment and Technology for Each Unit: Basic Nursing equipment used as
appropriate:
i. Thermometers
3 iii. Pulseoximeter
iv. Nebulizers v. AED
vi. Oxygen Tanks
vii. Response to Codes and/or Drills
viii. Miscellaneous individual care items as ordered by physician G. Fluctuations in Size and Make-up of Unit
i. In the event the census on any one unit decreases to the point the Center may consolidate units to more efficiently utilize staff while continuing to provide the highest standard in patient care and safety, the Chief Nursing Officer or designee, in collaboration with the Center’s
Administration may decide to implement a plan to combine units.
ii. Patients may be housed on one unit while participating in specific programming in another unit.
H. Protocol for adequately staffing during an emergency, in circumstances when a significant number of patients are diverted from another facility and in the event a licensed nurse or MHT is absent or refuses work :
In the event of a large number of unexpected admissions (mass causalities, local disasters (such as floods, extreme weather conditions, earthquake), diversions from other hospitals or unexpected number of internal call outs for shift), Additional sources of staffing will be assessed from the following resources and manner.
1. Phone, text, or email all per diem staff and or staff that have been flexed, or are on PTO, part time and full time staff
2. Utilize mangers, directors, exempt staff to work on units
3. Call West Hills Hospital , or Northern Nevada Medical Center (UHS Hospitals),and Adult Mental Health Services (NNAMHS) , for staffing assistance
4. Non Nursing department staff will be called to help cover units , for non-licensed nursing positions
5. Clinical Services, in conjunction with physician will assess which patients may be safely send home on pass or discharged.
6. All PTO days during event may be cancelled
7. All staff are expected to be available for duty during community disasters
B. Scheduling and Work Assignments
A. Willow Springs Center provides 24 hour staffing and coverage on all units. Dayshift: 7am-3:30pm with a 30 minute break. Swing shift: 3pm-11:30pm with a 30 minute break. Night shift: 11pm-7:30am with a 30 minute break. In addition 12 hour RN shifts are utilized to provide overlap during known periods of high volume and acuity. 12 hour shifts include a 30 minute break with three paid 10 minute breaks.
B. When assigning employees work areas, scheduling workdays and/or shift assignments, the top priority is to evaluate each assignment in terms of the mission, goals and objectives.
C. These considerations shall include, but are not limited to the ability to accomplish the following: i. Providing the highest quality of patient care and patient safety including appropriate and
4 ii. Maintaining applicable health and safety requirements and comply with all required policies
and procedures
iii. Meeting the expectations of relevant licensing and training requirements iv. Responding efficiently and effectively to emergency needs.
D. Consideration of priorities will first require assessment of available employees’ competency levels, relative skill levels, certification level, and status in order to strategically fulfill priority (schedule) needs. Additional consideration will be given as to an employee’s ability to complete the physical characteristics of the position (as identified in the specific job description including ability to
actively engage in CPI and CPR) and gender (for specific assignments due to the need for minimum male and female staffing levels, gender may be considered to be a bonafide qualification).
E. Top priority considerations as stated above must be satisfied before the Nursing Department makes a scheduling decision on the basis of any priority. If the consideration of top priorities results in a decision (prior to a general announcement, etc.) that a particular employee is the only or best individual suited for the work area, workdays and/or shift in question, the nursing department may decide not to proceed with a posting process. Management will identify the factors considered in making a final decision and include those factors in a notification explaining the change in duty. F. When an administrative decision must be made to change an employee to another work area or
shift, or to change days off and there are no applicable requests for change of area, shift or days off are already submitted, the Chief Nursing Officer or designee shall first ask for volunteers. If there are no volunteers, the process will be consistent with the procedure for the scheduling process first considering the competencies, skills and other top priority considerations to meet the needs of the position.
G. When an open regular schedule occurs, it will be first posted internally for Per Diem for transfer of eligible employees. After an adequate time period and no eligible employees are interested in the position, per diem employees will considered to fill the vacancy. If no eligible employee is found among current staffing, Human Resources will then post the position for external applicants. Open positions will be posted by each time clock and emailed to the Willow Springs email group. It is each employee’s responsibility to periodically check for postings of positions in these areas. H. Per Diem employees will provide their availability to the Staffing Coordinator or designee in the
nursing department. Per Diem employees must be available to work a minimum of 5 shifts a month (including weekends). Per Diem employees must work 1 summer and 1 winter holiday annually. Per Diem employees will be held accountable for all hospital policies and timely completion of competencies.
C. Nursing Services Staffing Committee
A. In recognition of providing the highest possible quality and safety of patient care, as well as the importance of maintaining the mutually shared goal of patient care with hospital administration and nursing staff, a nursing staffing committee will be maintained.
B. The staffing committee must consist of:
i. Not less than one-half of the total members from the licensed nursing staff and a minimum of 1nMental Health Tech who are providing direct patient care hospital
5 ii. Adopt and disseminate a policy to license nursing staff and MHT’s concerning a staffing plan,
refusal and objection of work assignment.
iii. Not less than one-half of the total members appointed by the administration of the hospital. C. The staffing committee of a hospital shall meet at least quarterly.
D. Willow Springs Center shall prepare a written report concerning the establishment of the staffing committee, the activities, progress and efficacy of the staffing committee.
E. The hospital shall submit the report on or before December 31 of each:
i. Even-numbered year to the Director of the Legislative Counsel Bureau for transmission to the next regular session of the Legislature.
ii. Odd-numbered year to the Legislative Committee on Health Care.
F. The Center’s comprehensive staffing plan will be reviewed and revised as needed but at least every two (2) years.
G. The comprehensive staffing plan will include:
i. A detailed written plan setting forth the number, skill mix and classification of licensed nurses required in each unit in the health care facility, which must take into account the experience of the clinical and nonclinical support staff with whom the nurses collaborate, supervise or otherwise delegate assignments;
ii. A description of the types of patients who are treated in each unit, including, without limitation, the type of care required by the patients;
iii. A description of the activities in each unit, including, without limitation, discharges, transfers and admissions;
iv. A description of the size and geography of each unit;
v. A description of any specialized equipment and technology available for each unit; and vi. Any foreseeable changes in the size or function of each unit.
H. The nursing staffing committee will consider the following at the quarterly meetings: i. Method of improving patient care as it relates to staffing
ii. Assignments and workloads iii. Patient acuity and staffing factors
iv. The employment of Per Diem employees
v. Orientation requirements and proficiency training vi. Recruitment and retention
vii. FTE management and reduction of overtime viii. Review of proposed changes to the staffing plan
ix. Review of submitted RWAs and ADOs with recommendations to Chief Nursing Officer. I. Staffing committee decisions will be made through a two thirds majority vote
D. Refusing a Work Assignment
A. If a licensed nurse and or MHT wishes to refuse a work assignment, they will report to the Chief Nursing Officer or designee, in writing, the reason(s) for objecting to a work assignment within 24 hours of notification of the scheduled assignment. If the notification of scheduled assignment is within 24 hours or less of the shift start, the licensed nurse must notify the Chief Nursing Officer or designee no later than 4 hours before the beginning of the shift and before clocking in on the shift. (Attachment A)
6 B. The Chief Nursing Officer or designee will review the written refusal form, assess options and then
seek to remedy the situation.
i. The specific reason for refusal must be given on the refusal form.
ii. The specific reason a licensed nurse or Mental Health Tech may refuse a work assignment, as set forth in in 449.205 includes that he or she does not possess the knowledge, skill or
experience to comply with an assignment to provide nursing services to a patient; and is refusing to provide to a patient nursing services for which, as verified by documentation in the personnel file (of the registered nurse, licensed practical nurse, Mental Health Tech)
concerning his or her competence to provide various nursing services, demonstrates he or she does not possess the knowledge, skill or experience to comply with the assignment to provide nursing services to the patient, unless the refusal constitutes unprofessional conduct as set forth in chapter 632 of NRS or any regulations adopted pursuant thereto.
iii. The Chief Nursing Officer or designee will review the refusal reasons and decide if it meets the required criteria.
iv. The Chief Nursing Officer or designee will review the written request and attempt to resolve the situation utilizing available resources deemed appropriate.
v. If the Chief Nursing Officer or designee denies the refusal, the nurse must accept the assignment,
vi. The Chief Nursing officer may call an impromptu meeting of the staffing committee of an RN’s or MHT’s peers to review an Assignment Despite Objection (ADO) in order to determine possible resolution.
vii. If the licensed nurse or MHT is dissatisfied with the decision of the Chief Nursing Officer or designee, the licensed nurse or MHT should initiate an Assignment Despite Objection (ADO) form within 24 hours, but still accept the work assignment, despite the objection. (See
Attachment B: Assignment Despite Objection form). The nurse may also choose to utilize the Dispute Resolution Process.
viii. Willow Springs Center should respond to the objection as soon as practicable, but no later than 14 calendar days after receiving the objection.
ix. If the supervisor fails to approve the request without proposing a remedy, or a remedy is proposed but inadequate or untimely, the licensed nurse or MHT may choose to file a formal complaint with the Health Division if the licensed nurse or MHT feels, in good faith, the refusal meets the condition of the written policy for refusal of assignment.
x. The Assignment Despite Objection and resulting response will be submitted to the Staffing Committee and reviewed for trends by reviewing number of objections to a work assignment filed by a licensed nurse or MHT.
7 xi. The Staffing Committee will provide a response to the licensed nurse or MHT regarding an
explanation of how Willow Springs Center addressed this.
C. Duties of Willow Springs Center
i. Maintain records for at least two years of each request to be relieved of a work assignment, and refusals of a work assignment made by a licensed nurse
ii. Willow Springs Center shall provide to the staffing committee the number of requests to be relieved from work, refusals of a work assignment and objections to a work assignment. iii. Willow Springs Center shall provide to the staffing committee an explanation of how the
requests, refusal and objections were addressed
iv. In accordance with Willow Springs Center policy, harassment of employees, management, administration or non-staff is prohibited and will not be tolerated. It is the hospital’s policy to take immediate investigatory action and quickly apply sanctions when appropriate.
v. Ensure compliance with the written policy
D. The nurse or MHT is responsible to seek and obtain the training and information required to do their jobs in a timely manner. This includes completion of Healthstream assigned training. E. Willow Springs Center shall not retaliate or discriminate unfairly against employees and certain
other person’s as defined in NRS 449.205
F. The licensed nurse or MHT cannot just refuse the assignment and leave the premises without pursuing a resolution. A compliant for abandonment may be filed with the Board of Nursing if this occurs. REFERENCES: NRS 449.241 through 449.2421 inclusive NRS 449.205 NRS 632 SB 362
Level of Evidence: Level I Level II Level III X Level IV Level V
Chief Nursing Officer or designee Staffing Committee Dispute Resolution Process Timeline 7 to 10 Days 30 Days
Action Investigate Examine trends Respond to
Nurse
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Refusal of Work Assignment
I,
______________________________ ___________ am a licensed nurse
at Willow Springs Center and am submitting my refusal of Work Assignment for consideration. My reason for refusing this is assignment is: (Brief statement of the issue)
Date of Scheduled Assignment: _________________________________________________________ Time of Scheduled Assignment: _________________________________________________________ Type of Scheduled Assignment: _________________________________________________________ Date Notified of Scheduled Assignment:___________________________________________________ How Notified of Scheduled Assignment: __________________________________________________ ____________________________________________________________________________________ __________________________________________________________ _____________________
Printed Name of Licensed Nurse Employee Number
__________________________________________________________ _____________________
Signature of Licensed Nurse Date
__________________________________________________________ _____________________
Received by: (Chief Nursing Officer or Designee) Date
Response:
__________________________________________________________ _____________________
Printed Name of Licensed Nurse Employee Number
__________________________________________________________ _____________________
Signature of Licensed Nurse Date
__________________________________________________________ _____________________
Received by: (Chief Nursing Officer or Designee) Date
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Assignment Despite Objection Form
I, _________________________________________ am a licensed nurse at Willow Springs Center and am submitting my Assignment Despite Ojection for consideration.
My Objections to this assignment are: (Brief statement of the issue)
Date of Scheduled Assignment: _________________________________________________________ Time of Scheduled Assignment: _________________________________________________________ Type of Scheduled Assignment: _________________________________________________________ Who was notified regarding my Refusal of Assignment: ______________________________________ Date of Notification Regarding Scheduled Assignment: ______________________________________ __________________________________________________________ _____________________ Printed Name of Licensed Nurse Employee Number __________________________________________________________ _____________________ Signature of Licensed Nurse Date
__________________________________________________________ _____________________ Received by: (Chief Nursing Officer or Designee) Date
Response:
__________________________________________________________ _____________________ Responded by: (Chief Nursing Officer or Designee) Date
Date sent to Staffing Committee: _______________________________________________________ Response:
__________________________________________________________ _____________________ Responded by Chair of Staffing Committee Date
__________________________________________________________ _____________________ Reviewed by Licensed Nurse Date
__________________________________________________________ _____________________ Reviewed by (Chief Nursing Officer or Designee) Date
