Nurses Short Staffed & Shift Loads – Skewed or Unbalanced Assessment!

Nurses Short Staffed & Shift Loads – Skewed or Unbalanced Assessment!

A number of discussions about how nurses can develop a skewed or unbalanced assessment of the workload resulted from a complaint about nurses spending a lot of time at the nurses’ station chatting or relaxing while patients required care.  The basic issue was that nurses felt they were entitled to down tools because prior to this break they had worked very hard.

There has been some research on shift loads.  Unrelenting claims of short staffing often precipitated workload studies.  On the basis of a busy and demanding period within a shift some nurses judged the whole shift as a horror and reported their shift as being unrelenting at handover.  Observations of the demands of the whole shift did not support the claim.  Some nurses did have very long and pressured periods of heavy workload during a shift, yet for others pace was steady and fairly constant.  What was interesting was how the whole shift team claimed to be frantic.

Another interesting finding was in spite of bursts of high demand and periods of calm, if jobs were left to the next shift the previous shift claimed demands on them had been so unrelenting they had never had a chance to complete their duties.  It was true that the calm periods may have been insufficient to allow for all the duties that had backed up to be attended but there was a definite pattern of justification (too busy) and types of duties (personal care) being handed over.

On one 5 day shift period in a busy neurological ward due to sickness they were one staff short each day for the 5 days.  The senior nurse each morning shift directed staff to “skip showers and bed changes and focus on critical duties, medications and observations”.  It will not come as a surprise that by day 3 the number of complaints from patients and families about lack of hygiene care were enormous.  Patients were physically distressed and in spite of the provision of a replacement staff member from day 2 working 4 hours to make up the shortfall (starting one hour after shift commencement) the team continued to consider themselves so short staffed they persisted in limiting hygiene tasks to “emergencies”.   There was a bit of an uproar and investigation over the work allocations.

This little research project turned into a fairly torrid affair.  The day shift staff had genuinely felt overwhelmed by missing one nurse for one hour at shift commencement and three hours in the afternoon.  They thought the strategy chosen was justified and it was a shock for them to realise how many days had passed without bathing and hygiene cares.  Why? Because each day there were different combinations of staff and each day they assumed that the afternoon shift would have picked up the slack.

Another consequence arising that week was that the afternoon manager had submitted a report complaining that day shift handover had constantly required pm staff to undertake missed duties and that in turn was causing frustration and animosity.  Interestingly some of the afternoon staff were previously early shift! 

Is there a habit of just focusing on the current shift workload and attributing short periods of frantic as being representative of a whole shift?  Years later when I asked why a shift team was gathered around the nurses’ station and obviously “resting” they reported how busy they had been and that this was a moment to gather thoughts and communicate information.  The magazines lying around did raise doubts.   This intrigued me enough to actually undertake a project that looked at this behaviour in 16 different hospitals in NSW and Qld.  Same responses to same behaviours.

I have recently read an American article about shift to shift animosity that occurs when tasks are left to the next team.  Each shift that handed over duties were confident that the next shift had it easier so they could take up the jobs.  There has always been a conviction that there are easier shifts than others and while crisis shifts are recognised and duties taken up by the next team, habitual demands are a cause of animosity and problems among staff.

A while ago I wrote about the feelings of patients and families being very negative about nurses gathered at the central station “socialising” and that thread continues in this blog.  Managers will also push for more work from fewer staff and I suspect nurses have developed techniques to block this trend.  Always claiming to be busy and pushed to the wall is a habit.  Believing our own myths is dangerous if our behaviour doesn’t conform however.  Has anyone ever worked out what is a reasonable day’s work for a nurse?  Do we truly know what is a fair demand and how can we insist on it when situations constantly arise that push us to the wall? 

There are enormous numbers of studies and many attempts to use productivity measures to calculate time and work load needs for nurse’s shifts.  The dependency and staffing allocation measures have been used for years.  Individuals know if they are working to satisfy unreasonable demands, the trouble is managers often don’t believe them because they see the social gatherings and they hear the complaints about duty handovers from later shifts.  No one can get everything done every day, no day is guaranteed to follow predicted pathways and permit a steady pace That is actually why most of us love the job, the variety of it.  I do think we need to be mindful of habits of thought or patterns that might not be accurately reflecting workloads however.

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