Critically Appraised Topics (Evidence Synthesis)

Population

The population of interest is nursing students attending a baccalaureate nursing program. To create new and sustainable approaches for development of the perioperative nursing workforce, perioperative nursing leaders at a hospital collaborated with administrators and faculty at a school of nursing to create an innovative learning model that reintroduces perioperative experiences to students in a nursing baccalaureate program.

Intervention

As the perioperative staff nurses and the associate dean of academic programs began the work of developing a perioperative experience, to create new and sustainable approaches for development of the perioperative

nursing workforce, perioperative nursing leaders at a hospital collaborated with

administrators and faculty at a school of nursing to create an innovative learning model that reintroduces perioperative experiences to students in a nursing baccalaureate program. The associate dean, the director, and the nurse manager from perioperative nursing began developing a nursing student extern course program with the purpose of building a pipeline for perioperative nurses through collaboration and teamwork with the School of Nursing. The associate dean for academic programs at the School of Nursing and two nurse leaders in perioperative services collaborated to design and gain university approval for offering a clinical practicum course they undertook a review of the existing literature. opportunity to continually recruit new colleagues into the practice of perioperative nursing that was successful.

Outcome

Key components of the initial approaches included an externship for nursing students and a revised internship for experienced nurses who wished to

work in perioperative nursing. Project leaders then expanded the nursing student learning opportunity by adding two additional elective perioperative courses to the curriculum. Formation of perioperative clinical placement sites within the senior level adult acute care course was an additional positive outcome of these initial

initiatives. These initiatives resulted in decreased use of agency nurses at the clinical site where the externships take place and increased numbers of younger nurses working in the perioperative areas where they externed, with high levels of satisfaction reported by nurses involved in the program. Through this innovative

collaboration, the perioperative nurse shortage at the hospital has abated, and the

opportunity to continually recruit new colleagues into the practice of perioperative nursing has been established.

Source #2 U.S. Office of Personnel Management. (2022). Workforce Planning Guide. https://www.opm.gov/policy-data-oversight/human-capital-framework/reference-materials/talent-management/workforce-planning-guide.pdf

Background Information/Expert Opinion

Population

The Workforce Planning (WFP) Guide is a resource for agency leaders, managers, supervisors, HR Specialists, and employees who are involved in analyzing the workforce, identifying gaps, as well as planning and implementing workforce action planning efforts.

Intervention

OPM’s Workforce Planning Model is a continuous process and is comprised of five different elements that present a roadmap for success. Each element builds upon the previous one until you have laid out a strategy and action plan(s) to meet your workforce planning objectives. This guide will walk you through the implementation of the model.

Outcome

Workforce data analysis is the foundation of a good workforce plan. It involves understanding the current workforce and how it is projected to change over time due to accessions, attrition, and trends. It also involves understanding and measuring talent demands, workforce gaps and risks, and talent supply.

The purpose of the checklists provided is to assist an agency with tracking workforce planning activities. These lists are not intended to be all-inclusive, and agencies should consider other activities appropriate to their respective workforce planning processes. Checklists are an excellent tool to reduce errors and ensure consistent quality, especially for repetitive tasks. Below are five reasons to use this powerful tool:

• Productivity: Checklists are proven to reduce errors, especially to complete repetitive tasks more efficiently.

• Delegation: Checklists can inspire confidence in delegating by breaking down major tasks into manageable and specific tasks, in turn, empowering team members.

• Organization: Checklists ensure that no critical steps in the process are inadvertently skipped.

• Creativity: Checklists reduce stress, which frees up mental energy for creativity and innovation.

• Motivation: Positive results from using Checklists creates a motivating feedback loop for ongoing timely completion of tasks

Source #3 Pearson, A., Pallas, L., Thomson, D., Doucette, E., Tucker, D., Wiechula, R., Long, L., Porritt, K., & Jordan, Z. (2006). Systematic review of evidence on the impact of nursing workload and staffing on establishing healthy work environments. JBI Library of Systematic Reviews, 4(8), 1–69. https://doi.org/10.11124/jbisrir-2006-356

Systematic Review

Population

This systematic review set out to examine the impact, if any, of nursing workload and staffing on creating and maintaining healthy work environments. 

Intervention

The review sought to determine the impact of:

·         Patient characteristics, nurse characteristics, system characteristics and system processes on workload, scheduling and concepts of productivity and utilization.

·         Workload, scheduling and concepts of productivity and utilization on the quality of outcomes for clients, nurses, and the system/organization.

The search strategy sought to find both published and unpublished studies and papers written in the English language. A three-step search strategy approach was used. An initial limited search of MEDLINE and CINAHL databases was undertaken to identify optimal search terms followed by an analysis of the text words contained in the title and abstract, and of the index terms used to describe the article. A second extensive search using all identified keywords and index terms was then undertaken. The third step consisted of a search of the reference lists of all identified reports and articles for additional studies.

Outcome

Healthcare organizations seeking to establish and maintain a healthy work environment need to consider the role of nursing workload and nurse staffing in the work environment. Based on the evidence reviewed it is recommended that:

·         Patients' severity of illness is taken into account when considering staffing and workload issues.

·         The relationship between the hours and proportion of RNs and patient outcomes (falls, pneumonia, pressure ulcers, length of stay and postoperative infection rates) should be noted when determining workload and scheduling of nurses.

·         When establishing workload and staffing, organizations should note that there is some limited evidence to suggest that a relationship exists between higher-intensity staffing and lower incidences of failure-to-rescue and mortality; decreased job satisfaction, staff turnover hierarchical approaches to decision-making.

·         The reliance on agency nurses is decreased to improve nurses' perceptions of standards of care.

·         Nurses are enabled to determine their shift allocations to increase their professional commitment.