Remembering the Simple Truths

John Nelson — nurse researcher, president of Healthcare Environments and CHCM adjunct faculty —  frequently shares data with us about the outcomes of our work with our clients. One hospital implementing Relationship-Based Care found that a richer skill mix decreased the dollars per Adjusted Patient Day, decreased ventilator-associated pneumonia and decreased patient falls with injury. John would hasten to add that this is a statistical correlation that does not indicate causality, but only a relationship between variables. I think the more we learn how to interpret and correctly discuss this kind of statistic, the better able we are to explain the importance of adequate staffing.

After the “reengineering” of nursing in the nineties (which had nothing to do with nursing, and everything to do with saving money), we lost sight of simple truths and replaced our authentic experience with “grids” which supposedly save money but which in reality wreak havoc with common sense.

Some truths we need to reclaim are:

• Skill mix should be related to acuity not to a financial goal.
• Changes in patient census should drive changes in total FTEs.
• Continuity of assignment increases productivity (having the same patients two days in a row increase productivity by approximately 25%).
• Use of support staff improves when delegation is based on trust. Working together builds trust, so pairing and partnering leads to the best use of NAs and LPNs.
• Staff should only be pulled off their home unit when not to do so will have DIRE consequences. It should never be done just “balance the numbers”.
• Morale of the staff determines quality of care. Morale is a function of how staff members treat each other.

Introducing Relationship-based Care is an excellent way to re-introduce these simple truths and return our profession to “common sense management”.