23 Sep

It is inevitable now more than ever. I challenge you to think hard about this. I am sure the reality will surprise you. We are more complacent to this statement than ever. Unfortunately, it prevents us from conquering the problems that impact our beloved system. Before I address the statement, take a second and think about why you are reading this article. Something attracted your attention to read or approach the problem differently. I commend you for moving past the typical complaint and realization and towards reality. What is the statement that has prevented an entire industry from growing? What is the statement that has brilliant people worried, scared, and ready to stop doing what they love? It won't come as a shock to you, but it will come as a shock to how these three words prevent professional, brilliant minds from being who they want to be as they influence our most precious industry.

"It's our staffing..."

Take a minute and think about how many times this statement appears in your day. These three little words stop us from being great. These three little words show up as if they are in charge of how we see our future. These three words take away our spirit, convictions, hopes, and dreams. Please stand up and take notice of these words. Pay attention to where, when, and how these words show up. Understand the context of how this statement is used, and you will start gaining the knowledge to fix the problem. 
The title of this article is "Are we really trying to fix our staffing?" You may immediately say in annoyance, "Of course we are. Are you crazy?!" I am not here to cast criticisms or judge that I understand all the specific situations that impact millions of healthcare leaders and workers daily. We should pause and begin to understand these words' weight on us, our actions, our convictions, goals, and abilities. The problem of having enough has and will always live boldly at the surface of our existence as a profession. We must embrace this as a constant variable without becoming paralyzed to be and do great things. 

Why do you want to fix your staffing?
What would your world look like if staffing was no longer a deciding factor that consumed most of your day? Do you feel as necessary now that staffing is no longer an issue as you did before? What will you focus on now that your worry shifted away from staffing your units, hospital, or healthcare system? Where do you want to go now that you are free of the day-to-day concern about having enough staff?
We must be positioned to ask these questions to understand why we emphasize the problem around staffing. This bold statement is not designed to strive for accusation, blame, or mistrust. Awareness begins the healing and rebuilding process. We must be aware that we hide under the words "It's our staffing..." 

How can you move past using the words "It's our staffing..." as a new habit? What else can you say to handle a problem? What are you doing to avoid using the phrases that stop all understanding because we don't have enough staff? How can you influence staff to move past the joint statement that they don't have enough staff?

To fix staffing, we must ask the questions that allow us to overcome this enormous obstacle and dissect the root causes. It begins with a curious mind that helps us gather the information needed to understand the problem. "It's our staffing" is the everyday driver now to shed reasoning for why moving forward as a profession is no longer possible. 
It is time to ask, "Do we really want to fix staffing?"

It is scary to ask these deep questions due to the answers they may contain. Are you prepared to take action based on the responses these questions generate? When I sought to understand how influential pay was in the driving decision to quit a job, I had to prepare myself for the answers this curiosity showed. Our biased brains point us in the direction of where we want and think the reality of the situation is. Our protective mechanisms shield us from truly understanding the problem. Once I unlocked data from nurses nationwide, I had to ask more questions. Thinking pay was the critical driver made it more accessible for a leader to cast a lack of ownership as it applies to the staffing crisis.

 Here is what I mean:

"Nurses are leaving because of the pay, not because of anything I am doing. I can't fix this problem and must be held to the reality that until the administration pays more, I will never fix this problem."
"I can't improve engagement because our staffing levels are so short every day that people are exhausted and can't do anything else."

We can begin healing once we understand that pay is not the driver behind when a nurse quits their job. I know this is hard to hear because now we must be willing and able to dig deeper to uncover why our sacred staff leave or complain about their realities. Please be cautious as a leader and professional. Curiosity to understand does not mean having the answers or committing to solving problems in real time. Curiosity means you are taking the time to dive past the superficial noise to understand what matters the most in your unique scenarios, cultures, and environments.
What else can you start saying when tasked with a challenge? How can you lead that avoid the mindset that we can't because "It's our staffing"? 

Where can you turn for strength and hope when surrounded by doubt?  
How can you help your staff think in abundance and not in scarcity? How can you motivate them to believe in ways to attract more people to their team?
In my dissertation, I discuss the evolution of the question, "How many nurses do we need?" Here is a small passage highlighting how the staffing problem is magnified based on our quest for perfection. This is a good thing; however, we tend to focus on our inability to achieve the perfect scenario versus analyzing how far we have come.   

Throughout the history of nursing, the golden question health care and nursing leaders try to answer is “how many nurses are needed?” The goal throughout history is to balance the demands of the patients requiring care with the correct supply of nurses who can provide the care. In the early 1900s, a study published in the American Journal of Nursing identified that student nurses completed 57% of the hospital work and graduate nurses completed 36% (Lewinski-Corwin, 1922; Saville et al., 2019). Through time, nursing schools have shifted away from diploma hospital programs to local colleges and universities degree programs. Supply in terms of student nurse ward and unit coverage became obsolete. In the 1970’s, the Professional Judgement method relied on senior nurse judgment in determining the number of nurses to employ per shift without formal calculations (Griffiths et al., 2020; Saville et al., 2019). The method shifted in the early 2000s as leaders attempted to staff by ratio. Nurse to patient methods rely on a nurse for a specific number of patients occupied beds per hospital ward or unit. Nurse-to-patient ratio methods assumes that all patients on the nursing units have a fixed or average demand for care criteria that is met with a set number of nurses (Saville et al., 2019).  Nurse staffing levels between units serve as benchmarks for planning. The initial levels used for comparison do not follow a formal assessment process for determining patient care requirements (Griffiths et al., 2020). In the early 2000-2010s, patient classification systems grouped patient care needs to nurse staffing levels (Saville et al., 2019). The shift from guessing nursing levels to systems for assessing patient care needs, increased the nurse shortage gap. Nurse staffing approaches vary across the U.S. Researchers continue to study the impact staffing approaches have on patient outcomes.

We will never cease to want better for our patients and organizations. The quest to be the best drives us. My warning is that when we don't meet this expectation, please don't live in a state of paralysis; instead, become more curious about how to meet these goals. Do not let the dreams of healthcare drive us to a point where we stop trying and live behind the words, "It's our staffing..."

We all have the power of understanding and influencing. Do not let the assumptions of why a nurse leaves you or that we can't meet all the goals determined by governments drive you. Increase your awareness around the phrases that stop you and ask the questions that can move you to action and understanding. I assure you that in 20 years, the same statements about staffing will live.
"How do you want to be remembered as a healthcare leader and professional?"

"What questions can you start asking that will move your teams past the daily statement "It's our staffing."?

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