Overtime, Mandating, and Working Short-Staffed

Lately, we've been hearing from many healthcare facilities that they simply do not have enough staff. They're referring to staff that serve to meet patient or resident case-mix requirements; staff skills such as RN's, LPN's, CNA's, MA's, Med-Tech's-front-line workers. As a result, front-line workers are feeling the pressure, living day-to-day with ongoing fatigue and a growing frustration of management, leadership, and ownership (as it might apply).

Short-staffing as a result of having too many vacant (unfilled) positions or approved vacations has its own set of challenges. Day-to-day challenges occur from call-in's or work status changes like work related injuries, or any other leave of absences. Sadly, we have found that most managers (executive leaders and owners too) take what we call the path of least resistance-they mandate which often causes overtime (this of course, depends on a person's prevailing wage and hour rule); and sometimes managers bring in (hire) supplemental staff.

Short-staffing compromises safety and quality not only the patient or resident, but the worker as well. Quality of care, safety and continuity of care are paramount! So to is the safety and well-being of workers (nursing staff) who so willingly give of their hearts, time, and talent.

Like any other management tool, mandating should be used sparingly. Mandating and overtime, in our experience having done staffing and bringing forth better practices, should (and can) be consistently minimal. Mandating and overtime (two separate issues, but intertwined) should (and can) occur on occasion or rarely. Mandating should only be used as a very last resort (or if it makes sense, given the circumstances or situation-we'll not expand on this here). When the staff being mandate speak out against such practice to fix short-staffing, the comments we often hear from managers are, "That's the way health care is, deal with it!" or, "I had to work like that when I was a staff nurse." Mandating as a practice can only sustain the willingness of an employee for a while...it will only buy some time before employees seek to work elsewhere. Mandating leads to turnover, another huge issue and challenge in healthcare.

Sustainable resolves don't happen by chance or with a one-item quick-fix. Most sustainable resolves require creative and innovative approaches, some of which are very counterintuitive. Sometimes worthwhile efforts to bring about sustainable resolves involve less desired utilization practices on the front-end (used primarily as a bridge) before things get better.

Until managers (executive leaders and owners too) listen and keenly observe workers behaviors and collaborative (or diminishing) spirit of good-will, Espirt de Corp and comradery, (a communications thing), turnover and short-staffing will prevail.

Until managers, (executive leaders and owners too) look for viable and sustainable resolves or are equipped to manage more proactively and have the ability to make more informed decisions that effect desired outcomes, turnover and short-staffing will prevail.

Mandating causes a spiral-down or slow-fade in the healthiness of an organization and it's people.

Think it through...there really are better and sustainable resolves to minimize (and very possibly near eliminate) overtime, mandating, or having to ever work short-staff.

"If you take care of your people, your people will take care of your organization."

~ G. Ken Kremsreiter