Strategies at work

How can a large health care facility best recruit and retain qualified staff? Giving nurses some control over their work schedule may be one way. At Mayo Clinic in Rochester, Minn., the department of nursing employs approximately 3,500 caregivers, and staffs 60 patient care units in 2 hospital locations. Mayo Clinic nurses are able to choose from a variety of schedules customized to each nursing area based on patient-care needs. Choices include start times, shift lengths, and days of the week. These scheduling options have become an essential component of job satisfaction. Employee participation in developing a unit’s work schedule varies from shift trades on a preliminary schedule to sign up for shifts on a blank or minimally developed schedule. The support of non-nursing centralized scheduling staff is available as a resource and its involvement in schedule development varies across units. Pinpointing the process Our nurse leadership acknowledged the importance of providing nurses with control over their work schedule, and wanted to ensure that schedules matched workload. Managers also acknowledged that schedule development would take less time if the nurses had tools to help them develop their self-scheduling models. To that end, we created a 16-member Employee Self-Scheduling work group, selecting members based on experience with self-scheduling and the department’s commitment to shared governance. The team consisted of directors of nursing, nurse managers, staff RNs, scheduling personnel, and a nurse educator. Through the work-group process, we: ♦ reviewed the literature ♦ defined self-scheduling, collaborative scheduling, and central scheduling ♦ revised the scheduling procedural guideline to include definitions of the scheduling model and a principle statement related to self-scheduling ♦ developed a resource packet for units interested in exploring various scheduling model options ♦ identified outcomes related to scheduling models. Definitions and revisions Based on literature reviews, current practices on patient care units, and significant discussion, the work group agreed on the following definitions: ♦Self-scheduling is when staff choose the day and shift they’ll work following criteria for appropriate unit staffing. ♦Collaborative scheduling is when the central scheduling staff develops the schedule and unit staff representatives adjust the schedule to meet patient care and staff needs. ♦Central scheduling is when the central scheduling staff develops the schedule and the nurse manager/designee reviews the schedule. Next, the work group revised the nursing procedural guideline on scheduling to include self-scheduling. It added the following policy statement: “Staff involvement in the scheduling process is facilitated through shared decision making and collaboration with management and resource staff.” The work group also added policy statements to the schedules procedural guideline that reflect the department’s vision and values, and identify parameters for further consideration when developing schedules. Tools to implement change The work group developed resource materials to give units the necessary tools to implement self-scheduling, including: ♦ an introductory statement about the resource materials and how to utilize the items in the packet ♦ a revised procedural guideline on schedules ♦ guidelines for defining the steps of schedule development ♦ instructions for comparing the completed steps and responsibilities grid to the staffing model that currently exists ♦ a list of issues that necessitate unit-specific guidelines, developed through shared governance. Issues include sign-up order, a process for granting vacation time, and number of requests per schedule per person. ♦ a set of three sample guidelines for units to use as a model when establishing their own ♦ a resource list of experts ♦ outcome measurement tools, which include a staff satisfaction survey and use of the steps and responsibilities for self-schedule development to determine resource utilization. In addition, the Employee Self-Scheduling work group made the following recommendations, which nursing leadership supported: ♦ Encourage the use of technology, namely software for schedule development. ♦ Track hours spent in schedule development by job category to ensure that the right people do the right job and that nurses aren’t spending long periods of time in schedule development. ♦ Minimize the number of staff hours spent by nurses in schedule development. ♦ Hold quarterly meetings with the nursing director, central scheduling staff, and the nurse manager to address the scheduling process and resources use.