Registered Nurses' Association of Ontario

Organizational Level Recommendations

Organizational Level

1.Organizations plan, implement, and evaluate staffing and workload practices at the three levels of decision-making – strategic, logistical, and tactical – that result in staffing that facilitates the delivery of safe, competent, culturally sensitive and ethical care.

Decisions about staffing to facilitate safe and quality care incorporate the following principles:

1.1 Strategic nursing staffing processes support the delivery of safe, competent, culturally sensitive and ethical care by:

  • Ensuring that the budget is aligned with the required staffing levels to meet patient/client needs and accommodate replacement, orientation and professional development.
  • Maximizing continuity of care and continuity of care givers.
  • Providing delivery methods to meet fluctuating patient/client and staff requirements.
  • Responding to staff work life considerations and work preferences.
  • Being fair and equitable.
  • Ensuring a full-time/part-time ratio of 70% / 30% to enable continuity of care and to ensure patient/client safety, a quality work environment and stability in the workplace.
  • Ensuring that nurse staffing, inclusive of staff mix, is planned on a unit/program basis and reflects individual and collective patient/client, nurse and system characteristics.
  • Ensuring that the category of nurse used reflects the best evidence available, recognizing the strong association between category of nurse and health outcomes for patients/clients.
  • Ensuring that nursing utilization rates are kept at a level necessary to achieve a balance between patient/client needs, the nursing effort, the experience, educational preparation and scope of practice of nursing staff, and the organizational demands. 
  • Ensuring that education and opportunities for reflection are provided that foster a climate of diversity and inclusively as it relates to the staffing objective

1.2  Logistical nursing staffing processes are conducted by unit/operational nurse leader(s) who have the requisite knowledge, professional judgment, skills and authority, in collaboration with nursing staff, at the point of care by ensuring that:

  • Nurse leaders can make decisions about the impact of changes to the patient/client care delivery systems on nursing staffing and workload.
  • Decision-making responsibilities encompass the required financial and human resources and appropriate utilization of nursing personnel.
  • A process is in place that results in a schedule that reflects an optimal trade-off between nurses’ preferences and the required coverage to meet patient/client care needs, while recognizing contractual obligations and human resources policies

1.3 Tactical nursing staffing processes result in balancing the required and actual nursing staff on each nursing unit or team at each shift or time-frame of care and are carried out by nurses at point of care who have the requisite knowledge and skills.

Tactical staffing decision-making includes:

  • adjusting staff supply (using contingency staff);
  • adjusting staff required (transferring patient/client or canceling scheduled admissions, scheduled programs or nurse visits); or
  • adjusting both staff supply and staffing required.

Tactical staff decision-making is facilitated by:

  • mechanisms in place to adjust to changes in patient/client acuity and staff replacement needs such as an internal resource team and pre-scheduling of replacement staff; and
  • nurses in all roles empowered to make appropriate staffing decisions that result in safe, competent, ethical care
2.0 The board, administrative leadership and human resources planning department work collaboratively to ensure that processes, infrastructure and staff are in place to provide adequate nurse staffing to meet patients’/clients’ needs

2.1 The senior management team includes a senior nurse executive who is involved in all phases of the organizations’ strategic planning, policy, evaluation and reporting processes.

2.2 Nursing fiscal planning provides for effective base staffing, and replacement of staff, and has the flexibility to accommodate changes in patient/client acuity affecting nursing intensity
2.3 Nursing budgets include financial resources for professional development, education, orientation, mentoring and other support systems needed to augment the skills and competencies in the face of changing technologies and influx of new staff
3. Organizations engage nurses in all roles, in all phases of the strategic planning process, including development, implementation and evaluation.
3.1 Strategic plans reflecting planned change are aimed at achieving and maintaining a healthy work environment through appropriate staffing and workload management practices throughout planned change processes

3.2 Organizations make every effort to mitigate the impact of major disasters and other unplanned change on staffing and workload by having disaster and crisis plans in place (i.e. plans for pandemic; influenza; natural disasters; significant staffing or governing/leadership change on all levels of governments, health care providers, and the system by aiming to maintain stable structures and processes, adequate supports (i.e. sufficient staff, information and involvement in decision-making), and open communication

4. Strategic planning and policy making that affects nursing workload and nurse staffing strategies are informed by measures that capture the impact of inputs, throughputs and outputs, as reflected in the Patient Care Delivery Systems Model (PCDSM).
4.1 Processes are in place for the ongoing evaluation, monitoring and refinement of measures that reflect the variables/elements of the PCDSM to ensure they are valid and reliable (i.e. used properly and measure what was intended), and reflect professional practice standards and evidence-based practices.
4.2 Decisions affecting nursing human resources (i.e. reorganization, service cuts, delivery models, etc.) consider evidence about healthy work environments to ensure safe, competent, ethical car
5.Financial and human resources are dedicated to support an infrastructure of integrated electronic systems to effectively design, manage and evaluate the scheduling, staffing, workload measurement and patient/client flow processes to meet the needs of patients/clients, nurses, other providers and the health care system.
5.1 Nursing management is involved in and supports the development and integration of problem solving tools, feedback processes, and monitoring systems (including indicators and data elements) linked to a comprehensive information management and decision support system

 

Healthy Work Environment
Developing and Sustaining Effective Staffing and Workload Practices
Healthy Work Environment Recommendations