Proposal Report (Student Example by Shelby Taylor)

Proposal for a Tumble of the Nursing Staff at

 Oregon State Hospital


DATE: May 19, 2016

TO: Lindsey Sande (Assistant Director), Mike Soaper (Director of Nursing)

FROM: Shelby Taylor (MHTT)

SUBJECT: Proposal for Staffing

OSH Logo

Introduction

The year of 2016 has brought many changes to Oregon State Hospital (OSH) and opened an exciting new chapter in the life of OSH. As a facility OSH has opened two new units (Flowers 3 in Salem and Mountain 3 in Junction city) leaving plenty of room for OSH to continue growing and accommodating the needs of our community and our state.

Unfortunately, not all the changes that 2016 has promised seem to be positive. This year the Senate proposed a bill (Senate Bill 469) that would allow for only one hour of mandatory overtime, as well as shifts that cannot exceed 12 hours in length. While this has minor impacts on most facilities, it will impact OSH in a different way.

For years now we have had 13 hour 20 minute shifts for three days a week (Friday-Sunday or Saturday-Monday). This system has accommodated many difficult schedules of employees as well as served to cover the weekend staffing issues that previously plagued our facility. Many people don’t want to see the 13 hour 20 minute shifts go, but we must find a way to balance the needs of our employees as well as comply with Senate Bill 469 if it is passed.

This proposal will bring to light an idea that I think will satisfy a majority of our 2000 employees, as well as compliant with the bill being passed by the Senate. This proposal will focus on Junction City, as it would be the pilot program to this new staffing system. Please take a moment to consider this possible solution to the staffing crisis that potentially lay ahead.

This is Oregon State Hospital of Salem. This portion of the hospital was remodeled and completely new on the inside, but the outside brick work, clock tower, and windows were preserved to keep the history of the building alive.
This is Oregon State Hospital of Salem. This portion of the hospital was remodeled and completely new on the inside, but the outside brick work, clock tower, and windows were preserved to keep the history of the building alive.

Background

Currently OSH-JC runs with a mixture of 8 hour, 10 hour, and 13 hour 20 minute shift lengths. My proposal is to eliminate the 8 hour and 13 hour 20 minute shifts in favor of 10 hour shifts across the board. This would mean each employee would work four days per week with 10 hours per shift. There would be three shifts per day: day shift, swing shift, and night shift. The night shift is already operating on this system of 4-10 hour shifts and would not need restructuring. Day shift and swing shift would follow suit and adopt ten hour shifts.

There is currently a lot of pressure to reform the schedules at OSH. Senate Bill 469 is the final push in this process. Photo credit to Simple Long Term Care.
There is currently a lot of pressure to reform the schedules at OSH. Senate Bill 469 is the final push in this process. Photo credit to Simple Long Term Care.

Night shift is currently 2200-0800. Day shift would be 0600-1600. Swing shift would pick up the gap at 1400-0000. Once again, similar to night shift we would need to stagger the shifts to ensure maximum staffing coverage. For the weekday staff there would be a Monday-Thursday option and a Tuesday-Friday option. For weekends it could be Thursday to Sunday and Friday-Monday.

Current Shifts at OSH

  • M-F 0630-1500
  • M-F 0230-2300
  • M-Th 2200-0800
  • Tu-F 2200-0800
  • F-Su 0715-2105
  • Sa-M 0715-2105
  • F-Su 1945-0900
  • Sa-M 1945-0900

Benefits and Feasibility 

There are many benefits to this proposal. One that would make an immediate impact is the improvement to RN coverage. The RNs would be placed on the Monday-Thursday shifts and the Thursday to Sunday shifts. The benefit of this would be a reliable schedule for the RNs and less overlap of RNs. There would be two RNs on each unit for each shift to accommodate call-ins and vacation time.

Another benefit would be the overlap on Thursday, Friday, and Monday. While the units may seem overstaffed on these days, it is important to have that extra staffing a few days a week. These extra staff would be used to improve staffing so that the clients could go on more outings, medical appointments, improve classes on the treatment mall, and better availability during days of high acuity (level of danger on the unit).

One of the hard working employees of OSH-Salem as he assists a client in making a clay craft. Proper staffing allows staff to assist clients with such activities. Photo credit to the Statesman Journal.
One of the hard working employees of OSH-Salem as he assists a client in making a clay craft. Proper staffing allows staff to assist clients with such activities. Photo credit to the Statesman Journal.

In addition, most call-ins occur on Fridays and Mondays due to weekend arrangements. This extra staffing on those days would bridge the gap and keep the unit up on their base staffing numbers. This would eliminate an extensive amount of overtime, which is costly for the hospital.

One of the problems that will be proposed is that there would need to be a tumble. A tumble is where the shifts are redistributed. OSH runs on a seniority system and it can take time to get into a position that is desired. With a tumble, each person will not be guaranteed to the job, or even the unit, that they may have been working on for years. This is a difficult thing, but with the Senate Bill 469 being enforced, something will need to change and with any change a tumble will result. This will need to be cleared with the union and presented the employees in the best way possible. Eventually things will settle out again, tumbles take time.

Lastly, this schedule would reduce employee burnout and increase employee morale. Mental Health is a high burn out field. It can be difficult caring for yourself when you are spending a majority of your days attending to the emotional needs of others. With this schedule, every employee would have three days off. This would improve the mental health of employees, creating the necessary separation of work and down time, as well as reducing the number of call-ins due to “Mental Health Days.”

Mental Health Days are a form of Sick Time that are taken regularly do to the high burnout nature of working in a Mental Health setting. Photo credit to the Center for Disease Control.
Mental Health Days are a form of Sick Time that are taken regularly do to the high burnout nature of working in a Mental Health setting. Photo credit to the Center for Disease Control.

Description of Proposed Schedule

As mentioned previously, we would have two RNs working each shift (day, swing, night) Monday through Thursday, and two RNs working each shift Thursday to Sunday. Due to the extra RNs on Thursdays, we would make Thursday the official day for Admissions and Discharges, that way there are plenty of RNs to cover the extra paperwork involved.

The LPNs would run on the inverse schedule of the RNs. There would be two LPNs on day and swing shift Tuesday through Friday and Friday through Monday. The LPNs would be able to cover medication passes, allowing the RNs time for their necessary duties. Having them staggered with the RNs allows different LPNs to work with different RNs during different parts of the week. This is important so as to create a cohesion between shifts, that way it doesn’t cause discomfort or rifts between different shifts’ staff.

The MHTTs (Mental Health Therapy Technicians/CNAs) would be evenly spread throughout all the shifts. Day shift would need 5 MHTTs per shift (2 MN1, 2 MN2, 1 FT2). Night shift would need 3 MHTTs per shift. When you take into account that there will be at least two shifts overlapping at any given time, this would mean 10 MHTTs on day and swing shift and 6 MHTTs on night shift. A visual of this schedule can be seen below.

It is important to note that different units have different levels of acuity and must be staffed accordingly. This schedule includes Mountain 1 (which requires a higher level of staff due to the level of difficulty faced on this unit), Mountain 2 (about the same level of acuity as Mountain 1), and Forest 2 (which requires the least staff because it is a transitional unit).


Schedule

Below is an example of the proposed schedule for Mountain 1. Please keep in mind that Mountain 2 would have the exact same staffing schedule, Forest 2 would have modified numbers as they require less staff.

Day Shift Staffing Levels:

Day Shift Staffing Levels
Swing Shift Staffing Levels:

Swing Shift Staffing Levels
Night Shift Staffing Levels:

Night Shift Staffing Levels



Costs of Staffing

Currently OSH has plans to employ 9 RNs per unit, with three units that is 27 RNs. Each RN is paid a monthly salary range of $5,474.00-7,231.00 (according to the job listing found here). For the sake of this estimate, I will assume that RNs make the base $5,474.00/month or $65,688.00/year. With the current staffing method, that means $1,773,576.00/year for OSH-JC. On the method I’m suggesting we would use 12 RNs per unit, for a total of 36 hospital wide. The total per year for that would be about $2,364,768.00/year.

Currently OSH employs 8 LPNs per unit (2 day, 2 swing, 2 weekend, 2 night). My plan would include 8 LPNs as well. The monthly salary for an LPN is $3,319.00-4,828.00/month (according to the job listing found here). This would add up to $39,828.00/year. For all the LPNs, regardless of which plan, it will cost $318,624/year for OSH-JC.

The LPNs is where we will make up the money a bit. Currently there are 64 MHTTs employed at OSH-JC. MHTTs make between $2,591.00-3,654.00/month (according to the job listing found here), for a grand total of $31,092.00/year. If you multiply that by the number of MHTTs currently employed, that adds up to $1,989,888/year. With my plan that number would be 52 MHTTs, for a grand total of $1,616,784.00/year for MHTTs at OSH-JC.

Staffing costs are important to keep in mind as OSH is a funded by the State and it's tax payers. Photo credit to Forbes Magazine.
Staffing costs are important to keep in mind as OSH is a funded by the State and it’s tax payers. Photo credit to Forbes Magazine.

Current Staffing Costs:

$1,773,576 + $318,624 + $1,989,888 = $4,082,088

Proposed Staffing Costs:

$2,364,768 + $318,624 + $1,616,784 = $4,300,176


Conclusion

Though the proposed staffing would cost $218,088 more per year, it would greatly reduce the amount of overtime required by adding extra staff on the days when most people call out. It will also increase the level of care and the amount of outings that the patients are able to participate in. It will also solve the problem of eliminating the 13 hour 20 minute shifts. The reduction of overtime will easily cover the costs of adding the additional staff. Overall, this plan is the most efficient way to solve the problem and increase the level of care for staff and clients.

 

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