The holidays can be a hard time for nurses to maintain work-life balance when illness, injury and death rates increase.
Hospitals experience tragic and sad situations with patients during the holidays with several studies showing a greater chance of dying on Christmas, the day after Christmas or New Year's Day than any other single day of the year.
"It's just a busy time. Hospitals try and make sure as many [employees] can be home as is possible. But there are a lot of patients with very tragic conditions that can't go home, and their families spend the holidays in the hospital with them, and then also there are emergencies over the holidays that are somewhat unpredictable. So that can create a lot of chaos in the life of somebody who's working in the hospital," says Karlene Kerfoot, PhD, RN, NEA-BC, FAAN, CNO of API Healthcare, a workforce management software and analytics solutions vendor.
To address this, hospitals have different policies for staffing during the holidays than during other times of the year, which means nurses often miss time with their loved ones because they're working on a holiday. Having to work holiday hours can have a major impact on nurse job satisfaction, which in turn affects their ability to provide adequate care to patients.
At the front lines of care, nurses are a core driver of improvements like the patient experience with studies showing that the availability of nurses for direct care is a determinant of better patient outcomes and fewer medical errors. The ability of nurses to improve the care experience is dependent on their work satisfaction. For every 10 percent of dissatisfied nurses, patient referrals decrease by 2 percent, according to an article published in Health Affairs.
So if nurses feel stretched in terms of their work hours, it leads to issues with nurse satisfaction and ultimately patient safety, Dr. Kerfoot says.
That's why it's important for hospitals to develop staffing systems and support systems so employees who need to work over the holidays feel supported and feel equitable in terms of the hours they work.
Dr. Kerfoot recommended hospitals take the following approaches to improve nurse satisfaction, especially during the holidays.
1. Giving nurses the freedom to create their holiday schedules. Dr. Kerfoot says it's much better for hospital staff if they can choose the days and hours they work instead of having to accept a schedule they have no input in. "If they can have input into the schedule, that makes a huge amount of difference," she added. A study published in the Journal of Nursing Administration found that when nurses self-scheduled their work, their for job satisfaction rates, work-life balance and team cohesion improved.
2. Incentivizing nurses who work on holidays. There are many ways for hospitals to thank nurses who work on holidays. Leaders may make hospital rounds thanking nurses, or the hospital can offer a point-based incentive system that works much like a frequent flyer or credit card program as a way to assure adequate staffing over the holidays. Dr. Kerfoot says hospitals should also create a sense that it's a privilege to work with patients and families over the holidays. "Not only are you [the patient] sick and you're frightened. But it's also the holidays and you can't be with your families. It's a wonderful time to work with families to make sure management appreciates that and create some fun things at work," Dr. Kerfoot says. Those fun things could include a potluck, or a visit to the unit from Santa Claus.
3. Implementing a staggered scheduling system. Dr. Kerfoot says an equitable scheduling system should also be set up. For instance, dividing nursing staff and assigning groups to every other major holiday, and switching the year after is one method that can be used. That way the same people aren't working all the holidays, and hospitals can reduce the number of illegitimate call-ins for unexpected absences, which can impact scheduling efficiencies. "As long as [nurses] participate in that kind of schedule and believe it's fair, they can go along and feel satisfied. If they don't participate in that kind of schedule and can't plan ahead for holidays, they aren't satisfied," Dr. Kerfoot says. "So having staff involved in the schedule and making sure there's a fair and equitable way of establishing who works when — it's very important and does lead to much more satisfaction on the part of the staff."
Dr. Kerfoot noted it's also easier to accomplish staggered scheduling with an electronic system that shows schedules, and helps determine ahead of time who's on the schedule to work and where there are shifts other employees can sign up for. "A lot of staffing is done by hand on a spreadsheet. But it's much easier and better both in terms of fairness to staff and for the managers to do scheduling this way," she says.
Putting these steps into practice
At Durham, N.C.-based Duke University Health System, officials aim to practice such steps. The goal is to be systematic and creative in how the system staffs during the holidays, to ensure the organization meets patients' needs as well as nurses' needs, according to Sylvia Alston, RN, MSN, associate CNO of Duke.
The health system tries to allow as many people off as possible on holidays, and it recognizes staff, generally during a holiday celebration. Duke employees who work on holidays also receive free parking on the holiday and are compensated higher for working a holiday. Additionally, if the number of patients is down, Duke may let employees leave work early.
Ms. Alston says all of these things help improve nurse satisfaction and work-life balance during the holidays.
"When patients are in the hospital on the holiday, it's really hard for them. And having nurses around that are energetic and happy have such an impact on the patient that even though you're [the nurse] actually working, it elevates your mood as well because you know you're actually meeting a need of a patient, a family who actually can't be at home," she says.
Dr. Kerfoot agrees.
"This is just saying, 'If our staff is happy, our patients are happy,' and that includes holidays when it's difficult to be at work when you'd rather be with your family...," she says. "It's very basic but very important."
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