Safe staffing practices: Nursing retention toolkit
On this page
- Goal statement
- Initiative – Clinical supports: Establish processes to identify and ensure the accessibility of appropriate supports (i.e., mentors, preceptors, educators, leaders) for nurses
- Initiative – Safe staffing framework and tools: Develop a comprehensive framework to help understand staffing needs and their impact on immediate and long-term outputs, and identify supporting tools for the implementation of the framework
Goal statement
Support physically safe and psychologically brave workplaces by implementing staffing practices (e.g., nurse-patient ratios) that reflect factors like patient acuity, nurse experience, and work-life balance.
Initiative – Clinical supports: Establish processes to identify and ensure the accessibility of appropriate supports (i.e., mentors, preceptors, educators, leaders) for nurses.
Intended outcome
- Enhanced physical and psychological safety for nurses at work, ultimately leading to better patient outcomes and safety.
- Improved health system cost-effectiveness through reduced staff turnover costs and sick time from increased nursing satisfaction.
- A deeper understanding into why clinical supports are needed and for what they are being used.
Description
This initiative focuses on creating clinical supports for nurses to enable safe staffing practices.
Examples of supports include:
- Dedicated positions for clinical nurse experts, coaches, and mentors: Clinical support and mentorship should be provided by individuals with a dedicated position (or protected-time in existing role) and title, preventing these nurses from being floated to other areas for clinical responsibilities. These supports can help with students' and other nurses' workload, education, and development of non-technical skills (e.g., soft skills). Embedding protected mentorship time into collective bargaining agreements could be a key enabler for these clinical support roles.
- Diversity in clinical supports and mentors: An organization's clinical supports and/or mentorship pool should reflect the intersectional and diverse identities of the workforce.
- Engaging retired nurses: Support may be offered by engaging retired nurses and end-of-career nurses to transition to a clinical support or mentorship role. Those who fill these positions should be provided guidance and mentorship themselves.
- Incentives: Incentives to participate as a mentor should be outlined. This may include allocated time and decreased workload, financial incentives (e.g., pay premiums per hour, and formal recognition by the organization). Embedding incentives into collective bargaining agreements could be a key enabler.
- Support from students: Introduce students and new grads to float teams to support workload with appropriate measures to ensure team integration, such as assigning a home base, and implementing a "solidification period" where students and new graduates become comfortable in one team before moving on to another.
- Digital tools: Implement innovations that address how support is delivered (i.e., nursing-to-nursing support delivered via technology).
Planning considerations include:
- Develop feedback mechanisms for all clinical support programs to ensure the success and sustainability of implemented supports. Nurses can use these feedback mechanisms to share the value of the program, what was useful, and why they use it.
- Recognition for support provided, in the form of payment, should be standard whenever possible.
- Consider clinical nurse specialist roles where feasible.
Target nursing population
- New Grad nurses: To target those who are new to the workforce and nursing profession.
- Internationally Educated Nurses (IENs): Provide clinical supports that address their specific needs and circumstances (e.g., cultural norms, community integration), create a safe and supportive environment for racialized and marginalized communities, and ensure ethical recruiting practices are followed.
- Mid-career nurses: To support nurses transitioning from one clinical area or sector to another, or who are returning to work after an extended leave.
Stakeholder involvement and role of nurses
- Responsible: Management.
- Accountable: Senior executive leaders.
- Consulted: Unions, professional organizations, point-of-care staff, college of nurses, educational institutions.
Reference resources and examples (See appendix for links)
- SE Health Clinical Practice Coaches: A coaching, mentoring, and quality improvement approach is used to provide clinical practice leadership to nurses, PSWs, and allied health professionals.
- RNAO Advanced Clinical Practice Fellowship: This fellowship provides the opportunity for Registered Nurses and Nurse Practitioners to build their clinical research skills and expertise by advancing projects to meet a service gap in their organization.
- Canadian Association of Schools of Nursing (CASN) National New Nurse Residency Program: aims to support the retention of newly licensed Registered Nurses in Canada's health care workforce by enhancing their competence and resilience and reducing job stress.
- Canadian Black Nurses Alliance (CBNA) National Professional Mentorship Program: CBNA offers one-on-one mentorship for professional and practising nurses.
- Black Nurses and Students Allied for Success (BNSAS) Undergraduate Mentorship Program: Nursing learners are paired with mentors based on their individual interests and professional and academic goals. This mentorship program will be scaled across 15 academic chapters over the next five years.
- UHN 80/20 Model: This model enables staff to spend 80% of their time on direct patient care and 20% on professional development activities.
- Prairie Mountain Health (PMH) Emergency Department New Graduate Program: In this program, new graduates are supernumeraries and buddied with an experienced nurse for 6 weeks of extended training specific to the emergency department.
- Prairie Mountain Health (PMH) Nurse Specialty Orientation: PMH offers a program to nurses interested in critical care, which includes online and in-class learning, followed by a "buddied" clinical learning phase where learners are paired with an experienced nurse on the unit to provide patient care. This is further followed by a "Specialized Orientation" phase where learners care for patients independently with an assigned preceptor. The program aims to build knowledge, independence, and integration into the unit over the three phases of training.
- Health Careers Manitoba's Undergraduate Nurse Employee Program: Undergraduate nursing students in their third or fourth years can apply to be an undergraduate nurse employee (UNE) who works under the supervision of a Registered Nurse or Registered Psychiatric Nurse to gain practical experience with direct clinical support from experienced nurses.
- Canadian Nurses Association Clinical Nurse Specialist (CNS) role overview: An overview of the CNS role is provided, including an explanation of how this role differs from the Nurse Practitioner practice role.
Initiative – Safe staffing framework and tools: Develop a comprehensive framework to help understand staffing needs and their impact on immediate and long-term outputs, and identify supporting tools for the implementation of the framework.
Intended outcome
- Enhanced physical and psychological safety for nurses at work, ultimately leading to better patient outcomes and safety.
- Improved health system cost-effectiveness through reduced turnover and sick time from increased nursing satisfaction.
- A deeper understanding into why safe staffing frameworks and tools are needed and what they are being used for.
Description
This initiative focuses on the development of a safe staffing framework that may be used and adjusted by individual departments and units depending on their local context. Safe staffing tools should also be identified, which can help determine patient needs and required workloads to ensure that enough nurses are available to provide care. The purpose of the framework is to serve as a guiding principle.
Planning considerations include:
- Evidence-based: Staffing ratios should be informed by evidence and leading practices to enable safe staffing. Review existing evidence-based literature, research, and guidelines related to staffing ratios in your specific care setting, specialty, and geographic region.
- Include key considerations: The framework should consider patient acuity, the care environment (e.g., rural, remote, urban, supports available, the care area of specialty), education / experience of the nurses.
- Thoughtful replacements: A nurse's education, experiences, and scope of practice should be considered when creating and updating shift schedules and doing workforce planning. Review the education, experience, and scope of practice of nurses in your specific care setting. Determine ratios that align with the skills and competencies of the nursing staff.
- Feedback loop: All safe staffing frameworks and tools should have a feedback mechanism that enables nurses to share the value of the framework and tools, what was useful, and why they use it.
- Customizability and flexibility: Each unit or nursing site needs to have a committee structure to tailor the staffing framework to its needs, and include insights based on clinical judgment. Further, the framework should be flexible, because patient acuity is fluid and staffing demands can change frequently.
- Opportunity for nurses to provide input on safety: Nurses should be given the opportunity to provide input on what safety means to them, to inform the refinement (or new development) of safe staffing tools, and assessments.
- Empowerment by nursing leadership: Nurses need to feel empowered by nursing leadership to set boundaries when patient needs and workloads exceed levels of safety.
- Increase attractiveness of organizational positions: Consider approaches for increasing attractiveness of organizational positions (i.e., full time, part time, and casual) to minimize the use of agency nurses. See "Flexible Work Design" for more considerations.
Target nursing population
All point-of-care nurses (Student, New Grad, Mid-Career, Late-Career, etc.), managers and leaders in nursing environments.
Stakeholder involvement and role of nurses
- Responsible: Management.
- Accountable: Senior executive leaders.
- Consulted and informed: Unions, Professional organizations, Point-of-care staff, College of Nurses.
Reference resources and examples (See appendix for links)
- CNA/CFNU Evidence-based Safe Nurse Staffing Toolkit: This toolkit includes tools related to Real-Time Assessments of Patient Needs, Nursing Workload and its Management, Professional Responsibility Concerns, Staff Mix Decisions, and Nursing Care Delivery Models to promote safe nurse staffing practices.
- CNA Staff Mix Framework: This decision-making framework is intended to support staff mix decisions by nurse managers, point-of-care staff and nurse executives.
- Acuity-based staffing model pilot project in Newfoundland and Labrador: A system called "Integrated Capacity Management" (ICM) that supports staffing based on patient acuity was introduced to improve quality outcomes.
- RNAO "Developing and Sustaining Safe, Effective Staffing and Workload Practices" Best Practice Guideline (recommendation 2.1, pages 11, 33): Organizations use electronic health records (EHRs) and other integrated systems as appropriate to support safe, effective workload processes.
- Department of Health, Government of Nunavut policies and procedures for safe staffing: These policies include clear delegation tables, "must do" and "must not do" lists of tasks for specific nursing ratios, and guidelines for when virtual triage is triggered.
Page details
- Date modified: