RQHR Research Showcase 2008 Robin Evans, RN, PNC(C), PhD Sharon Garratt, RN, MBA

1. Evaluation of the Effect of Additional Staffing as Support for Implementation of the Changed Model of Care on the Mother Baby Unit RQHR Research Showcase 2008 Robin Evans, RN, PNC(C), PhD Sharon Garratt, RN, MBA

2. Background to Study • Changing Model of Care on Mother Baby unit • Moving from different nurse providing care for mother and baby to same nurse providing care for both • Individual nurse assuming responsibilities for clients previously handled by “charge” nurse – i.e. communication with physicians and other health professionals, coordinating lab work, etc. • One extra nurse on each shift from Feb 2, 2008 to April 4, 2008: 11 on Days; 8 on nights. • to facilitate transition to the new model of care.

3. Funding • Funding provided by Saskatchewan Health through the Health Workforce Retention Program

4. Challenges to Implementation • Some shifts were unable to staff extra person due to sick calls and no available staff • 16 shifts short 1 nurse; 7 shifts short 2 nurses on Days • 9 shifts short 1 nurse; 4 shifts short 2 nurses on Nights • Increased number of deliveries

5. Method • Pre-implementation survey conducted with nurses on the unit assessing nurse satisfaction and baseline data. • A second survey administered two months later, after the additional staffing was discontinued. Included items from the pre-implementation survey and additional questions related to changes in job demands, decision latitude, and social support. • Focus groups held with nurses to assess staff morale and relationships. • Third survey will be administered six months following the second survey to assess long term effects. Focus groups will also be again held.

6. Inclusion criteria • Pre-implementation survey • RN or LPN working full time, part time or casual on the mother baby unit. • Second survey • RN or LPN who had completed the pre-implementation survey. • Focus groups • RN or LPN working full time, part time or casual on the mother baby unit.

7. Position Title

8. Shifts Worked in Previous 4 Weeks

9. Preliminary Findings

10. Time available to do job adequately • Nurses felt that the time they had available to do their job adequately decreased: Pre-implementation: • 24% indicated they somewhat agreed • 76% somewhat or strongly disagreed Post implementation: • 100% somewhat or strongly disagreed

11. May have been related to the number of times there wasn’t staff available to ensure the extra person on a shift • “It also created a lot of anxiety if that person wasn’t covered, you know, a shift where that extra person wasn’t there.” • “It kind of settled a bit in March. When people started to know what they were doing. Now sliding into a new [staffing pattern] again, [everyone’s] panicky. Now those 2 new staff are gone again and now we have to deal with that. So again its back to [being like] that first month in February where it was all in a panic mode.”

12. Comments • “Just on the Monday and Tuesday that I worked where I had 4 moms and babies, it was beautiful. You know I felt like I was giving proper, adequate care. I was able to do my teaching. I was able to stay with my Mom and help her breast feed. I only had 4 patients, 3 were primes [first time mother]. I was able to really spend time with them.” • “Your workload was less. You ended up with 3, maybe 4, moms. But even if you have 3 moms and you knew that you were going to have an admission, you knew you had time to do this admission properly. You didn’t need to rush through it, the same way as if you had 4 moms and get an admission. You know, it does make a big difference.”

13. Comments • “At nights there are 2 on each team, which really made a difference. You worked as a pair. Because when you have an emergency - you’re stuck, you really are.” • “When I had those 2 beautiful days, I was like… Wow, Ok, I can look forward to my days again, because I dreaded days.”

14. The inconsistent availability of the extra staff for the changed model of care may have contributed to stress at work for the nurses • Pre-implementation: • 40% indicated most days at work were not very stressful or a bit stressful • 60% indicated most days at work were quite stressful • Post implementation: • 13.3% indicated most days at work were a bit stressful • 86.6% indicated most days at work were quite stressful or extremely stressful

15. Comments • “It was awful because we didn’t even have our regular number, let alone the 1 extra.” • “You know they’re upset, and then other people say, well if we’re short 2 again tonight I’m not coming to work.”

16. Job satisfaction was also impacted • Pre-implementation: • 16% were very satisfied with their job • 68% were somewhat satisfied • 16% were not too satisfied • Post implementation • 33% were somewhat satisfied with their job • 67% were not too satisfied or not at all satisfied

17. “People just look at us and say we can’t do it. They’ve been used to having this (extra staff) and it, you know when people have the 4 patients it was really nice. They said this is manageable, this is great.” • “I certainly remember when we had the extra staff. People were saying, this is manageable, this is manageable. When you have 4 patients, 4 mothers and 4 babies, it’s kind of manageable.”

18. “I just came on shift but we were so busy and crazy… I see this Dad [in L&B when she took his partner there] just sobbing so I went and comforted him. I called my unit, and said I’m just going to be a few minutes, I’m just comforting Dad. I got yelled at, you get back to the floor now, you have 2 gyne patients asking for pain medication, you have another ante-partum that’s cramping, this and that. So I had to leave this poor father to grieve and he didn’t know what was going on… I felt horrible as a nurse.” • “I feel like we are just running from room to room to room. We don’t really care about moms that have their babies in neo. They’re emotional, [but] we don’t have time for that, … we are truly neglecting the emotional and spiritual side of it, and I think that’s sad, especially [since] this is such a big change in a Mom’s life for a first time Mom.”

19. As was satisfaction with the organization • Pre-implementation: • 24% were often satisfied with the organization • 15% were sometimes satisfied • 16% were rarely satisfied • Post implementation: • 6% were often satisfied with the organization • 40% were sometimes satisfied • 53% were never or rarely satisfied

20. What this means for RQHR • Change is stressful and can impact on employee’s sense of job satisfaction, satisfaction with organization • Change needs to be planned carefully • Extra staff is helpful to support change • If the additional staffing is consistent • Need to prepare for when the additional staffing is finished

21. What’s next

22. Questions Thank you