The challenge of operating within staffing budgets on the maternity unit at New England Memorial Hospital despite a fluctuating census.

PROJECT

Improve staffing policies and procedures on the Maternity unit to reduce the chronic practice of exceeding the budget for nursing hours per patient day (NHPPD). Principals: Maternity Service nursing staff and unit secretary. Process Improvement Method: Plan-Do-Check-Act. Timeline: Begun: March 1991. RESULTS reported here: FY 1992 (October 1, 1991-September 30, 1992).

KEY FINDINGS

Patient census fluctuated dramatically from shift to shift. To staff the unit during peak times, nurses from other units were floated in, but many lacked sufficient obstetrics training. Conversely, at slack times, OB nurses were floated to other units. All the above factors resulted in nursing dissatisfaction as well as the Maternity unit exceeding its nurse staffing budget by 25 percent. Improvements: Unit-based staffing, which eliminated floating and increased ownership on the unit, was implemented, along with other changes in operations, policies, and procedures. A charge nurse position was created and implemented to coordinate activities between shifts. Staffing policies and procedures were clarified and updated.

RESULTS

Nursing hours per patient day are now on budget, and nursing morale is also improved.