Self-scheduling and staff incentives: meeting patient care needs in a neonatal intensive care unit

The effect of self-scheduling on organizational justice and work attitudes through leader-member exchange: A cross-sectional study using propensity scores

BACKGROUND

Nurses have a very stressful and demanding job, which probably affects their health and well-being. This has resulted in a search for an optimal nurse schedule. Self-scheduling is one method to enhance flexibility and give more control to the employee. Literature on self-scheduling is scarce and mainly focused on the implementation process. So far, little is known about the long-term effects of self-scheduling.

OBJECTIVE

The comparison of effects of self-scheduling versus fixed scheduling on three dimensions of organizational justice (distributive, procedural, interactional justice) and three work attitudes (job satisfaction, affective commitment, global empowerment). This total effect is decomposed into direct and indirect effects via hypothesised mediators (leader-member exchange and organizational justice).

DESIGN

A cross-sectional multisite-matched study.

SETTING

A questionnaire was distributed to nurses and nurse assistants of twelve nursing homes in Flanders (Belgium). Six matched pairs of nursing homes were formed, each containing a nursing home that uses self-scheduling (for at least one year) and one that uses fixed scheduling.

PARTICIPANTS

The study sample included 308 nurses and nurse assistants, of which 160 surveys were from nursing homes using fixed scheduling, versus 148 surveys from nursing homes using self-scheduling.

METHODS

Using a double robust fixed effects regression model adjusted for the propensity score, the total effect of self-scheduling compared to fixed scheduling was analysed on the proposed outcomes. Subsequently, a (multiple) mediation analysis was performed.

RESULTS

If all people would have used self-scheduling instead of fixed scheduling, on average a significant decrease in the mean procedural justice score (estimated mean difference = -0.20, 95% CI -0.36 to -0.05) would be found. There is a significant negative direct effect (estimated mean difference = -0.12, 95% CI -0.21 to -0.03) and indirect effect via the mediator leader-member-exchange (estimated mean difference = -0.08, 95% CI -0.15 to -0.01) on procedural justice. In addition, significant negative indirect effects of self-scheduling were found via the mediator leader-member exchange on all the investigated outcomes.

CONCLUSION

Drawing up the work schedule is perceived as less fair in the case of self-scheduling. Furthermore, self-scheduling has a negative indirect effect on several work attitudes as a result of the changed relationship between the head nurse and the employees. The increase in task variety and decision-making autonomy for the employees and the altered leadership role of the head nurse can have a major impact on the dynamics of the entire team.

Systematic review: What is the impact of self-scheduling on the patient, nurse and organization?

AIM

To systematically review and evaluate the literature on the impact of self-scheduling on patient, nurse and organization-related outcomes.

DESIGN

A systematic review.

DATA SOURCES

PubMed, Embase, Web of Science, Cinahl, Scopus, Google Scholar, ERIC and Cochrane Library were screened until October 2019 (week 40) for peer-reviewed, empirical articles, written in English, Dutch or French.

REVIEW METHODS

Two reviewers screened title and abstract using predetermined eligibility criteria and one reviewer screened the full texts of relevant hits. Quality was assessed with the Mixed Methods Appraisal Tool.

RESULTS

Studies (N = 23) were retained and classified into explanatory and descriptive studies. The articles reported on a range of outcomes: patient- and nurse-reported quality of care, job satisfaction, satisfaction with scheduling, work/life balance, planning involvement, interaction with colleagues, health and well-being, psychosocial factors, professional development, nurse manager's scheduling time, general working conditions, turnover, temporary employment agency use and absenteeism, recruitment and retention.

CONCLUSION

The evidence base is limited. Several studies confirmed the positive impact of self-scheduling on the nurse and the organization. However, other studies found negative outcomes or no change. These outcomes should be interpreted in the light of contextual factors and the implementation process, which was often not without difficulties. Future research should use a multimethod longitudinal design, bear in mind the possibilities of quantitative research (e.g. for studying psychosocial factors) and employ a theoretical framework.

IMPACT

This review informs about the inconsistent evidence on the association between self-scheduling and patient, nurse and organization-related outcomes and includes enablers and barriers to a successful implementation. These outcomes are influenced by the implementation process and the sustainability of the self-scheduling system, which are still major challenges for healthcare management. This demonstrates the urgent need for further research.

Variables that predict admission to hospital from an emergency department observation unit

OBJECTIVE

To determine factors predictive for patients requiring ongoing hospital admission from the emergency department observation unit (EDOU).

METHODS

Prospective observational study on all patients admitted to the EDOU over 3 months. The primary outcome measure was patients requiring subsequent admission to hospital from the EDOU.

RESULTS

Of 860 EDOU admissions occurring from 8337 ED presentations, 145 (16.9%) were subsequently admitted as inpatients. Of all analysed variables, four (inability to independently mobilize in the ED, requiring ongoing active treatment while in the EDOU, requiring referral to another subspecialty prior to transfer to the EDOU and requiring multidisciplinary allied health assessment while in the EDOU) were significantly associated with admission to hospital.

CONCLUSIONS

Variables exist that predict a 'failed' short stay admission. These might be used to identify patients less suitable for admission to the EDOU and better suited to admission directly under a hospital team.

Trends in nursing staff allocation: the nurse-to-patient ratio and skill mix issues in Israel

PURPOSE

This article describes a case study relating to trends in nurse-to-patient ratios and nursing staff mix in Israel.

BACKGROUND

In recent years, there has been a worldwide trend towards changing nurse-to-patient ratios and nursing staff mixes. On the one hand, the patient's status has become more complex and requires a more professional nursing staff to maintain treatment, safety and quality, on the other hospitals have become more economically focused. In light of this, the need to re-examine the issues of nurse-to-patient ratio and nursing staff mix are of primary importance to the health system. Legislation of nurse-to-patient ratios is being widely discussed in nursing circles, and nurse-to-patient ratios are now mandatory in the State of California, USA, and the State of Victoria, Australia.

CONCLUSION

The trend in nursing staff mix in Israel has been towards increased hiring of academic registered nurses, leading to the clinical development of quality treatment programmes and decreased mortality rates. Subsequently, license practical nurses are phased out, and where necessary auxiliary staff, which represents a cheaper work force, provides unskilled care. Today, the staff mix distribution in Israeli general governmental hospitals consists of 73% registered nurses, 11% licensed vocational nurses, and 16% auxiliary staff. In addition, there is a special collective agreement related to the allocation of nursing positions, including a classification method involving 10 categories of inpatient wards.

Nurse turnover: a literature review

Ongoing instability in the nursing workforce is raising questions globally about the issue of nurse turnover. A comprehensive literature review was undertaken to examine the current state of knowledge about the scope of the nurse turnover problem, definitions of turnover, factors considered to be determinants of nurse turnover, turnover costs and the impact of turnover on patient, and nurse and system outcomes. Much of the research to date has focused on turnover determinants, and recent studies have provided cost estimations at the organizational level. Further research is needed to examine the impact of turnover on health system cost, and how nurse turnover influences patient and nurse outcomes.