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RBC Element of Care Delivery:
Scheduling
Judy Westers BS, RN
Nurse Educator
Ferris State University MSN Student
Inspiration
In the first 28 days of a long stay, a patient and their family
experienced 27 different RNs assigned to their care.
In one six-week schedule a staff member experienced 20
different work partners.
Struggling NA on orientation, we couldnt find two nurses who
shared a schedule for two weeks.
There are no guidelines or structures in place to prevent this
from happening.
Purpose
Develop an element of care delivery to guide the
scheduling practices for hospital nursing staff.
Base the element on Jean Watsons theory of human
caring and the principles of Relationship-based Care
(RBC).
Objectives
Study the impact of a shared schedule on a team of two
RNs and one nursing assistant.
Engage a Small Guiding Team
Examine the literature
Write the element of care delivery
Support the scheduling guide with Watsons theory
Reflect on lessons from a pilot team that experienced
continuity by sharing a schedule
Team Members
Judy Westers, MSN Student
Mary Dougherty, Scholarly Project Mentor
Jodi Mendez, Nursing Supervisor 2 South
Ellen Milroy, Hope BSN Student
Courtney Mulder, Hope BSN Student
Carol Sadate-Akhavi, Nurse Manager CTICU
Sue Teman, Nurse Manager NICU
*Donna Garrett, Hope professor
*Ad hoc member for student supervision
Literature
Positive teamwork builds trust, mentoring, accountability,
ability to deal with conflict, competency, & workload
awareness of team (Gavlin, 2010; Weydt, 2010).
Working with the same team = 25% more efficient
(Koloroutis, 2013).
Working with the same patients = 25% more effective
(Koloroutis, 2013).
Team continuity requires same shift length and consistent
schedule (Kalisch, Begeny, & Anderson, 2008).


Literature
More staff doesnt help if there isnt accountability (Manthey &
Koloroutis, 2004).
Team awareness (having a bad day, struggling, or heavy
assignment) and teamwork (not staffing) will improve the
situation (Douglas, 2010).
Adverse events and incident reporting cite communication
and teamwork as most frequent contributing factor (Manser,
2008).
Teamwork versus clinical skills, is more likely to contribute to
errors (Manser, 2008).


Literature
Team characteristics are collective orientation, leadership,
performance monitoring, adaptability (Kalisch & Schoville, 2012)
Using scheduling software reduced manager time from eight
hours per week to minutes (De Grano, Medeiros, & Eitel, 2009).
Geographical layout of an assignment kept at a minimum
improves workload and organization
(NSW.gov.au/nursing/projects, 2011)
Team size impacts the ability to function as a team (Kalisch &
Begeny)

Pilot Teams
Two medical-surgical floors each provided a 3-person team.
One team selected by nurse manager
One team recruited by interested RN
Teams consisted of:
2 RNs
1 NA
Shared schedule from October 6 to November 16, 2013
Research: Pilot Teams
Hope BSN students in senior research class:
Extracted data on number of work partners
Structured interviews on teams to discuss:
Workload
Stress
Teamwork
Communication
Relationships
Work Satisfaction
Lessons Learned
Mix of 4, 8 and 12 hour shifts
12 hour shifts for most employees while staffing standards
change after 16 hours (2300).
8 hour employees not leveled.
One unit sacrifices geographically-based assignments to
balance acuity.
One unit tries to maintain geography and adjusts resources
to address acuity.
12 hour shifts create a part-time feel for days worked in a
row.
Lessons Learned
NAs and RNs are on different weekend intervals.
Ill calls, downsizing, one team member requesting changes
to schedule, etc., all impact continuity of team.
Both units have 2:1 as standard but use 3:1 when pushed by
staffing/census challenges.
One unit frequently resists the challenge and utilizes the
recommended primary team (no nursing assistant).
Group Size vs. Communication Channels
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Group Size
Communication Channels 2:1
RN1
RN2
NA1
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Quantitative Results
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Subject
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Subect
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Subject
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Subject
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Total Number of Staff Members Study Subjects
Worked with Over a Six-Week Period
Total Staff Members -
Pre-Shared Scheduling
Total Staff Members -
Shared-Scheduling
Qualitative Results
Quotes about Teamwork and Stress
Pre-Shared Scheduling Common Themes
when you know that you have two good nurses who are
going to work with you, it lowers the stress level.
decreases it [stress] greatly because they are really good
coworkers
Qualitative Results
Quotes about Teamwork and Stress
Intra-Shared Scheduling Common Themes
Well, the better the quality [of teamwork], the less
workload...
But everyone pitches in andit makes my life much easier.
It [teamwork] affects it [stress] very much because when you
know you can depend on somebody or know that someone
has your back
over time that the continuity of the people you work with
helps you just because of the fact that you can predict things
a little bit more
obviously its more stressful when you dont feel like you
have help
Qualitative Results
Quotes about Teamwork and Stress
Post-Shared Scheduling Common Themes
The better the teamwork, the lower the stress.
.the more you work as a team, the easier your workload
becomes.
RBC Element of Care Delivery
Scheduling
Purpose
Rationale
Key Behaviors
Considerations
Purpose
Build patient-centered scheduling practices that maximize
continuity of care and continuity of team.
Rationale
Continuity of care provides consistent and effective patient care
through well-developed relationships with patients and families.
Continuity of team improves communication, trust, and care-
coordination by building stronger relationships with consistent
colleagues.
Teamwork built on strong relationships provides mentoring,
accountability, safety, ability to learn, satisfaction and an intuitive
connection with work partners.
Patients and families who receive care from strong and consistent
teams experience quality, safety, and overall satisfying health
care.
Continuity of care and continuity of team provides predictability,
reduces stress, and makes work easier.

Key Behaviors
Continuity of Care
Track caregiver and patient relationships.
Minimize the number of different caregivers who care for
a patient.
Minimize the number of work partners each employee
experiences.
Next Steps
Nursing Teamwork Survey (NTS)
Program to collect teamwork data.
Data will be available for inquiry projects.
Teamwork and geographically-based assignments
Teamwork and call light response
First inquiry:
Teamwork and Falls
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Questions?
Questions for me?
Question for you
References
De Grano, M. L., Medeiros, D. J., & Eitel, D. (2009). Accommodating individual
preferences in nurse scheduling via auctions and optimization. Health Care
Management Science, 12(3), 228-242. http://dx.doi.org/10.1007/s10729-
008-9087-2
Douglas, K. (2010). When caring stops, staffing doesnt really matter. Nursing
Economics, 8(6), 415-419. Retrieved from
http://www.nursingeconomics.net/necfiles/staffingunleashed/su_nd10.pdf
Drake, R. G. (2013, August 3). The nurse rostering problem: From operational
research to organizational reality? Journal of Advanced Nursing, 1-11.
http://dx.doi.org/10.1111/jan.12238
Kalisch, B. J., Begeny, S., & Anderson, C. (2008). The effect of consistent
nursing shifts on teamwork and continuity of care. The Journal of Nursing
Administration, 38(3), 132-137.
http://dx.doi.org/10.1097/01.NNA.0000310721.28042.0b
Kalisch, B., & Schoville, R. (2012). It takes a team. American Journal of
Nursing, 112(10), 50-54.
http://dx.doi.org/10.1097/01.NAJ.0000421024.08037.0d
References
Manser, T. (2009). Teamwork and patient safety in dynamic domains of
healthcare: A review of the literature. Acta Anaesthesiologica Scandinavica,
53, 143-151.
Nance, J. J. (2008). Why hospitals should fly: The ultimate flight plan to patient
safety and quality care. Bozeman, MT: Second River Healthcare.
Spectrum Health website. (2013). http://www.spectrumhealth.org
Watson, J. (2008). Nursing: The philosophy and science of caring (Rev. ed.).
Boulder: University Press of Colorado.
Ways of working in nursing: Resource package. (2011). Retrieved from
http://www.health.nsw.gov.au/nursing/projects/Documents/wow-
resource.pdf
Westers, J. B. (2013a). Reflection journal one (Unpublished masters thesis).
Ferris State University, Big Rapids, MI.
Westers, J. B. (2013b). Reflection journal two. Big Rapids, MI: Ferris State
University.

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