Process for Escalating Staffing Decisions. Staff with concerns about their patient care assignment or unit staffing should address concerns with the charge nurse. Staffing and workload issues should be addressed promptly by the charge nurse at the time of occurrence, and may be resolved through resources such as adjustments in assignments, the use of other staffing resources (e.g., per diem nurses, float staff, agency nurses), adjustments to work loads, adjustments to work schedules, or other resources. The charge nurse may adjust staffing levels to meet patient care needs. To assist in addressing a staff nurse’s immediate concern, the charge nurse shall have the authority to take the steps outlined below, which will be summarized in an algorithm made available to all units: Take the concern to the Administrative Nursing Supervisor, the Nursing Resource Office as well as place phone calls and/or text staff to obtain additional resources; Consult the Administrative Nursing Supervisor to call an ad hoc charge huddle if appropriate; Contact the manager (manager on call or designee) for additional assistance Escalate urgent, unaddressed concerns up through the Director or Administrator on call. (See Escalation of Immediate Staffing Concerns algorithm Appendix L) Director or Administrator on call will consider resolving staffing concerns including delaying admissions and elective procedures and surgeries and/or reallocating patients (i.e. treating and transferring), as well as management assisting with patient care Administrative Nursing Supervisor will communicate progress reports back to the unit charge nurses throughout the escalation efforts as well as report the outcomes so that campus staffing committees can do a learning look back. A nurse who remains concerned after having taken the foregoing steps may fill out a Staffing Variance form. If the nurse believes the Unit Based Staffing Committee has not sufficiently addressed the staffing issue, the nurse may advance the staffing issue to the Campus Based Staffing Committee for review. Nursing leadership will develop a staffing escalation tracking tool to be reviewed at Campus Based Committees. Nurses will not be counseled, disciplined, and/or retaliated against for appropriately escalating staffing concerns.
