In the event of an incident causing a large influx of inpatients into a healthcare organization, contingency actions outlining alternatives to usual staffing plans should be developed. The primary focus when implementing alternative staffing actions is patient safety. Alternatives to regular staffing plans will differ dependent upon the specific incident causing the influx, the organization’s complexity and services provided. The following are some general considerations when developing such actions.
Considerations:
Inventory current staff to determine skill set and competencies
Identify administrative staff who may be moved to patient care activities (educators, managers/clinical staff performing QAPI/Risk Management, etc.)
Ensure Orientation of alternative staff to assigned area
Orientation for patient and staff safety:
- Patient safety – what types of procedures/treatments/assessments expected within the given patient population
- Staff safety – specific safety codes, policies, etc.
- Rapid orientation focus on essentials for safe patient care
- Think focused (or mini) agency onboarding orientation
Cross-training of staff with the same clinical expertise to other (like) areas
- Critical care areas (CVICU to MICU, etc.)
- PACU to Critical Care/Critical Care to PACU
- Advance Practice Nurse to critical care areas as appropriate (e.g., CRNA to ICU)
Assignment of staff with the same level of licensure without the same clinical expertise, in specialty areas
- Must have oversight by specialty trained and competent staff member with same level of licensure
- Real-time training (preceptorship) likely necessary
- Team nursing model to leverage experienced staff
- Progressive care to Critical Care
- Clinic/outpatient staff providing care in the inpatient setting
- Medical/Surgical RN to areas where the medical/surgical skill set can be employed to supplement specialized staff
Assignment of staff with a different clinical scope or licensure or without certification to areas where care can be provided under supervision
- Aides/LVN/LPN
- LPN/CNA taking vital signs and reporting patient verbalization of condition to RN
- Staff member on unit requiring BLS or CPI training with certification – must have staff member available to unit with these certifications
- Other disciplines
Cohorting of patients to allow for care in a proximate environment
Extension of hours of work
Hiring temporary staff
Care by volunteer staff
- Volunteer staff with active out-of-state license
- Volunteer staff with inactive license
- Faculty staff (if teaching institution)
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