I would like to visit the topic of working with limited resources as this has become the reality in all practice settings. As Covid numbers soar, healthcare professionals are faced with limited resources every day, staffing shortages are escalating across Canada coupled with higher patient intakes and acuity across all healthcare environments. At Solutions we would like to acknowledge the important role that you play during this time of unprecedented challenges. You have shown and continue to show great compassion towards your clients, their families and your communities.
We understand that you have significant concerns about safe nursing practice, and the challenges faced at every level in healthcare, today. It is important to remember that even in situation where you cannot provide optimal care due to circumstances beyond your control such as limited resources and increased workload, your ability to to provide essential care is paramount. Nurses and other healthcare professionals often feel that they are “putting their license at risk” when they are working with limited resources. In unpacking this, lets have a look at what our Registering Bodies have to say about working with limited resources.
From BCCNM ….
Nurses and midwives are responsible for providing the best care possible under the circumstances, setting priorities, using critical thinking and professional judgment, communicating with their employer and participating in efforts to improve client care. During this uncertain time remember that you are expected to follow your employer’s organization policies and procedures and seek out any relevant resources they may have available.
We’ve heard from registrants worried that a complaint may be brought against them for circumstances out of their control during this challenging time. Remember that complaints are not uncommon; some professionals need to address complaints in the course of their career. Each complaint is carefully assessed within the context of the practice environment. We encourage you to visit our complaints section to learn more about the process.
Our clinical team has put together a short video on managing clinical challenges when you are on assignment with Solutions Staffing Inc so that we may support you in your practice. Managing Clinical Challenges if you are unable to access this link, copy and paste the following address into your browser -https://youtu.be/7YL9GPPV3v8 Take the time to assess and gather your resources:
Collaborate with Colleagues, Identify who may be able to provide you with additional resources – Clinical Nurse Leader, Facility or Unit Manager, Solutions Clinical Team – Communicate in clear, concise language so that the listener can offer resources and guidance appropriate to your situation.
Although you may be working outside of British Columbia, the information provided by BCCMN is applicable to all areas of practice and this registering body has provided the following 10 tips for working with limited resources.
Situations where the need for health care is greater than the resources available may occur in any practice setting. In these situations, nurses and other healthcare professionals must provide care to the best of their ability given the circumstances. If you find yourself working with limited resources, here are 10 strategies to make the situation safer:
Assess and Set Priorities
- Identify and discuss client care needs requiring immediate or urgent attention with your colleagues.
- Quickly review clients, assessing specific concerns and immediate needs. Differentiate activities that are absolutely necessary from those that can be delayed. Modify clients’ plans of care and or delivery of care as necessary.
Collaborate and Communicate
- Review your assignment and caseload to determine how to provide care based on client needs. Decide what care can be safely delayed, eliminated or assigned to others. Determine if care can be provided in a different way by negotiating with other members of the healthcare team.
- Meet with your team members or colleagues to review the situation and discuss how and when you will communicate during your shift or work day.
- Inform clients, as appropriate, about changes in their respective plans of care and provide clear factual information about the care or services they can expect. For clients in the community, ensure that they are aware of what action to take or who to contact if their situation changes.
- Schedule a brief report or meeting part way through the day or shift to update each other and reassign care accordingly. In community settings, communicate at the end of the work day to highlight or identify clients requiring urgent follow up the next day.
- Communicate any changes in client conditions, as needed, with other members of the healthcare team.
- Decide if your supervisor/manager needs to be informed immediately about the situation. If so, clarify roles and responsibilities for resolving the situation.
Communicate and Document Patient Safety Concerns
- Document your concerns about the situation and provide a copy to your manager.
- Be prepared to work collaboratively with your manager to resolve these types of situations which promote safe, ethical and competent care.
Resolving Clinical Practice Concerns
Define the issue
- Identify the factors interfering with your ability to provide safe, appropriate care
- Discuss your concerns with knowledgeable people such as colleagues, managers, professional practice office staff, your Solutions Clinical Team
- Look for information such as BCCNM RPN Professional and Practice standards, CNA Code of Ethics, employer policies, legislation, collective agreements or employment contracts
- Communication is key. It’s important to inform the appropriate person (supervisor, coordinator, manager) when a lack of support or resources interferes with your ability to provide safe, appropriate client care.
Whether you are a direct care nurse or a nurse manager, documentation outlines your concerns.
- Use the standards to describe safety issues including care that could not be provided and/or possible client outcomes
- Be a specific as possible. General statements about clients being at risk, working short staffed/with limited resources, and being unsafe do not provide enough information to help others to address concerns
Work collaboratively with others to resolve these situations by suggesting strategies and supporting solutions that promote safe care.
- Identify your options and develop a plan.
- Implement the plan, evaluate it and change if needed.
Use Resolving Professional Practice Problems to help guide you through this process. If you’re facing an ethical dilemma, follow the ethical decision-making framework in the Duty to Provide Care practice standard.
Nurses in leadership roles are expected to review your concerns and take appropriate action. They are expected to use strategies that support the provision of safe, competent and ethical care such as:
- Reviewing the number and mix of qualified staff
- Developing and using effective contingency plans
- Limiting elective admissions and procedures
- Minimizing non-nursing duties for RNs
- Managing and supporting RNs in overcapacity situations
- Sharing staff and client care concerns with higher levels of administration
- Advocating for adequate resources to support client care