Implementation Plan – Short Staffing in the ED in Order to Affect the Patient Satisfaction

The development of the implementation plan is a necessary step to guarantee the further effective implementation of the proposed solution to the problem of staff shortages in facilities. Emergency Departments (EDs) in hospitals are often overcrowded, and it can lead to the problem of patient dissatisfaction if the department is short staffed (Chan, Killeen, & Vilke, 2012, p. 547). To overcome the problem, the approval of the facility’s leaders and staff is important to support the implemented project. This paper aims to provide the plan for implementing the solution to the nursing staff shortages in the ED with the focus on the detailed description of the approval procedure, problem, proposed solution, rationale for the selected solution, evidence, implementation logistics, and resources.

Methods of Obtaining the Approval

The approval of the organization’s leaders and fellow staff provided for the project planned to be implemented in the facility is important because of the necessity to integrate the project implementation within the regular work of the ED. The first step is the consultation with the ED leaders, administrators, physicians, and nurses on the problem of staff shortages to propose the effective solution for the implementation. This stage is associated with the informal approval to receive the necessary support of the leaders and staff. The second step in the process of obtaining the approval is the discussion of the implementation plan’s first draft. The final draft needs to be prepared based on the administrators’ comments and then proposed for signing and using as the project plan. The stage of the formal approval will include filling in protocols regarding the ethical issues observed during the project.

Description of the Problem

Staff shortages in EDs usually cause the high levels of patients’ dissatisfaction because persons do not receive the necessary and appropriate assistance in time (Horwitz, 2010, p. 134). As a result, it is possible to assume that nurses in fully staffed EDs and facilities can provide patient with the more effective care than nurses in short staffed ED rooms, while causing different levels of satisfaction in patients (Burström, Starrin, Engström, & Thulesius, 2013, p. 96). The ED where the project is planned to be conducted can be described as short staffed now. The nurse-patient ratio is not correlated with the ED requirements to guarantee the effective delivery of the care for patients. The level of the patient satisfaction can be discussed as low in comparison with the data for the periods when the ED was fully staffed. Thus, it is possible to speak about the association between staff shortages and patient satisfaction in the ED. The change needs to be implemented in the ED staff scheduling in order to overcome the identified problem. Currently, the scheduling is highly regulated and rule-based.

The Proposed Solution

The solution to overcome the problem of short staffing in the ED is based on changing the approach to nurse staff scheduling. Thus, it is important to change the rule-based scheduling with the self-scheduling. The procedure will depend on using the online scheduling tool by nurses who have the authorized access to the schedule planning file and can make changes in it. In order to avoid short staffing during different shifts, nurses are expected to sign up for the desired number of 12-hour shifts during the four week period. The nurses will be able to plan their schedules independently, while addressing the regulations, parameters, and rules and guaranteeing flexibility. In spite of the hour limits for the shift, nurses will be able to control their time during a week and sign up for the extra shifts according to their capacity. The system will allow controlling nurse-patient ratios to avoid short staffing and long waiting times.

Rationale for the Proposed Solution

The focus on self-scheduling is an effective approach to overcome staff shortages in the ED. While planning their shifts individually and placing the preferable number of shifts and dates to the organization’s scheduling system, nurses have the opportunity to sign up for the open shifts while covering the number of available shifts and agree to sign up for the extra shifts. As a result, the problem of short staffed shifts will be overcome because of the focus on more flexible and predictable schedules. In order to guarantee the patient satisfaction in EDs and reductions in waiting times, the number of nurses in the EDs needs to be adequate (Oredsson, Jonsson, Rognes, & Lind, 2011, p. 44). Self-scheduling is effective to guarantee the presence of full staff in the shift, as a result, the level of absenteeism decreases along with the waiting time for patients (Dent, 2015, p. 44). In addition, self-scheduling is appropriate to prevent extended work shifts that cause fatigue in the staff. Furthermore, self-scheduling can be discussed as the least expensive strategy to guarantee the presence of the full staff in EDs in order to increase the quality of care and reduce the waiting time (Stimpfel, Sloane, & Aiken, 2012). The reason is that the self-scheduling online system can be integrated into the current electronic system used by administrators to set shifts according to parameters (Wang, 2013, p. 4). The positive result of such approach is the improved nurse staffing and appropriate ratios of patients to nurses in the ED.

Implementation Logistics

The implementation of the solution will be realized in several stages. The first stage is the planning of the self-scheduling system integration as a pilot. The details of the integration need to be discussed with the administrators of the ED. At this one week-long stage, the system requirements are determined in cooperation with Nurse Administrator. The third stage is Integration and Configuration of the System. At this stage, Nurse Administrator determines the information that needs to be included in the schedule protocol, specifies staffing and scheduling parameters on which the self-scheduling will be based, and determines regulatory parameters. IT Specialist is responsible for integrating these parameters and protocols in the Intranet system currently used in the hospital in order to provide all the nurses with the equal access to the electronic scheduling tool. Training of the nurse staff on the use of a self-scheduling tool is expected to be conducted by Nurse Administrator during the third week of the project implementation, when the tool is tested by IT Specialists.

The next stage is Deployment, during which nurses are planned to actively use self-scheduling to set shifts. This stage will last four weeks. Nurse Administrator and Emergency Department Manager are planned to be responsible for monitoring this stage in order to report possible weaknesses in the system. The overall implementation process will be overseen by Emergency Department Manager who is responsible for the evaluation of the implemented solution at the final stage of the project development (Table 1).

Table 1. Timeframe for the Project Integration

Stage Week 1 Week 2 Week 3 Week 4 Week 5 Week 6 Week 7 Week 8 Person Responsible for Completion
Planning Nurse Administrator
Integration and Configuration Nurse Administrator and IT Specialist
Training Nurse Administrator
Testing IT Specialist
Deployment Nurse Administrator,
ED Manager
Evaluation ED Manager

Resources Required for Implementation

Focusing on the nature of solution and on the proposed implementation plan, it is possible to determine the human and material resources required for the effective implementation of the self-scheduling tool in the ED. The staff required for the effective implementation of the online self-scheduling tool includes IT Specialists for integrating software and guaranteeing the interoperability of the systems’ components. The participation of Nurse Administrator is also the important condition to ensure that the requirements of the ED are met and all the necessary parameters are addressed. Furthermore, Nurse Administrator is responsible for conducting training sessions for the ED nursing staff.

Educational materials for training sessions include PowerPoint presentations describing the challenges of short staffing in the ED in association with the patient satisfaction and handouts providing the step-by-step instructions for using the online scheduling tool and making changes in the schedule according to the parameters and within the set timeframe. Assessment tools will include questionnaires separately developed for nurses and patients. Questionnaires for nurses will examine the situation before the intervention and then assess changes in the nurse staff’s experiences in relation to work and life balance, flexibility, job satisfaction, productivity, burnout, and performance. Questionnaires for patients will aim to represent patients’ visions of efficiency of the nurse care in the ED before and after the intervention to compare the results for the short-staffed and fully-staffed settings.

The technology required for the solution integration is the software for online self-scheduling. The program should guarantee the authorized access for the nurse staff to the schedule and allow them to correct the schedule. The necessary hardware includes two additional tablet computers for the ED in order to allow nurses fix changes in the schedule in cases when personal computers or laptops in the Nurse Office or at Nurse Stations are not available. The project will be funded by the hospital authorities as the part of the management program. The overall costs will include costs of technology and costs of educating the nurse staff (Table 2). Nurse Administrator and Emergency Department Manager are expected to be responsible for overseeing and evaluating the change in the ED.

Table 2. Planned Costs

Category Costs
  1. Tablet computers (2)
  2. Software integration
Staff Training
  1. Printing handouts
  2. Printing questionnaires
Data Analysis
  1. Packages for the data analysis
Total $880


The proposed solution aims to overcome the problem of short staffing in the ED in order to affect the patient satisfaction levels. The implementation of the self-scheduling approach and tool will be effective to examine the relationship between the factors of short staffing and full staffing as influential for changes in the patient satisfaction. The focus on gathering the data before and after the intervention is important to guarantee the collection of the appropriate information in order to conclude about the possible correlation.


Burström, L., Starrin, B., Engström, M., & Thulesius, H. (2013). Waiting management at the emergency department – a grounded theory study. BMC Health Services Research, 13(1), 95-102.

Chan, T., Killeen, J., & Vilke, G. (2012). Effect of mandated nurse–patient ratios on patient wait time and care time in the emergency department. AEM, 17(5), 546-572.

Dent, B. (2015). Nine principles for improved nurse staffing. Nursing Economics, 33(1), 41-45.

Horwitz, L. (2010). US emergency department performance on wait time and length of visit. AEM, 55(2), 133-141.

Oredsson, S., Jonsson, H., Rognes, J., & Lind, L. (2011). A systematic review of triage-related interventions to improve patient flow in emergency departments. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 19(2), 43-52.

Stimpfel, A., Sloane, D., & Aiken, L. (2012). The longer the shifts for hospital nurses, the higher the levels of burnout and patient dissatisfaction. Health Affairs, 31(11), 2501-2509.

Wang, X. (2013). Emergency department staffing: A separated continuous linear programming approach. Mathematical Problems in Engineering, 2(3), 1-9.

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