The 10-Hour Schedule: The Journey to Creating a Work-Life Person-Centered Care Balance

Purpose: Burnout and compassion fatigue, compounded by national staffing shortages, increasing workloads, personal and professional demands, and national safety incidents (workplace violence) are currently plaguing the nursing workforce and environments. These issues negatively impact recruitment and retention efforts, further worsening the shortages. They have resulted in a call to action to innovate workflows and schedules and provide work-life balance for nursing staff. Crabtree-Nelson et al. (2022) identifies the consideration and use of innovative workflows and schedules to combat burnout, fatigue, and compassion. Additionally, person-centered care improves the patient experience and has been directly linked to access to care and health equity efforts. Meeting patients where they are and providing them access based on their own schedules also enhances trusting nurse-patient partnerships and supports adherence to self-care regimens. A panel of stakeholders reported actionable priorities to improve access to care and continuity, including care coordination and optimized visit schedules. Finally, elevating nurses to work at the top of their license while supporting their professional growth and development also produces a need to evaluate team-based schedules with extended hours. In fact, flexible work schedules which include shorter work weeks and a scheduled day off have been shown to directly influence recruitment, retention, performance, and productivity and have been linked to positive work and family life balance.
Description: The nursing leadership team provided a justification to executive leadership for the proposed schedule change, obtained nursing staff buy-in to update team schedules, and collaborated with provider leadership for simultaneous updates to provider schedules. The RN and provider team schedules changed to 10-hour days, which provided extended hour coverage and increased both access to care and continuity. The entire care team worked the same schedule, had the same administrative time to complete patient-centered medical home (PCMH) requirements (pre-visit planning, care planning, and patient portal/ lab follow-ups), chronic disease follow-ups, and time for wellness activities. The care team worked the same Saturday schedule and had the same scheduled day off during the week. Due to the success of the care team schedules, the chronic disease RN schedule was also updated to 10-hour shifts to mirror their assigned care teams.
Evaluation/outcome: Improved collaboration and cohesiveness between care team members improved quality of care and care outcomes, as evidenced by meeting and exceeding chronic disease SMART targets and successful implementation of evidence-based projects. Increased access to care, continuity of care, and improved health equity with extended hours and care by the patient’s care team. Provided time and opportunity for team-based learning such as PCMH and team-building exercises, enhancing communication and collaboration between team members. Supported personal and professional growth and development, as evidenced by nursing and ancillary staff enrollment in academic programs. Decreased absenteeism. Enhanced desirability to work in a practice setting which provides work-life balance as verbalized by RN applicants and incumbent staff members.
Learning outcomes: At the end of the presentation, the learner will understand the impact of burnout, compassion fatigue, and workplace demands on nursing staff and care quality; identify one innovative measure which can be implemented to support work-life balance; and identify one positive person-centered outcome of innovative workflows.