Blog WSH

CEO Staffing Plan

This past Thursday (4/23/15) the CEO of WSH released a new staffing plan to the Joint Nurse Staffing Committee (note: the CEO is NOT a licensed clinician nor a member of the Joint Nurse Staffing Committee).  It is very important to note that the CEO was provided a staffing plan BY the Joint Nurse Staffing Committee which (in violation of Article 40.5) was never responded to in writing PRIOR to submitting his own staffing plan.  By DSHS having the CEO submit a staffing plan prior to providing a written response to the Joint Nurse Staffing Committee staffing plan was a clear Unfair Labor Practice and an intent to restrain and coerce employees from exercising the collective bargaining right to develop a staffing plan through the Joint Nurse Staffing Committee process as is clearly defined under Article 40.   

The CEO Staffing Plan was provided as an Excel Workbook that indicates a vast reduction of licensed staffing on all wards to a level that would create a unaccredited custodial care facility.  The level of licensed staffing in the CEO plan would eliminate Federal funding and Joint Commission accreditation.  Each ward at Western State Hospital holds approximately thirty patients.  The proposal apparently eliminates one full time RN2 per general ward and creates one part time RN2 position in its place to cover for weekends.  The same format applies to LPN’s.  There is no plan for other than intermittent part time RN2’s to cover for scheduled and unscheduled absence (and apparently daily breaks).  Thus each RN2 would be personally responsible for the liability of thirty patients throughout the shift without having a second RN2 relief person available to cover for breaks and lunch.  The same would apply to LPN’s.  Thus only two licensed personnel would be present on each ward (and each shift) for three quarters of a shift if breaks and lunch are taken into consideration…  Thus for two hours during each shift, high alert medications such as insulin cannot be legally given, and for a twenty-four hour period six hours a day per ward high alert medications could not be legally passed.  For six hours per day, physician orders could not be carried out by nursing personnel.  This places the credentials of the physicians, registered nurses, and licensed practical nurses at risk.  Please take time to review the CEO staffing plan.  

The CEO Staffing Plan runs completely in the opposite direction of the Joint Nurse Staffing Committee submitted plan and what the Western State Hospital Staffing Model had indicated using the most accurate statistics available.  The WSH Staffing Model can be used to crunch the numbers provided by the CEO Staffing Plan, what emerges is that the fact that the CEO has zero understanding of clinical care requirements that are present at Western State Hospital.  

In a recent blog entry I outlined what the WSH Staffing Model had indicated.  The interesting thing is that the staffing model accurately indicated all staffing trends including the number of unscheduled absence and scheduled absence that occurs daily based on months of data.  Vacancies of licensed staff are now increasing quickly as a result of private sector wages and benefits which DSHS can no longer compete with.  A market adjustment in wages will be required to retain physicians, registered nurses, as well as licensed practical nurses.  The CEO nor DSHS has asked for a market adjustment to maintain recruitment and retention.   In fact, I was present at the Legislative hearing where the CEO denied that WSH required ANY additional staffing to address the massive overtime costs that were occurring.  

Facts will always speak for themselves.  Western State Hospital statistics cannot be argued with.  Western State Hospital requires a competent leader as well as DSHS Administration for State Hospitals. A change in leadership is required to prevent more extensive damage than has already been done.  

For 1199NW, file unfair labor practice charges immediately.  For the Joint Nurse Staffing Committee, run the CEO’s “plan” through the staffing model using the most recent statistics and wait for the CEO’s written response for your staffing plan as is required by the Collective Bargaining Agreement.  

In order to get the most accurate information the following data must be obtained:

  1. Identify the average number of direct patient care Full Time Equivalent positions for RN2’s, LPN’s/PSN’s, and MHT/IC/PSA’s from March 2014 to March 2015. [This number identifies an average fixed number of positions that perform full time direct patient care duties.  This number is not influenced by part time personnel and on-call personnel.]
  2. Identify the average number of full time ward direct patient care providers that report to work daily from March 2014 to March 2015. [This number establishes for x-number of full time positions what amount of those full time positions report to work daily for a period of a year.  This takes all factors into consideration like vacancies, scheduled and unscheduled absence, training, etc.]
  3. Identify the average number base number of staff required to provide care for a 24 hour period from March 2014 to March 2015.  [One year of statistics will provide the average number of staff required daily to 24 hours of care at WSH.]
  4. Take the average number of full time ward personnel that reported to work daily (2) and subtract the average number of staff needed daily to provide base staffing (3).  If the number is a negative, this indicates a staffing deficit or the average number of staff per day that require supplementation.  A positive number would indicate a staffing surplus.  
  5. To determine the EXACT number of full time positions required to meet base staffing needs, you divide actual average number of full time direct patient care positions that are funded for each ward (1) with the average number of full time direct patient care positions that report to work daily…  This number gives you the multiplier (a correct ratio/proportion [FTE to daily staff]) that is needed to determine the number of FTE’s required to remedy the daily deficit or surplus of staff.  Our staffing model indicated an 89.63 daily staffing deficit.  Our total ward level FTE’s (1) was 756. Our average daily staffing was 381.37.  756/381.37=1.982   If you take the staffing deficit 89.63 and multiply by 1.982 you get 177.7 additional full time positions that are needed to maintain base staffing. [To explain further… Each full time position works five days in a seven day week… The variables are scheduled and unscheduled absence, position vacancy (recruitment and training).  The only way to measure these variables is to take a defined period of time and determine a daily average worth of a full time position.]

I hope the above information did not put you to sleep…  This is the process that needs to be done to give EXACT numbers of full time positions that are required to perform care at base staffing levels taking all factors including training into consideration.  Utilizing this process ELIMINATES negotiation.  It will detect surpluses AND deficits of staffing.  The reason the union opposed this approach was because facts do not lie and are not subject to politics or political pressure.  DSHS opposed this approach because nobody within DSHS had any concept of how to perform this equation until it was pointed out to them, and the number of staff that Western State Hospital was deficit was an indicator of incompetence in leadership.  To be fair, there was severe incompetence demonstrated by both the Union as well as DSHS Administration.  We need cold hard facts to determine staffing needs, not politics.

The daily metrics that are currently being used to measure performance at WSH are close to worthless.  ALL metrics must relate to a daily average for a set period of time.  Unscheduled absence must be measured as a daily average and scheduled absence must be measured as a daily average.  Average daily attendance would be the key performance indicator.  Average daily staffing deficit/surplus should be updated monthly and published.

Western State Hospital currently does not have a full time Medical Director through actions taken by DSHS Administration…  DSHS chose to not extend the Medical Director’s contract after there was a no confidence vote taken against the CEO by the physicians.  DSHS Administration placed the PERT team outside of Medical Director oversight.  DSHS Administration created Unit Directors that operated outside of Medical Director clinical chain of command and oversight.  In each of these cases the CEO created management structures that operated outside of WSH Medical Bylaws.  Each of these structures that were created outside of WSH Medical Bylaws represent positions that could be completely eliminated and would result in an improvement of productivity and reduction of budget that could be put towards correcting the direct patient care staffing deficit.

I call for an audit of ALL Western State Hospital chain of command structures that operate outside of the Medical Director chain of command (report directly to the CEO).  Since the current CEO assumed authority, determine how many direct patient care positions have been created or eliminated versus how many administrative/management positions were created or eliminated (full time positions, not part time positions although part time positions should be accounted for also).  Then determine how many direct patient care positions received raises versus administrative/management positions by direct action of the CEO.  The numbers will speak for themselves.

I would recommend that the next Western State Hospital CEO be a clinical professional that has at least some remedial understanding of clinical care processes and standards of care.  The previous interim CEO of Western State Hospital had these qualities and vastly improved the level of care provided by Western State Hospital through her understanding and actions in the short months she performed her duties.    

What is Senate Bill 6098?

Please take the time to review Senate Bill 6098.  It is a unique document pertaining to collective bargaining.  Take time to read the document.   I personally do not know the impact that this document may have upon State employee wages. The system is currently broken…  But is this the fix?  

“Feasible financially for the state" means the sum of the general fund and related funds cost of the collective  bargaining agreements negotiated under the authority of this chapter, 38 RCW 41.56.026, 41.56.028, 41.56.029, 41.56.510, and 74.39A.270 does not exceed the most current estimate of state financial resources for 40 p. 2 SB 6098 the term of the agreement.

Overtime at WSH

Take time to review the newly generated Western State Hospital overtime document.  See smaller rendition of the document below:

For the past months at Western State Hospital all education classes and competency reviews had been cancelled.  Supervisors were tasked to work out of their job classes as a “body” on the ward in lieu of retaining required overtime to provide quality care.  

As a result no correction plans met their due dates and all wards operated at less then base staffing because supervision did not essentially exist for direct patient care personnel.  RN3 supervisors never knew what duties they would be required to perform on any given day.  If an RN3 was not working as a “body” on a ward, the RN3 was often covering six or more wards on a unit.  All productivity stopped while skewed overtime statistics were generated.  Now you can view the skewed statistics that Western State Hospital Generated.

Western State Hospital has recently been on a hiring spree for intermittent personnel that only work several days per week rather than address the ACTUAL problem of having too few full time positions to meet the current patient care needs within the hospital.  We are now encountering a huge shortage of Registered Nurses, which is the reason WSH has been unable to open new wards to expand psychiatric beds…  Along with the current physician shortage.  RN’s and physicians require a market adjustment in wages to compete with the Federal Government as well as the Private Sector, the figure that is required is over 20%.

As the former Co-Chair of the Joint Nurse Staffing Committee, I am aware of the following facts:

  • WSH has a total of 756 full time funded direct patient care nursing positions.

  • Based on eight months of statistical data, 756 full time positions results in the average staffing per day of 381.37 staff (taking all components into considerations such as scheduled absence, unscheduled absence, vacancies, and training).

  • Based on eight months of statistical data, a total of 471 staff are required daily to meet minimum staffing levels.  The total daily staffing deficit is 89.63 per day.

  • Based on eight months of statistical data, taking into consideration that it takes 756 full time staff to produce 471 staff per average day, we can calculate that it will take an additional 178 full time positions to produce the additional 89.63 staff per day to null out all overtime use if ALL factors are taken into consideration.

  • Western State Hospital currently has 27 wards that operate on three different shifts.  Thus an additional 2.19 full time positions per ward per shift would be required to null out overtime taking all factors into consideration.

  • Based on high risk medication policy, three licensed staff are required for each ward and each shift to be able to provide medications throughout a shift taking breaks and lunch into consideration.  Under the current staffing configuration WSH will require an additional 90 RN2’s (81 RN2’s to bring one additional RN2 to each ward and each shift and an additional nine RN2’s to provide three full time RN2’s per ward per shift).

  • The additional staff above the 90 additional full time RN2 positions will be 9 LPN2’s and 79 mental health technicians.

  • Staffing models indicate that current WSH staffing levels can only support five staff per ward on day and evening shift and four staff per night shift for seven days per week (average staffing).  Current base staffing levels average six per ward for day and evening shift (some as high as eight), base levels of staffing for nights averages five.

You are free to check out the numbers in the staffing model that was created for Western State Hospital using the most current data.   

For any Legislators that are viewing this data please ask the following:

  • Did DSHS ever ask for an additional 178 FTE’s to null out overtime in order to meet current clinical requirements of care?  (Or 2.19 additional FTE’s per ward per shift)

  • Did DSHS every convey the need for a market wage increase for RN’s and physicians of over 20% to be able to recruit and retain from the Federal Government and the Private Sector?

  • Did DSHS use “collective bargaining” to group Physicians and RN’s into categories of just being another DSHS employee in importance?

I would ask any Legislator to seek the actual number of RN’s and Physicians that are employed within DSHS.  I would ask that Legislators seek the current recruitment and retention number of RN’s and Physicians.  You will note that RN’s and Physicians constitute a very small minority of all employees within DSHS.  But RN and Physician coverage is critical to maintain accreditation and Federal funding.  

I must state for the record, if the above factor was taken into consideration and addressed by the Senate…  Collective Bargaining and its shortcomings would be appropriately addressed by rejecting the wages proposed within the labor contracts that were negotiated.  

Please look at the facts and crunch the numbers.  

© Paul Vilja 2017