Excessive call offs from both Mental Health Technicians and the nurses

Problem Statement

            There is an emergent crisis at the Shalom hospital, where staff, especially mental health technicians and nurses, call off shifts at an increased rate. The issue aggravates further because they call off almost to the beginning of their shift or pull out during their shifts. This has led to inadequate staffing ratios, burnouts, and mandatory holding of available staff. The hospital records decreased success for better health outcomes, attributed to a lack of consistency in nursing care by former studies (Twigg et al., 2016). This problem relates to policy development and implementation at both hospital and state levels, which determines the staffing ratios, thus, resource management and health outcomes (McHugh et al., 2020). 


            Firstly, the shift coordinator, charge nurse, and staffing manager acknowledge the increased call-offs as a crisis. In a structured interview, they express their anxiety and lack of confidence that a particular shift will have enough staff to meet the recommended staffing ratio. Secondly, the ward operations reveal unattended patients, prolonged working period for present staff, physical tiredness, and disappointment from shift coordinator, charge nurse, and staffing manager. Besides, Stimpfel et al. (2012) found that nursing absenteeism leads to extended shifts for in-shift nurses and higher burnout levels to cause even more call off.


            Twenty units hold 27 patients, both male and female. They are under the care of 10 mental health technicians, two registered nurses, and one licensed practical nurse per unit. Patient demography reveals that three require one-on-one care, and three require continuous care depending on the unit they are admitted. The staffing ratio is below the recommendation by Massachusetts on staffing ratio; that is, more than one nurse for every two patients (Carlson, 2014).

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            The cause of excessive call-off concerns the lack of adequate permanent staff. The hospital heavily relies on agency nurses, who work on a call-on basis. Also, the agency staff does not even the recommended staffing ratio due to budgetary limitations. Staff who avail on shifts end up serving a prolonged period through a mandatory hold over policy when units are short-staffed. Also, the patients’ demography reveals volatile patients who need an increased level of attention. De Oliveira et al. (2019) explain that increased patient attention and care burdens staff both physically and increases work stress, thus requiring them to rests more often.

Proposal Solution

            This proposal suggests the following strategies through policy development and implementation based on the causes of excessive call-offs. First, the hospital increases the number of permanent staff. That will reduce the reliance on the agency and on-call staff program. It will also reduce agency nurses’ hiring costs since they are paid a higher rate per hour than permanent staff. Cutting the cost of hiring agency and on-call staff will help in boosting other hospital programs. Secondly, the hospital will have an employee’s assistance program that will cater to their mental health. It is noted from the hospital that burnouts, mental fatigue, and personal issues affect the performance of staff. This program will help combat workplace stresses that demotivate staff attendance or cause health issues like burnouts (de Oliveira et al., 2019). It will be free for permanent staff. Third, the hospital should abolish the mandatory hold over policy and encourage volunteer programs for staff into shifts. This may be done through incentive and appreciation programs, using funds saved from hiring agency staff. It is a critical strategy that will ensure attendance since staff will have paradigms that appreciate not being forced into certain roles. Forth recommendation entails organizing training for staff to care for volatile patients and ensure an assignment program that honors the minimum staff per patient. The training will ensure that staff interacts with volatile patients safely and that the experience does not affect staff well-being. Fifth, enact four hours call off policy, which will allow timely planning to fill in the staffing gap. Staff who violate this policy will be subject to disciplinary measures.

Resources and Cost Benefits

            The resources needed and cost-benefits will depend on each proposal recommendation’s strategic approach, as shown in table 1.

Addition of staffA shift-staffing sheetThis will have backup staff who will only attend a shift when the primary staff calls off, unlike the ordinal sheets.Reduce the cost of paying overtime to regular staff and on-call staff.
Employee’s assistance programResources portalThere will be a portal to access valuable resources to combat work place stresses on the hospital website and library. That will include the assistance program in which staff can enroll.Reduce staff injuries, and thus reduce insurance costs and cost for paying overtime and on-call staff.
Abolish mandatory hold overIncentivesThis will encourage staff to volunteer into attending shifts, in replacement for the mandatory hold over. Incentives will include gift cards, unit pizza parties, poster board to highlight improvements, unit reward fundReduce the cost of paying overtime to regular staff and on-call staff.
Four hours call off policyA staffing hot lineThe hospital will establish a communication system that will notify all relevant departments, especially the shift coordinator, charge nurse, and staffing manager when there is a call off.Reduce the cost of paying overtime to regular staff and on-call staff.



            The project will proceed immediately upon approval to achieve short-term and long-term goals. The short-term goals – four hours call off policy and abolishing the mandatory hold over shall be implemented within 60 days. This is regarded as ample time to assess the improvements in the call-offs. Concerning the long-term goals –  hiring more permanent staff and employee assistance programs shall be fully implemented between half to one year.

Key Stakeholders

            Key stakeholders for the implementation of this proposal include the unit manager who will ensure that all units are staffed adequately, the shift coordinator will ensure the staffing ration is maintained in all shifts, and the staffing manager who will schedule 300 permanent staff and 200 agency staff workers both MHTs and nurses. Mental health technicians will provide direct care to patients while nurses are responsible for delivering care such as medications, wound care, admissions, discharges, and supervise the MHTs.

            I will engage with all stakeholders to ensure a seamless implementation of the proposal. In preliminary engagement, I explained to the unit manager who works from 8 am to 4:30 am the effects of attending to volatile patients and how demotivating it feels to lack consistency to a particular unit. To the shift coordinator, I revealed how we had interacted when they pulled me to a shift, which had an emergency call off. We rarely encounter the staffing manager, but I highlighted the ongoing crisis due to excessive call-offs. I am inconsistent in engagement with fellow nurses and mental health technicians, who acknowledged the crisis. All stakeholders expressed their support for the recommendation regarding their roles. They would dedicate their human resource to ensuring the reduction of avoidable call-offs.

Implementation and Gauging success

            The hiring process for the hospital will undertake a sophisticated process since this is a state facility. This proposal’s success will be gauged before the end on one year to check if there is more than one nurse for every two patients per the state’s recommendation (Carlson, 2014). The unit manager will organize contests to assess the units with the highest attendance rate and laisse with management for an appreciation through the incentive program. This proposal’s success will be analyzed from attendance sheets, from which a score above 95% within 60 days will be considered significant. The shift coordinator will assign staff to relevant units and ensure training and support through the employee’s assistance program. A reduction in staff injuries related to volatile patients in one year will help gauge its success. Zero cases of stress, burnouts, or other work-related stress will mark ultimate success. The staff manager will also help in the employee’s assistance program and ensure an environment that encourages employees to discuss possible burnout issues or any mental health issue deemed affecting work performance. All staff will be kept posted about the project’s progress using emails, unit posters, and newsletters. More than 95% of staff engagement through this strategy in 60 days will reveal success in implementing the proposal.

Roles Fulfilled During This Exercise

            First, I took the role of a scientist to research and report about excessive call-offs. Through observation, I identified the problem and formulated a problem statement. Then interviewed relevant stakeholders and conducted a literature review to identify the causes of excessive call-offs. The interviews ensured confidentiality to ensure that staff views are appreciated and honored as required by the research ethics. I have lately developed a proposal for this problem. Secondly, I took a detective’s role to investigate all stakeholders’ relationships and excessive call-offs—this entailed gathering information from staff and observing the situation as a bystander. Lastly, I did fit into the roles of a manager of a healing environment. My nursing roles entail ensuring better health outcomes through nursing competency. Thus, I informed other staff about the crisis to motivate them to reduce unnecessary call offs, collaborated with management to stand shifts that had inadequate staff, and motivated burdened staff as we undertook our various roles.


Carlson, J. (2014). Mass. law would set ICU nurse staffing ratios. Modern Healthcare. Retrieved 1 November 2020, from https://www.modernhealthcare.com/article/20140627/NEWS/306279965/mass-law-would-set-icu-nurse-staffing-ratios.

de Oliveira, S., de Alcantara Sousa, L., Vieira Gadelha, M., & do Nascimento, V. (2019). Prevention Actions of Burnout Syndrome in Nurses: An Integrating Literature Review. Clinical Practice & Epidemiology In Mental Health15(1), 64-73. https://doi.org/10.2174/1745017901915010064

McHugh, M., Aiken, L., Windsor, C., Douglas, C., & Yates, P. (2020). Case for hospital nurse-to-patient ratio legislation in Queensland, Australia, hospitals: an observational study. BMJ Open10(9), e036264. https://doi.org/10.1136/bmjopen-2019-036264

Stimpfel, A., Sloane, D., & Aiken, L. (2012). The Longer The Shifts For Hospital Nurses, The Higher The Levels Of Burnout And Patient Dissatisfaction. Health Affairs31(11), 2501-2509. https://doi.org/10.1377/hlthaff.2011.1377

Twigg, D., Myers, H., Duffield, C., Pugh, J., Gelder, L., & Roche, M. (2016). The impact of adding assistants in nursing to acute care hospital ward nurse staffing on adverse patient outcomes: An analysis of administrative health data. International Journal Of Nursing Studies63, 189-200. https://doi.org/10.1016/j.ijnurstu.2016.09.008