80/20 Staffing Model Pilot Project in a Newfoundland and Labrador Long-Term Care Facility

Newfoundland and Labrador

Newfoundland and Labrador has the oldest demographic in Canada, due in part to the outmigration of younger adults. As a result, the needs of the growing population requiring gerontological care is not being met with a similar influx of qualified care personnel, particularly nurses.

Although RNs are paid at parity with RNs working in acute care, it is harder to recruit and retain them in the long-term care (LTC) sector. In LTC, the average age of the province’s RNs is 48, compared to 42 in acute care. RNs working in this area need to broaden their scope of practice and take on stronger leadership roles, in part due to the increasing importance of LTC, and the expanding complexity and type of interventions it requires.

Recognizing these issues, the Newfoundland and Labrador Nurses’ Union, the Newfoundland and Labrador Department of Health and the Central Regional Health Authority (CRHA) proposed the adoption of an 80/20 RN staffing model, an idea developed by the University Health Network in Toronto. (Bournes and Ferguson-Paré, 2007) This model has been shown to enhance nurse satisfaction and respond to calls for patientcentered care.

Carmelite House (CH) was chosen as the implementation site for the project. The 64-bed LTC facility is located in Grand Falls-Windsor, a town of about 15,000 in the Newfoundland interior. The 80/20 staffing model at CH provided project participants with the opportunity to spend 80% of salaried time in patient care and 20% in various professional development activities such as distance-based learning and clinical skills training.

Project Objectives: 
  • Provide the time for RNs to develop leadership and clinical skills, engage in workrelated activities, and enhance a residentcentered environment
  • Improve the measured indicators of job satisfaction at the project site
  • Increase capacity for RN leadership, training and support within an LTC facility
  • Enhance the profile of LTC as a desired area of practice
  • Increase the RN retention rates in LTC facilities
  • Increase evidence-based research of 80/20 RN models in LTC
Project Implementation: 

Six RNs and one LPN participated in the project. During the planning phase, the project coordinator conducted an assessment to identify how the 20% time would be best utilized based on the needs of the participating nurses. Educational resources and supports were then developed. A similar-sized LTC facility within the CRHA was selected as a comparator site for the pilot project.

The 80/20 model was implemented in two six-month phases. In Phase One, three participants engaged in a distance-based university course, one completed a post-basic gerontology diploma program, two attended the 5th Canadian Conference on Dementia and one developed a falls prevention program for CH. In Phase Two, two participants continued work on distance-based university courses, one participant worked on a Diabetes Educator diploma and the LPN participant worked on courses to transition into a Bachelor of Nursing program. Four participants continued work on developing a palliative care policy for CH. This policy was very timely as the CH opened a palliative care suite which is utilized by the community palliative care program. In addition, participants were able to attend a variety of conferences and workshops including: a palliative care seminar, the 2010 Nursing Leadership Conference, a provincial palliative care conference, a skin and wound care conference, a foot care course and a seminar entitled “A Closer Look at Long-Term Care.”

Project Outcomes: 
  • 100% of participants expressed high satisfaction with the 80/20 staffing model project
  • Staff expressed an increased interest in further educational opportunities
  • Nurses are bringing new knowledge back to their units and are using it to improve the workplace and patient care
  • Upon completion of the project, four of the participants expressed an interest in registering for the distance-based Post-Basic Program in Gerontology for RNs
  • The LPN participant is continuing courses to transition into a Bachelor of Nursing program
  • The nurse who took the falls prevention course developed a high-risk falls assessment and a falls prevention program (FPP) for Carmelite House which was presented to the regional committee and integrated into a regional falls prevention program.
  • The evaluation findings of the project will increase evidence-based research of 80/20 staffing models in LTC
  • A program proposal has been developed for submission to the Department of Health for the implementation of an 85/15 staffing model project to be delivered in six sessions lasting four months each