Staffing Needs

goal of staffing

provide appropriate numbers and mix of nursing staff to match actual or projected patient care needs to provide effective and efficient nursing care

managers role with staffing

must examine workload pattern for the designated unit, department, or clinic to determine needed staff

joint commission role with staffing

• identifies staffing expectations

• requires the right number of competent staff to be provided to meet patients needs based on organization-selected

why is scheduling difficult in nursing?

• doesnt fit traditional business 9-5 cycle

• erratic and unpredictable health care demand

• high level expertise is required 24/7

• stress of job requires balanced work recreation schedule

• staffing mix varies with acuity

centralized staffing

staffing decisions made by personnel in a central office or staffing center

strengths of centralized staffing

• provides organization-wide view of staffing needs, which encourages optimal utilization of staffing resources

• staffing policies tend to be employed more consistently and impartially

• more cost effective than decentralized staffing

• frees the middle level manager to complete other management functions

limitations of centralized staffing

• provides less flexibility for the worker and may not account for a specific workers desires or special needs

• managers may be less responsive to personnel budget control in scheduling and staffing matters

decentralized staffing

each department is responsible for its own staffing

strengths of decentralized staffing

• manager retains greater control over unit staffing

• staff can take requests directly to their manager

• providers greater autonomy and flexibility for the individual staff member

limitations of decentralized staffing

• can result in more special pleading and arbitrary treatment of employees

• may not be cost effective for organization bc staffing needs are not viewed holistically

• more time consuming for the unit manager

common scheduling options in health care organizations

• 10 or 12 hour shifts

• premium pay weekend work

• part time staffing pool for weekend shifts and holidays

• job sharing

• supplemental staffing from outside registries and float pools

cyclical staffing

• allows long term knowledge of future work schedules bc a set staffing pattern is repeated every few weeks

• allows nurses to exchange hours of work among themselves

shift bidding

allows nurses to bid for shifts rather than requiring mandatory overtime

scheduling alternatives

• agency nurses

• travel nurses

• flextime

• self scheduling

• float pools/staff

flextime

• work system that allows employees to alter their start and end times while still working a full, standard number of hours

• ex: paid to work 30 hours/week but can sometimes go up to 40hours/week

float staff

they must be able to perform core competencies of the unit they are floating to meet their legal and moral obligations as caregivers

closed unit staffing

occurs when staff members on a unit make a commitment to cover all absences and needed extra help themselves in return for not being pulled from the unit in times of low census

staffing by acuity

• grouping of patients according to specific characteristics

• hours of nursing care assigned for each patient classification

• ongoing review is critical

types of patient classification systems (PCS)

• critical indicator PCS

• summative tasks PCS

at the national level, use of a PCS is a condition for participation in Medicare and is required by the Joint Commission for certification.

critical indicator PCS

uses broad indicators such as bathing, diet, IV fluids, meds, and positioning to categorize patient care activities

summative task PCS

requires the nurse to note the frequency of occurrence of specific activities, treatments, and procedures for each patient

as RN hours decrease in NCH/PPD…

adverse pt outcomes increase such as increased med errors, pt falls, decreased pt satisfaction with pain management

mandatory overtime

• employees are forced to work additional shifts often under threat of patient abandonment

• has even more devastating short term impact in terms of staff perceptions of a lack of control and its subsequent impact on mood, motivation, and productivity

• should be last resort not standard operating procedure bc an institution does not have enough staff

organizational staffing policies

1. sick leave

2. vacations

3. holidays

4. call offs for low census

5. on call pay

6. tardiness and absenteeism

7. shift work

examples of employee staffing policies

• name of person responsible for staffing schedule

• type/length of staffing cycle used

• rotation policies if shift rotation is used

• fixed shift transfer policies

• time and location of schedule posting

• when shift begins and ends; day of week schedule begins

• weekend off policy; tardiness policy

• low census procedures

• absenteeism policies

• policy for trading days off; days off request procedures

• policy regarding rotating to other units

• procedures for vacation time and holiday time requests

• procedures for resolving conflicts regarding time off

• emergency request policies

• transfer request policies

• mandatory overtime policy