Class 19: Workload measurement and staffing

Staffing

Determining how many and what type of staff are needed to provide safe patient care.

Having the right people for the job

Scheduling

Planning when staff will work to meet staffing needs.

Making sure the right people show up 

Consequences of understaffing

• Increased patient errors (medication mistakes, missed care)

• Longer patient wait times

• Reduced quality of care

• Burnout and stress for staff

• Higher absenteeism and turnover

• Lower patient satisfaction

• Safety risks (falls, infections, complications)

Patient factors impacting workload and staffing

Acuteness of patients illness

Age 

Primary diagnosis 

Comorbidities 

Treatment stage

Patient classification systems

Typically use both:

Prototype evaluation system

Factor evaluation system

Prototype evaluation system

Generalized care plan (neuros, vitals etc)

A simple ranking system where jobs are compared to a “prototype” or benchmark job. Jobs are rated as better, worse, or similar to the prototype.
Example: An RN role is compared to a benchmark med-surg RN position to determine relative value for pay or staffing.

Factor evaluation system

A detailed point-based system that evaluates jobs based on specific factors (e.g., skills, effort, responsibility, working conditions). Points are totaled to rank jobs.
Example:
An ICU RN’s role is scored on knowledge required, complexity, decision-making, and working conditions to decide compensation level.

Factors to consider for staff mix decision making framework

Client (Health care needs, community, acuity etc)

Staff (How many RNs, LPNs, PCAs etc)

Organizational (nursing care delivery model, environment, leadership…)

STaff mix decision makiing framework

Plan

Assess

Impliment 

Evaluate

Staff mix decision making framework guiding principles

1. Base decisions on client health needs 

2. Base decisions on nursing care delivery model and evidence 

3. Sustain implementation with organizational components and leadership

4. Involve direct care providers and nursing management 

5. Make decisions wityh the supprortnof information systems 

Staff mix decision making framework outcomes

Client: Safety/quality of care, QOL, Satisfaction continuity of care and provider

Staff: Satisfaction, engagement, work-life balance, overtime, absenteeism etc

Organizational: Evidence informaed practice, Acess, Safety/quality of care etc

Factors impacting staffing needs

Projected units of service and populaiton needs(increased acuity, fluctuates, hours of care)

Historical staffing requirements 

Effectiveness of current staffing plan

Trends in acuity on unit 

Anticipated skill mix 

Experience and education of staff

New staff, programs, or technology 

Patient outcomes 

Educational updates 

Master staffing plan variables

Hours of operation

Shift length

Activity patterns (more staff on days)

Maximum work stretch

Shift work requirements

Weekend requirements

Personal and professional requirements and time off

Master staffing plan

A long-term plan that outlines how many staff are needed, what types of staff, and when they are needed to provide safe patient care.
It guides scheduling by planning staffing needs based on unit workload, shift patterns, and time-off requirements.

Models of scheduling

Decentralized scheduling

Centralized scheduling

Staff self scheduling

Decentralized scheduling

Scheduling is done on the unit by the nurse manager or charge nurse.
Key Point:
More flexible and personalized for staff.

Centralized scheduling

Outside staffing office creates schedule for multiple units
Key Point:
More consistent and fair across the organization. 

Can be inefficient bc dont know staff 

Staff scheduling

Staff create their own schedules within guidelines, then the manager approves.
Key Point:
Promotes autonomy and increases staff satisfaction.

Evaluating unit staffing and productivity

Average daily census 

Percentage of occupancy 

Average length of stay

Average daily census

Average number of pts care for/day

Upward trend justifies more staff on certain shifts, times etc

Percentage of occupancy

Patien census/by number of beds

Average length of stay

Average days pt remained in an occupied bed