Comprehensive Overview of Staffing and Cost Effective Care in Nursing

What is decentralized staffing?

Nurse Manager (or Patient Care Director) is responsible for setting the schedule and making sure all shifts covered

PRO/CON:

• More personal connection to person doing staffing

• Can create more feelings of autonomy and teamwork

• Hard work!

What is centralized staffing?

Outsource to a staffing agency (or delegate to a specific department that handles staffing within an organization)

PRO/CON

• Takes task off manager

• Less risk of bias

• Can be better use of re$ource$

• Can keep better eye on staffing data

How do you calculate percent occupancy?

# of admitted patients / # of available beds

What are the factors impacting staffing?

• Patient acuity

• Percent occupancy

• Unit turnover rates (31)

• Shared governance

What are patient ratios for different units?

Operating = 1:1

ICU = 1:2

Pediatrics, ER, Telemetry, L&D = 1:3

Medsurge = 1:4

Rehab = 1:5

Well baby = 1:6

What is the nursing model for team, primary and modular?

• Team leader

  • RN who is assigned group of patients and is responsible for coordinating a group of licensed and unlicensed personnel to provide client care to that group of patients.

  • Team leader assigns each team member specific responsibilities

  • Charge nurse assigns clients to the team

• Primary care

  • One nurse responsible for all needs of assigned patients

• Modular nursing

  • Like zone defense in basketball, all assigned to an area in proximity

What is the clinical ladder for RN and what should be considered the highest level?

Reward system for clinical excellence, different responsibilities and advantages for each progressive level

I to 2 > nurse manager, preceptor, research

3 > leadership, pay, QI

What is an 8hr vs 12hr shift?

1. We love our 3 on - 4 off lifestyle!

2. Careful with batching shifts and picking up extra shifts -links between overtime and increased adverse events for patients

3. As we learned in slide 1: for some patient measures, an improved RN:pt ratio correlated with decreased adverse events (specifically RNs)

4. Same study also showed less events with increased BSN (compared to Associate degree) and nurses with more experience

What are agency/travel nurse considerations?

Issues

• Continuity of care

• Satisfaction of staff nurses

• Costs

• Training

What are nursing union considerations?

• Unions can be expensive

• Ability to negotiate pay and ratio

• Management is not unionized

• Higher weekly pay

• Better noncash benefits

• greater number of weekly hours

Which of the following is a key factor influencing nurse staffing in healthcare settings?

1. Patient satisfaction scores

2. Nurse job satisfaction scores

3. Budget constraints

4. Hospital location

3. Budget constraints

Q: What is the data point most likely to impact nurse staffing levels?

1. Patient adverse event

2. Nurse job satisfaction scores

3. Budget constraints

4. Hospital location

1. Patient adverse event

Follow-up Q: What mostly impacts pt adverse effects?

12 hour shift + overtime

W8Q1. A nurse manager is evaluating staffing patterns on the ICU. Which data should the manager analyze to determine the effectiveness of current staffing levels?

1. Patient satisfaction scores

2. Number of overtime hours worked by staff

3. Unit's nurse turnover rate

4. Incidence of medication errors

4. Incidence of medication errors

while all the others are relevant data, this one is adverse patient outcome and therefore the most important

W8Q2. A nurse manager is planning staffing for the upcoming shift on a MedSurg unit. Which factor should the nurse prioritize when determining appropriate staffing levels?

1. Availability of ancillary staff

2. Nurse's years of experience

3. Nurse-to-patient ratio

4. Number of admissions and discharges

3. Nurse-to-patient ratio

this is #1, others may beconsidered, but much less so

W8Q3. The charge nurse is planning staffing assignments for the incoming day shift for a pediatric unit. Which principle should most guide the charge nurse's decisions about staffing assignments?

1. If any nurses returning from yesterday's day shift, assign them to the same patients they had yesterday.

2. Rotate nurse assignments to prevent burnout

3. Assign nurses with more experience first

4. Assign patients to the nurse based on how close their rooms are together on the unit (for example, room 25, 26 and 27).

1. If any nurses returning from yesterday's day shift, assign them to the same patients they had yesterday.

Once again, all answers have merit, but continuity of care is especially beneficial to patient, to outgoing nurse and incoming nurse. Only time charge may not do this if patient (or patientassignment) ended up being unfairly busy yesterday, then the charge nurse should spread out the workload

W8Q4. The number of adverse events -such as falls and pressure ulcers - has been increasing on the unit over the past few months. The nurse manager should plan to implement which of the following strategies to address the issue?

1. Increasing the total number of staff on the unit

2. Increasing the pay for staff working overtime on the unit

3. Increasing the number of nurses working 12-hour shifts on the unit

4. Increasing the total number of RNs with experience on the unit

4. Increasing the total number of RNs with experience on the unit

studies have shown that both an increased RN-to-patient ratio and anincrease in RNs with more experience and/or education at the BSN levelor above, have led to fewer adverse patient events; overtime and 12-hourshifts (compared to 8) have been linked to greater adverse events

W8Q5. You are the nurse manager for a 75-bed unit. At start of shift, you had 68 patients on the unit, 6 were discharged and 12 were admitted. Central staffing calls to confirm percent occupancy. What number do you report? (Round up to nearest whole number.)

99%

68-6 = 62, 62+12 = 74, 74/75 =

W8Q6. Which of the following are potential consequences of changing from an 8-hr nursing shift to a 12-hr nursing shift organization?(Select all the apply.)

1. Increased overtime pay

2. Increased nurse satisfaction regarding scheduling

3. Decreased cost

4. Increased judgment errors

5. Increased need for continuing education

1. Increased overtime pay (nurses more likely to work extra shifts because more days off)

2. Increased nurse satisfaction regarding scheduling(nurses like this schedule, even though it has been shown to lead to greater burnout and even linked with increased job dissatisfaction)

4. Increased judgment errors (this is the big one)

W8Q7. A busy medical unit has been increasing the use of agency nurses. Which of the following should the nurse manager anticipate as possible consequences of this decision? (Select all that apply.)

1. Increased dependence on LPNs

2. A need to convert 12-hr shifts to 8-hr shifts

3. Frustration from permanent nursing staff

4. Short-term savings cost

5. Decreased continuity of care

3. Frustration from permanent nursing staff (As discussed, the pay difference between agency/travel nurses and permanent nurses is considerable)

5. Decreased continuity of care (because agency are contractual and usually only stay for a few months at a time)

W8Q8. A nurse manager works on a unit that has a decentralized scheduling system. As part of this system, the manager must be prepared to:

1. Work with staffing department to ensure that unit has coverage for high acuity patients

2. Refer any disputes to organization's conflict resolution department

3. Develop a transparent vacation request system

4. Advocate for new hires by scheduling their shifts first

3. Develop a transparent vacation request system (nurse manager always has to look at all the personal requests when they sit down to develop the calendar)

W8Q9. Which of the following tends to be a primary reason for the formation of unions?

1. Salaries are not keeping pace with inflation

2. Organizations are insensitive to employees' needs

3. Group-think among staff

4. Scarcity of jobs

2. Organizations are insensitive to employees' needs (maindrive is when employees are dissatisfied with management's lack of response to their needs)