Sullivan - CH 17 - Staffing & Selecting Staff

Effective Leadership and Management in
Nursing
Ninth Edition
Chapter 17
Staffing and Scheduling
Copyright © 2018, 2013, 2008 Pearson Education, Inc. All Rights Reserved
Learning Outcomes
17.1 Determine staffing needs using evidence-based tools.
17.2 Plan workforce full-time equivalents (FTEs).
17.3 Describe the various ways to schedule staff.
17.4 Explain how to supplement staff when needed.
Key Terms (1 of 2)
• Block staffing
• Demand management
• Full-time equivalent (FTE)
• Nursing care hours (NCHs)
• Patient classification systems (PTEs)
Key Terms (2 of 2)
• Pools
• Self-scheduling
• Staffing
• Staffing mix
Introduction
• Staffing and scheduling are important responsibilities of
the nurse manager.
• Decreasing nurse-to-patient ratios are associated with
higher patient survival rates.
• Nurses’ perceptions of workload and feelings of burnout
have been tied to job dissatisfaction, increased turnover,
and nurse-reported quality of care.
Learning Outcome 17.1
Determine staffing needs using evidence-based tools.
Staffing (1 of 4)
• Goal
– Provide appropriate numbers and mix of nursing staff to
match actual or projected patient care needs to provide
effective and efficient nursing care
• Managers
– Must examine workload pattern for the designated unit,
department, or clinic to determine needed staff
• Joint Commission identifies staffing expectations.
– Requires the right number of competent staff be provided
to meet patients’ needs based on organization-selected
criteria
Staffing (2 of 4)
• Patient Classification Systems
– Also known as patient acuity systems
– Use patient needs to objectively determine workload
requirements and staffing needs
– Data collected at midpoint for every shift and
analyzed before next shift.
– Ideally, this system would accurately predict the
number and skill level of nurses needed for the next
shift.
Staffing (3 of 4)
– Problems
▪ Nurses may call in sick.
▪ Patient's condition may change.
– Demand management
▪ Deviations are tracked and staffing adjusted
accordingly.
Staffing (4 of 4)
• Determining Nursing Care Hours
– Patient workload trends analyzed for each day of the
week.
▪ Each hour in critical care.
▪ For example, if 26 patients required 161 nursing care
hours, an average of 6.19 nursing hours per patient per
day (NHPPD) are required.
– N HP PD
▪ Total nursing care hours divided by total census
(number of patients)
– There are no specific standards for NCHs for any type of
patient or patient care unit.
Plan workforce full-time equivalents (FTEs).
Planning FTE Workforce (1 of 4)
• Calculating FTE
– One FTE equals 40 hours of work per week for 52 weeks.
▪ 2,080 hours per year
– One person working full-time usually works 80 hours (ten
8-hour shifts) in a 2-week period.
– To staff an 8-hour shift takes 1.4 FTEs, one person working
ten 8-hour shifts (1.0 FTE) and another person working
four 8-hour shifts (0.4 FTE) to provide for the full-time
person’s 2 days off every week
▪ Staff working all 8-hour shifts
– 1.4 FTEs × 33 shifts = 4.2 FTEs
– 2.1 FTEs are needed to staff one 12-hour shift each
day, each week
▪ Two people each working three 12-hour shifts and
one person working one 12-hour shift each week
▪ 0.9 FTE + 0.9 FTE + 0.3 FTE = 2.1 FTEs
– Staff working 12-hour shifts
▪ 2.1 FTEs × 32 shifts = 4.2 FTEs
• Determine Staffing Mix
– Hygiene care, feeding, transferring, turning patients
▪ LPNS or UAPs
– Assessments, patient education, or discharge
planning
▪ RNs
– High RN skill mix allows for greater staffing flexibility.
– Block staffing
▪ Scheduling a set staff mix for every shift
▪ May be trends in peak workload hours in
emergency departments, when additional staff (RN
, UAP, or secretary) beyond the block staff are
necessary
– Staff needs vary by shift or day of the week.
– Surgery patient census fluctuates.
▪ Higher census Monday through Thursday
Describe the various ways to schedule staff.
Scheduling (1 of 4)
• Nurse shortages and current restrictions in salary
budgets have made creative and flexible staffing patterns
necessary and probably everlasting.
• Flexible staffing patterns can be a major challenge and, in
some cases, a mathematical challenge.
Scheduling (2 of 4)
• Self-staffing and self-scheduling
– Empowerment strategy allows unit staff the authority
to use their backup staffing options.
– Self-scheduling allows staff to create and manage
aschedule by indicating their preferred shifts to work.
Scheduling (3 of 4)
• Shared schedule
– Two people share one full-time schedule.
▪ Splitting the day of 12 hours into half days of 6.5
hours each
▪ Alternating morning and afternoon shifts.
• Open shift management
– Allows staff to schedule additional shifts beyond their
expected shifts
Scheduling (4 of 4)
• Weekend Staffing Plan
– Acuity of patients in hospitals, including medical and
surgical patients, mandates staffing units on the
weekends by the same principles used for weekdays.
• Automated Scheduling
– Matching patient demand to nurse staffing is better
done by automated systems than by individuals.
– Automated systems improve patient care outcomes
because nurses spend more time with the patients
who need the most nursing care.
Explain how to supplement staff when needed.
Supplemental Staff (1 of 2)
• Nurse manager must occasionally find additional staff.
– Options include :
▪ PRN staff
– Scheduled as needed
▪ Part-time staff
Supplemental Staff (2 of 2)
• Internal pools
– Provide staffing at substantially lower cost than
agency nurses
– Can be centralized or decentralized
▪ Centralized pool is the most efficient.
• External pools
– Agency nurses become part of the regular staff
contracted to fill vacancies for a specified period of
time.
– Most agency nurses are used as supplemental staff.
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Sullivan - CH 17 - Staffing & Selecting Staff

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Effective Leadership and Management in

Determine staffing needs using evidence-based tools.

Plan workforce full-time equivalents (FTEs).

Describe the various ways to schedule staff.

Explain how to supplement staff when needed.

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