Nursing Management & Leadership

RECRUITMENT AND STAFFING

Objectives:

At the end of this lecture student will be able to:

 Identify different terms of Job analysis and its uses.
 Describe the differences between Recruitment and Retention
 Discuss Interviewing purpose and strategies.
 List Interview steps & Process of staff selection
 Identify the different terms of Staffing
 Demonstrate how to determine the staffing pattern
 List the different factors that affect staffing
 Demonstrate appropriate staffing calculation
 Identify the Principles of Scheduling
 Discuss the Methods used to solve nursing shortage
 Identify Scheduling level
 Discuss the methods to evaluate staffing effectiveness
Recruitment
 JOB ANALYSIS
It is the process of objectively determining the
needed personal skills and qualifications required
to perform the job.
It includes:
1) job description (which include; job title,
division/department)
2) job specification (which include; qualification,
experience and skills) that Helps in recruiting and
selecting the candidates to fulfill the job.
 JOB DESCRIPTION
 Is a written statement of the duties, responsibilities and organizational relationships that required of
the employee in a given job.

Uses of job description

1. Serves as basis for selecting and recruiting an individual to fill the position
2. Essential for the placement and orientation of new employees.
3. Essential for employee's performance evaluation, transfer and promotion.
4. Useful in identifying the needs for employee's training.
5. Helps to prevent arguments among employees about “who should do what.”
 Recruitment and Retention
 Recruiting adequate numbers of nurses is less difficult if the organization is located in a
progressive community than if recruitment is in rural areas.

 One of the best ways to maintain an adequate employee is by the recommendation of the
organization’s own satisfied and happy staff.

 Recruitment is not the key to adequate staffing in the long term. Retention is and only occurs
when the organization is able to create a work environment that makes staff want to stay.

 Some turnover is normal and it infuses the organization with fresh ideas. However,
excessive or unnecessary turnover reduces the ability of the organization to provide
effective and high quality of care.
 Interviewing as a Selection Tool

 An interview may be defined as a verbal interaction between individuals for a

particular purpose.

 The purposes or goals of the selection interview are:

1. The interviewer seeks to obtain enough information to determine the applicant’s

suitability for the available position.

2. The applicant obtains adequate information to make an intelligent decision about

accepting the job.
 Strategies of interview process
The major defect of the interview is subjectivity

1. Prepare for the interview: have a complete and clear understanding of the open
position before interviewing a candidate. This includes knowing the job
description, educational and experiential requirements.

2. Use a team approach: having more than one person interview the job applicant
reduces individual bias.

3. Develop a structured interview format for each job classification: interviews must
be structured to fit the position. The same structured interview should be used for
all employees applying for the same job classification.
 Interview Format and steps:
1. Introduce your self and great the applicant.

2. Make a brief statement about the organization and the available positions.

3. Ascertain the position for which the person is applying.

4. Discuss the information on the application, and seek clarification as necessary.

5. Discuss employee qualifications, and proceed with structured interview format.

6. If the applicant appear qualified, discuss the qualification and the position further.

7. Explain the subsequent procedures for hiring and contract, such as hiring date.

8. Terminate the interview.

 Process of Selection of staff after interview:
This process involves:

1. Confirmation of Educational and credentials requirements.

2. Reference checks.

3. Pre-employment testing.

4. Physical examination as a selection tool.

5. Making the selection (using the same standard to evaluate all the candidates).

6. Finalizing the selection (follow-up/ notifying the applicant).

 Staffing

Refers to the plan for how many nursing personnel, of what classifications will be
needed to work for each unit on each shift.
Is process of determining and providing the acceptable number and mix of nursing
staff to met and produce desired level of care to meet the patient's demand for care .

Staffing components:
Staffing has two main components, staffing pattern and staffing plan.
Adequate staffing

 Care quality is highest when workload and staffing resources are properly
balanced.
 Serious understaffing impairs care quality, because overworked nurses lack time
to perform essential protective and therapeutic measures.
 Marked overstaffing impairs care quality by encouraging excessive socializing
among nursing staff, which leads to relaxed practice standards and neglect of
critical care measures.
Staffing pattern

Indicating number of staff with specific skills or job classification should be on duty
per each unit, per shift, per day.

Day shift Night shift

Head nurse -

RN I 1 RN I

3 RN II 3 RN II

1 NA 2 NA
How to determine the staffing pattern

1. Patient acuity/classification systems:

Focus on patient needs based on different categories,
or acuity of patients.
2. Task-quantifying systems:
Focus on nursing activities: Common nursing tasks
are related directly or indirectly.
Factords/ Variables Affecting Staffing
Pattern
1. Patient factors 3. Health care organization
Acuity/ patient condition. Factors
Length of stay
Patient number per shift
Age groups ( pediatric, adults) • Financial resources available
2- Staff factors • Personnel policies, especially
Job description regarding work time
Educational level of staff • Support services within the
Experience level of staff
organization (NA, porter ..)
 Staffing plan

 Calculating that determine in advance how many nurses needed to be hired to fill
a single positional slot on a day shift on a given patient care unit.
Staffing process
1)Identifying the type and amount of services needed.
2) Determining the staff categories that have the knowledge and skill to perform needed works.
3) Predicting the number of staff in each job category that will be needed to meet the work demands.
4)Obtaining budgeted points for the numbers in each job category.
5) Recruiting personal to fill available positions.
6) Selecting and appointing staff .
7) Orienting staff to fulfill assigned responsibilities.
8) Assigning responsibilities with specific job description.
Methods of staffing plan:

1- Using calendar days:

 Divided the number of days in the year (365) by the number of days actually worked per nurse per
year to determine the number of staff required to fill one position for the year.
 Example :
The nurse worked 16 shift per month.
 So actual working days/year=16×12=192 days
 The number of nurses needed to fill one position of professional nurse = 365/192=1.9 worker.
 The number of nurses to fill 6 positions of nurses/year = 6*1.9=11 nurses.
2-using the care hours:

 Example In chemotherapy unit

The patient needs 2 hours of care.

The patient come to take this therapy daily (within the week)=20 pts.
The number of hours of care = 2×20=40h/day.

 The number of working hours in one shift= 8h.

Then the nurse required to give these hours= 40/8= 5 nurses
 Working hours in Schedules
 According to ministry of labor in KSA, the working hours should not exceed 8 hours per day, and
48hours per week maximum.

 If the staff is working 8 hours per day, will work 5 days and 2 off per week.

 12 hours shift the staff will have 3 to 4 shifts per week and 3 off per week.

 40hrs/w divided by 12hrs= 3.33 shifts/w

 48hrs/w divided by 12hr= 4 shifts/w

 The recommended nurse-patient ratio

Unit/ Service Ratio

• Critically ill/ventilated patients admitted in the ICU 1:1
• Stable patients in a general unit (Med, Surg) 1:5-6
• Patient in labor stage 1 1:2
• Ventilated patient in stable condition in the ICU 1:2
• Hemodialysis chronic patients 1:3
• Patient delivery- 2nd and 3rd stage of labor
1:1
• Stable patients but need HDC (high dependency care) in the
CCU 1:3-4

(MSD Policy & Procedure, 2007)

 Class Activity
Based on MSD Nursing Policy and Procedures,,

calculate the number of staff required in Medical/ Surgical Units with

approximately 25 beds capacity.

(if you know the nurse patient ratio is 1:5 to 6)

Principles of Scheduling:
 Equity of treatment of all employees
 Optimization on use of professional expertise.
 Maintenance of job-satisfaction of personnel.
 Consideration of unique needs of staff as well as patients.
 On-duty" time should be planned.
 "Off-duty" time should be planned so that each staff member is assured adequate rest and
relaxation.
 Special requests should be granted if they are reasonable and conform to the policies.
 all staff members should be assigned similar hours/shift on duty.
Schedualing
Staff Su
nd
Mon
day
Tue
sday
Wed
nesd
Thu
rsd
Fri
day
Satu
rda
Sun
day
Mo
nda
Tue
sday
We
dnes
Thu
rsda
Frid
ay
Satu
rda
Sun
day
Mo
nda
Tue
sday
We
dnes
Thu
rsda
Frid
ay
Satu
rday
name ay ay ay y y day y y y day y

Head M M M M M / / M M M M M / / M M M M M / /
nurse
RN D D D / / / D D D D / / D D D / / D D D /
RN N N N / / / N N N / / N N N N / / N N / N
RN D / D D D D / / / D D D / / D D D / / D D
RN N N N / / / N N N / / V V V V / / N N / N
RN D D D / / / D D D D / / D D D / / D D D /
Type of Scheduling

1. Cyclical Scheduling (D/N)

2. Blocked scheduling (working day /OFF)
3. Computerized Scheduling
Methods used in case of staff shortage

1. Borrowing method
2. Floating method
3. On – call staff
 A) Borrowing method
 This common method of borrowing staff from unit
to unit .to help those who have too little staff .
 The problem with this method is that:
The staff often dislike being transferred from unit to
unit specially if they do not have experience in the
other area.
B) Floating method
 This is a better method for managing staffing needs . Nurses who are permanent
workers but don't belong to any special units are used to fill any shortage in staff.
(or from one unit to another)
 Advantage :-
1- help to manage the day to day shortage.
2- some nurses like this method to gives her chance to work with different types of
patient.
C) on-call staff
 Usually on-call staff is filled with fixed staff that receive (over time) for being on
call whether they are called or not .
 This method is useful in OR , ICU
 Scheduling level
1. Centralized ( a member of nursing administration
determines the schedule for the entire organization).

2. Decentralized ( scheduling occurs at the unit level)

3. Self schedule ( Employees choose their own work

schedule)
 How to evaluate staffing effectiveness?

1. Patient outcomes

The American Nursing Association study confirms the relationship between nursing and patient

outcomes by measuring of the following:

 Pneumonia (incidence and length of stay)

 Postoperative ulcers

 Pressure ulcers

 Urinary tract infections

 How to evaluate staffing effectiveness?

2. Nursing Outcomes:

 It is also important for nurse manager to track staff perceptions about

staffing adequacy. (if the staff complain of shortage or workload)

 Staff need to have both verbal and written ways to report their concerns.

 Inadequate staffing are associated with reporting negative changes in the

patient condition and medication errors.
Staffing Key Concepts for manager to consider :
 The manager has both a fiscal and ethical duty to plan for adequate staffing to meet patient care

needs.

 Innovative and creative methods of staffing and scheduling should be applied to avoid overstaffing

or understaffing as patient census and acuity fluctuates.

 Staffing and scheduling policies must follow labor laws, national laws, union contracts.

 Workload measuring tools and workload measurement systems should be reviewed.

 Staffing Key Concepts:

 Mandatory overtime should be the last option.

 Managers must remain aware of mandatory staffing ratio and manage the staffing
according to that.

 Managers should attempt to have staff that will meet the cultural and language
needs of the patient population.