Ch 16: Nurse Staffing and Scheduling – Flashcards
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Staffing
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Goal
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To provide appropriate numbers and mix of nursing staff that match actual or projected patient care needs to provide effective and efficient nursing care
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Managers
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Examine workload pattern for the designated unit. department or clinic
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Staffing guidlines
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Joint Commission. American Nurses Association. Individual state boards of nursing.
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Joint Commission
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Provide the right number of competent staff to meet parent's needs based on organization-selected criteria
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American Nurses Association (ANA)
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Focus on the level of nursing competency required to provide quality nursing care
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Patient classification systems
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Measurement tool to determine the nursing workload for a specific patient or groups of patients over a specific period of time. Also known as patient acuity systems. Data collected at midpoint for every shift and analyzed before next shift
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Patient acuity
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The measure of nursing workload that is generated for each patient
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Problems
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- nurses may call in sick - patient's condition may change
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Demand management
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Deviations are tracked and staffing adjusted accordingly
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Nursing care hours (NCH)
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Patient workload trends analyzed for each day of the week and each hour in critical care If 26 patients required 161 nursing care hours, an average of 6.19 nursing hours per patient per day (NHPPD) are required
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NHPPD
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Total nursing care hours divided by total census (number of patients)
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Calculating FTEs
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One full-time staff 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
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Staff working all 8-hour shifts
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1.4 FTEs x 33 shifts = 4.2 FTEs
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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
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09 FTE + 0.9 FTE + 0.3 FTE = 2.1 FTEs
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Staff working 12-hour shifts
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2.1 FTEs x 32 shifts = 4.2 FTEs
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Determine staffing mix
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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
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Distribution of staff
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Staff needs vary by shift or day of the week. Surgery patient census fluctuates - higher census Monday through Thursday Emergency patient census also fluctuates and is volume dependent - may need to stagger staff throughout busier times an more quieter times to meet the volume demands based on prior information
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Surgery patients
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Shorter length of stay than medical patients. Medical patient census rarely fluctuates Monday through Friday, less on weekends (diagnostic tests not done)
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Scheduling
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- creative and flexible scheduling - self-staffing and self-scheduling - shared schedule - open shift management - Baylor plan for weekend staffing - supplemental staff
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Self scheduling
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Increases staff autonomy through control over their schedules. Self scheduling can promote staff retention by providing flexibility. Can decrease absenteeism. Self scheduling also supports team development through a heightened sense of accountability to one another as negotiations amongst staff take place.
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Supplemental staff
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PRN staff - scheduled as needed Part-time staff. Internal float pools - provide staffing at substantially lower cost than agency nurses External pools - outside agency nurses; require orientation to facility and unit
