Flashcards in Lecture 15 Staffing and scheduling Deck (27):
Reasons that scheduling is challenging in nursing include _
1. Nursing does not fit the traditional business cycle.
2. Erratic and unpredictable demand for health care.
3. High-level expertise is required 24/7/365.
4. Stress of the job requires a balanced work-recreation schedule.
5. Staffing mix varies with acuity.
The mix (percentages) of RNs, licensed vocational nurses/licensed practical nurses, and unlicensed personnel working at a given time.
Responsibility for scheduling continues to be an important function of _
First- *and* mid-level managers.
Form of staffing in which staffing decisions are made by the personnel in a central office or staffing center.
Form of staffing in which the *unit manager* is often responsible for covering all scheduled staff absences, reducing staff during periods of decreased patient census or acuity, adding staff during periods of high patient census or acuity, preparing monthly unit schedules, and preparing holiday and vacation schedules.
Strengths of centralized staffing
1. Provides an organization-wide view of staffing needs, which encourages optimal utilization of staffing resources.
2. Staffing policies tend to be employed more consistently and impartially.
3. *More cost-effective than decentralized staffing.*
4. Frees the middle-level manager to complete other management functions.
Limitations of centralized staffing
1. Provides less flexibility for the worker and may not account for a specific worker's desires or special needs.
2. Managers may be *less responsive to personnel budget control* in scheduling and staffing matters.
Strengths of decentralized staffing
1. Manager retains greater control over unit staffing.
2. Staff are able to take requests directly to their manager.
3. Provides *greater autonomy and flexibility* for the individual staff member.
Limitations of decentralized staffing
1. Can result in more *special pleading* and *inconsistent treatment* of employees.
2. May not be cost-effective for the organization, since staffing needs are *not viewed holistically*.
3. More time-consuming for the unit manager.
Regarding the two major approaches to staffing, _ is fairer to all employees because policies tend to be employed more consistently and impartially.
Key areas that staffing policies must address include _
1. Sick leave.
4. Call-offs for low census.
5. On-call pay.
6. Tardiness and absenteeism.
Minimum staffing ratios represent _
The *maximum* number of patients an RN can be assigned to care for under any circumstance.
System that allows employees to select the time schedules that best meet their personal needs while still meeting work responsibilities.
Group of employees who agree to cross-train on multiple units so that they can work additional hours during periods of high census or worker shortages.
An employee who generally has the flexibility to choose *if and when* they want to work. In exchange for this flexibility, they receive a higher rate of pay, but usually no benefits.
Agency and travel nurses
1. Nurses employed by an *external nursing broker* who work for premium pay (2-3 times more than a regularly employed staff nurse), with or without benefits.
2. These nurses provide scheduling relief on a short-term basis.
3. *Expensive* when used long-term, and may result in *poor continuity of care*.
Nursing care hours per patient day - *calculation*
NCH/PPD = (Nursing hours worked *in 24 hours*) ÷ (Patient census)
Examples of staffing productivity standards
Inpatient units = NCH/PPD
Surgery = minutes per case
Emergency departments = total visits
Labor and delivery units = number of births
Home health agencies = visits per month
Staffing based on acuity is accomplished through the use of a _
Patient classification system (PCS) - patients are grouped according to similar characteristics, and hours of nursing care are assigned for each patient classification.
Critical indicator PCS
Uses broad indicators such as bathing, diet, intravenous fluids and medications, and positioning to categorize patient care activities.
Summative task PCS
Requires the nurse to note the frequency of occurrence of specific activities, treatments, and procedures per patient.
National level PCS
A condition for participation in Medicare; also required by The Joint Commission for accreditation.
Evidence has demonstrated that as RN hours decline in NCH/PPD, patient outcomes suffer, particularly regarding _
1. Medication errors.
2. Patient falls.
3. Patient satisfaction with pain management.
Occurs when the staff members on a unit make a commitment to cover all absences and needed extra staffing (i.e., to cover increased patient census) in return for not being pulled from the unit in times of low census.
1. When nurses are forced to work additional shifts, often under threat of patient abandonment.
2. Should be a last resort, not standard operating procedure.
Full-time equivalent (FTE) - calculation
1.0 FTE = 40 hours per week; five 8-hour days of staffing; 2,080 hours per year.
Nurse working three 12-hour shifts per week: 36 ÷ 40 = 0.9 FTE.