Leadership Ch. 17: Staffing Needs and Scheduling Policies

5

"The evidence-based benchmark implemented in California of no more than _____ patients per nurse on medical and surgical units has become 'the number' against which to evaluate hospital staffing"

Generation X

(born between early 1960s and early 1980s), may lack the interest in lifetime employment at one place that prior generations have valued, instead valuing greater work hour flexibility and opportunities for time off. This likely reflects the fact that many individuals born in this generation had both parents working outside their home as they were growing up and they want to put more emphasis on family and leisure time in their own family units.

Millenials (generation Y)

(born early 1980s to 2000), represents the first cohort of truly global citizens. They are known for their optimism, self-confidence, relationship orientation, volunteer mindedness, and social consciousness. They are also highly sophisticated in their use of technology. This is why some people call this generation "digital natives."

Common Staffing and Scheduling options

10- or 12-hour shifts Premium pay for weekend work Part-time staffing pool for weekend shifts and holidays. Cyclical staffing, which allows long-term knowledge of future work schedules because a set staffing pattern is repeated every few weeks. Figure 17.1 shows a master staffing pattern that repeats every 4 weeks. Job sharing Allowing nurses to exchange hours of work among themselves Flextime Use of supplemental staffing from outside registries and float pools Staff self-scheduling Shift bidding, which allows nurses to bid for shifts rather than requiring mandatory overtime

Silent generation or veteran generation

1925 to 1942

Baby boomer or boom

1943 to early 1960s

NCH/PPD

= (nursing hours worked in 24 hours)/(patient census)

Outcomes

A leadership challenge for the manager is to develop policies that focus on __________ rather than constraints or rules that limit responsiveness to individual employee needs.

Communication errors

A rising number of migrant patients and foreign-trained staff means that these between health-care practitioners and patients, when one or both are speaking a second language, are increasingly likely and can be life-threatening

Management

Accountability for a prenegotiated budget is a ___________ function.

First and middle level

Although many organizations now use staffing clerks and computers to assist with staffing, the overall responsibility for scheduling continues to be an important function of these level managers.

Large savings

Because personnel budgets are large in health-care organizations, a small percentage cut in personnel may result in

Inconsistently

Decentralized staffing, however, carries the risk that employees will be treated unequally or ____________

Minimum Criteria for Safe Staffing

Decisions made must meet state and federal labor laws and organizational policies. Staff must not be demoralized or excessively fatigued by frequent or extended overtime requests. Long-term as well as short-term solutions must be sought. Patient care must not be jeopardized.

Generation X

Early 1960s to early 1980s

Generation Y (Millennials)

Early 1980s to 2000

Reasonable workload

Employees have the right to expect this. Managers must ensure that adequate staffing exists to meet the needs of staff and patients.

internal or external forces affecting unit needs

Examples could be a sudden increase in nursing or medical students using the unit, a lower skill level of new graduates, or cultural and language difficulties of recently hired foreign nurses.

Self scheduling

allows nurses in a unit to work together to construct their own schedules rather than have schedules created by management. With self-scheduling, employees typically are given 4- to 6-week schedule worksheets to fill out several weeks in advance of when the schedule is to begin. The nurse-manager then reviews the worksheet to make sure that all guidelines or requirements have been met.

Generational diversity

allows patients to receive care from both the most experienced nurses as well as those with the most recent education and likely greater technology expertise.

Less economically drive

generation X may have this characteristic when compared with prior generations and may define success differently than the veteran generation or the baby boomers.

Workload measurement

is a technique that evaluates work performance as well as necessary resource levels. Therefore, it goes beyond patient diagnosis or acuity level and examines the specific number of care hours needed to meet a given population's care needs. typically capture census data, care hours, patient acuity, and patient activities.

Nursing management

is highly decentralized in most hospitals, with considerable variation found in staffing among patient care units.

primary purpose of the acuity system

is to have subjectivity give way to objective data. With this data, organizations can staff according to documented need rather than perceived convenience, decreasing distrust, fostering collaboration, and moving finance and patient management toward a common goal.

disadvantage of shift based staffing

it is time consuming and somewhat subjective because acuity or classification systems leave much to be determined by the person assigning the acuity levels.

generation Y nurses

may test the patience of their baby boomer leaders because they may appear to be brash or impatient and often come with a sense of entitlement that can be an affront to older workers. On the other hand, generation Y is known to work together well in teams, exhibit a high degree of altruism, have a higher ecoawareness, and far greater multicultural ease than their older coworkers.

Float staff

must be able to perform the core competencies of the unit they are floating to meet their legal and moral obligations as caregivers.

Adequate staffing

needed to ensure that care provided is at least safe and hopefully more. Proponents also suggest that such ratios protect the most basic elements of the public health we take for granted and argue that the government must take on this responsibility to ensure that safe health care is provided to all Americans

Closed unit staffing

occurs when the staff members on a unit make a commitment to cover all absences and needed extra help themselves in return for not being pulled from the unit in times of low census.

Scheduling relief

one of the benefits of using travel nurses

Personnel policies

represent the standard of action that is communicated in advance so that employees are not caught unaware regarding personnel matters.

Standard 6 (Office of Minority Health)

requires that all verbal offers and written notices regarding patients' access to these services be available to patients in their preferred languages.

Standard 5 (Office of Minority Health)

requires that health-care organizations offer language assistance services, including bilingual staff and interpreter services, at no cost to clients with limited English proficiency.

summative task PCS

requires the nurse to note the frequency of occurrence of specific activities, treatments, and procedures for each patient.

Staffing levels

should be considered an important—though not the only—factor in safe patient care.

Decentralized scheduling and staffing

staffing at unit level (by unit manager), allows person who knows the individual unit to best make staffing decisions, allows staff to take requests directly to their own manager (gives increased autonomy and flexibility), increases risk that employees may be treated unequally, time consuming for unit manager

Individualistic

the baby boomer generation is often described as this, as a result of the "permissive parenting" they may have experienced in childhood. This often results in greater creativity and thus nurses born in this generation may be best suited for work that requires flexibility, independent thinking, and creativity. Yet, it also encourages this generation to challenge rules.

In centralized staffing

the manager's role is limited to making minor adjustments and providing input. continues to have ultimate responsibility for seeing that adequate personnel are available to meet the needs of the organization.

Shift bidding

the organization sets the opening price for a shift. For example, this may be at a higher rate of pay than the hourly wage of some nurses, and nurses may bid down the price in order to be assigned the overtime shift.

silent generation

the veteran population is sometimes called this bc they are less likely to question the status quo or push for change

staffing shortages

these frequently occur on a day-to-day basis. These occur because of an increase in patient census, an unexpected increase in client needs, or an increase in staff absenteeism or illness.

Managers

these staff members must clearly understand the unique cultural and linguistic needs represented in their patient population and try to address these needs through an appropriately diverse staff.

Once an appropriate PCS is adopted

hours of nursing care must be assigned for each patient classification. Although an appropriate number of hours of care for each classification is generally suggested by companies marketing PCSs, each institution is unique and must determine to what degree that classification system must be adapted for that institution.

Seven

how many states (Connecticut, Illinois, Nevada, Ohio, Oregon, Texas, and Washington) now require hospitals to have staffing committees responsible for plans and staffing policy

Workload measurement tools

include NCH/PPD, PCS, and workload measurement systems. All should be periodically reviewed to determine if they are a valid and reliable tool for measuring staffing needs in a given organization.

Cross training

involves giving personnel with varying educational backgrounds and expertise the skills necessary to take on tasks normally outside their scope of work and to move between units and function knowledgeably. (strategy to combat nursing shortage)

Flextime

is a system that allows employees to select the time schedules that best meet their personal needs while still meeting work responsibilities.

Written

these type of policies generally provides a means for greater consistency and fairness.

veteran generation

this age group is typically recognized as those nurses born between 1925 and 1942. Currently, about 5% of employed nurses belong to this age group highly respectful of authority, supportive of hierarchy and disciplined; traditional work values, loyal to employers

California

this state has enacted legislation requiring mandatory staffing ratios that affect hospitals and long-term care facilities.

Fiscal accountability

to the organization for staffing is not incompatible with ethical accountability to patients and staff. The manager's goal is to stay within a staffing budget and meet the needs of patients and staff.

The critical indicator PCS

uses broad indicators such as bathing, diet, intravenous fluids and medications, and positioning to categorize patient care activities. The summative task type requires the nurse to note the frequency of occurrence of specific activities, treatments, and procedures for each patient.

40%

what percent of the nurses belongs to generation X

patient classification systems (PCSs)

also known as workload management, or patient acuity tools, were developed in the 1960s. This system groups patients according to specific characteristics that measure acuity of illness in an effort to determine both the number and mix of the staff needed to adequately care for those patients.

Staffing clerks

although many organizations use these and computers to assist with staffing, the overall responsibility for scheduling continues to be an important function of first and middle level managers

Flexible

any approach to predicting staffing must be _________ and based on expert nursing judgment that takes into consideration patient complexity and available resources.

12 hr shifts

have become commonplace in acute care hospitals even though there continues to be debate about whether extending the length of shifts results in increased judgment errors related to fatigue

Burnout

Generation X workers also report higher levels of __________ as compared with baby boomers, related to incivility from colleagues and cynicism. In addition, there may also be conflicts related to competencies and strategies for knowledge acquisition.

15%

Generation Y currently represents only ______ of the nursing workforce, but this number will increase rapidly over the coming decade

Shift staffing

(based on a patient acuity system) does, however, allow for more consistent staffing and is better able to identify overstaffing and understaffing on a timelier basis. In addition, this is a fairer method of allocating staff.

baby boomers

(born 1943 to early 1960s), represent 40% of the current workforce; also displays traditional work values; however, they tend to be more materialistic and thus are willing to work long hours at their jobs in an effort to get ahead. more apt than any other to be called "workaholics."

Unit manager

In organizations with decentralized staffing, the ____ ________ 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.

Ethically accountable

Managers who constantly expect employees to work extra shifts, stay overtime, and carry unreasonable patient assignments are not being

Last resort

Mandatory overtime should be a _____ _______, not standard operating procedure because an institution does not have enough staff.

mandatory licensing requirements

Many US states, with the backing of professional nursing organizations, have moved toward imposing these

decentralize staffing

Some organizations do this by having unit managers make scheduling decisions.

Fiscal and ethical

The manager has both a _______ and an ________ duty to plan for adequate staffing to meet patient care needs.

Staffing ratios

Under Assembly Bill 394 ("Safe Staffing Law"), passed in 1999 and crafted by the California Nurses Association (CNA), all hospitals in California had to comply with the minimum ________ ______

Restructuring and redesign

Unit managers must understand the effect that these things have on their staffing and scheduling policies as well. As new practice models are introduced, there must be a simultaneous examination of the existing staff mix and patient care assessments to ensure that appropriate changes are made in staffing and scheduling policies.

Over or understaffing

When a hospital uses flextime, units have employees coming and leaving the unit at many different times. Although flextime staffing creates greater employee choices, it may be difficult for the manager to coordinate and could easily result in this

Employees

When possible, __________ should be involved in developing these staffing and scheduling policies. This helps establish the trust needed to build team spirit when dealing with temporary staff shortages.

Float pools

are generally composed 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. They are adequate for filling intermittent staffing holes, but like agency or registry staff, they are not an answer to the ongoing need to alter staffing according to census because they result in a lack of staff continuity.

PCSs

are institution specific and must be modified to reflect the unique staff and patient population of each health-care organization.

Advantages of decentralized staffing

are that the unit manager understands the needs of the unit and staff intimately, which leads to the increased likelihood that sound staffing decisions will be made. In addition, the staff feels more in control of their work environment because they are able to take personal scheduling requests directly to their immediate supervisor. also leads to increased autonomy and flexibility, thus decreasing nurse attrition.

Joint commission

at the national level, the use of a PCS is a condition for participation in Medicare and is required by this organization for certification

Success of staffing

depends on the leadership skills of the manager to support the staff and demonstrate patience and perseverance throughout the implementation.

Determining an appropriate skill mix

depends on the patient care setting, acuity of patients, and other factors. There is no national standard to determine whether staffing decisions are suitable for a given setting

numbers alone

do not ensure improved patient care, as not all RNs have equivalent clinical experience and skill levels. There is also the argument that staffing may actually decline with ratios because they might be used as the ceiling or as ironclad criteria if institutions are not willing to make adjustments for patient acuity or RN skill level.

Nursing staffing difficulties

does not fit traditional business cycle, erratic and unpredictable health demand, high level of expertise required 24/7, stress of job requires balanced work-recreation schedule, and staffing mix varies with acuity

Centralized staffing disadvantages

does not provide as much flexibility for the worker, nor can it account as well for a worker's desires or special needs. In addition, managers may be less responsive to personnel budget control if they have limited responsibility in scheduling and staffing matters.

mandatory overtime

employees are forced to work additional shifts, often under threat of patient abandonment should they refuse to do so. Some hospitals routinely use this in an effort to keep fewer people on the payroll.

Standard 7 (Office of Minority Health)

ensures the competency of this language assistance by interpreters and bilingual staff

Centralized staffing advantages

fairer, allows for managers to work on other things, more cost effective, easier to adapt to variations

Per diem staff

generally have 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. Like agency or travel nurses, high use of per diem workers may increase risks to patient safety because they often receive less orientation to a facility than permanent staff and thus are less likely to be familiar with organizational policies and procedures