Exam 1: Unit 7: Staffing and Scheduling
What nurse staffing position statement did the ICN come out with?
"Inadequate or insufficient nurse staffing levels increase the risk of care being compromised, adverse events for patients, inferior clinical outcomes, in-patient death in hospitals and poorer patient experience of care," in addition to increased risk of burnout and high turnover rates for nurses. (September 28, 2018)
What is FTE?
- Full-time equivalent
How do you calculate staffing by PCS? How many nurses are needed to staff this night shift? 1 pts = 0.5 (Needed NCH) 2 pt = 1.0 3 pt = 2.0 3 pt = 2.8
1 pts x 0.5 (Needed NCH)= 0.5 (Staffing for Nights) 2 pts x 1.0 (Needed NCH)= 2.0 (Staffing for Nights) 3pts x 2 (Needed NCH)= 6.0 (Staffing for Nights) 3pts x 2.8 (Needed NCH)= 8.4(Staffing for Nights) Total NCH needed for night shift= 16.9 2 RNs working eight hours each are needed for this shift
What are two limitations of centralized staffing?
1. Less flexible 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 staffing and scheduling matters
What are the advantages of decentralized staffing?
1. Managers have greater control 2. Staff can take requests directly to the manager 3. Greater autonomy and flexibility for the individual staff member
What are the disadvantages of decentralized staffing?
1. Moe special pleading and arbitrary treatment of employees 2. Not cost-effective 3. More time consuming for the unit manager
What are the advantages of centralized staffing?
1. Provides organization-wide view of staffing needs 2. Staffing policies are employed more consistently and impartially 3. Frees middle level manager to complete other management functions 4. More cost effective than decentralized staffing
What are the three general approaches that state staffing laws tend to fall into?
1. Require hospitals to have nurse driven staffing committee 2. Legislators mandate specific nurse to patient ratios in regulation or legislation 3. Requiring facilities to disclose staffing level to the public and/or regulatory body
What seven things do we need organizational staffing policies for?
1. Sick leave 2. Vacations 3. Holidays 4. Call-offs for low census 5. On-call pay 6. Tardiness and absenteeism 7. Criteria for different staffing options
o 40 hours/week = ____ FTEs o 36 hours/week (3-12 hour shifts) = ____ FTEs (36/40) o 24 hours/week = ____ FTEs (24/40) Part time status
1.0 0.9 0.6
What states have addressed nurse staffing in hospitals?
15 states, AZ, CA, CT, IL, MA, MN, NV, NJ, NY, OH, OR, RI, TX, VT, WA
Patient Census is 5 patients · 12 midnight to 12 noon 4RNs 12 hours each · 12 noon to 12 midnight 4RNs 12 hours each Calculate the first step of the NCH/PPD
4 staff @ 12 hours each = 48 hours 4 staff @ 12 hours each = 48 hours total = 96 hours The nursing hours worked in 24 hours is 96 hours.
How long are nursing shifts?
4-8-10- or 12-hour shifts
Staffing Formula If you need 5 nurses everyday for 7 days and each nurse works 5 days a week, it would take ___ people of FTEs to cover the entire week.
7 (5x7= 35, 35/5= 7)
What does MN require?
A CNO or designee develop a core staffing plan with input from others
State staffing may requires hospitals to have what?
A nurse driven staffing committee
What is the patient classification system unique to?
A specific institution
What does FTE not take into account?
Absenteeism, vacations, or holidays (you will need more workers to account for that)
What is the result of using the NCH/PPD?
All nursing and ancillary staff are treated equally when determining hours of care. No differentiation is made for differing acuity levels of patients. May result in an inaccurate picture. Does not take into consideration the type of healthcare worker it is. It takes into account the # of people.
What is shift bidding?
Allows nurses to bid for shifts rather than requiring mandatory overtime "I will work for $40 an hour" "I will work for $38 an hour"
Question: What are some advantages to an organization using travel nurses? A. They command premium pay. B. They provide scheduling relief. C. They offer good continuity of care. D. All of the above
B. Rationale: Although travel or agency nurses can fill in during a scheduling emergency, their pay can be hard on the budget, and their continued use can compromise care continuity.
Question: The effects of mandatory overtime are most detrimental in the: A. long-term B. short-term
B. short-term Rationale: Although mandatory overtime has negative long-term consequences, the immediate effects on the staff's mood, motivation, and productivity are even more worrisome.
The ICn recommends effective staffing systems based
Both patient safety and the health and well-being of staff
What type of indicators does the critical indicator PCS use? Examples?
Broad indicators bathing, diet, intravenous fluids, and medications, and positioning to categorize patient care activities
Which states have staffing committees responsible for plans and staffing policy?
CA, CT, IL, NV, NJ, NY, OH, OR, RI, TX, VT, WA
Which state is the only state to have laws and regulations as a required minimum nurse to patient ratio at all times by unit?
California
Which is more cost effective, decentralized or centralized?
Centralized
What are the two types of PCSs?
Critical indicators and summative task
What type of staffing is used?
Cyclical staffing
How can you generate a staffing pattern from specific patient or patients?
Determine the nursing care hours needed for a specific patient or patients then generating the FTEs and staff-to-patient ratio needed to provide that care
What is the second step in solving the NCH/PPD problem?
Divide the nursing hours worked in 24 hours by the patient census.
What is mandatory overtime?
Employees are forced to work additional shifts, often under threat of patient abandonment.
What does scheduling allow nurses to do among themselves?
Exchange hours of work among themselves
What type of staffing and scheduling policies needed to be written and communicated?
Fair and uniform
What are the cons of 10 hour shifts?
Fatigue Overlap Difficulty
What are the cons of 10 hour shifts?
Fatigue Overlap Difficulty finding substitute Decreases costs Cover peak workloads
Who is overall responsibility for scheduling?
First- and middle-level managers
How is supplemental staffing found?
From outside registries and float pools
What are the cons of a 12 hour shift?
Greater exhaustion at end of work week Increase in tension at end of work week Increase in minor accidents Increase in medication erros Home and social life suffer the week worked
How does the patient classification system work?
Groups patients according to specific characteristics that measure acuity of illness
What is assigned to each patient classification?
Hours of nursing care
FTEs help you to figure out what?
How many total nurses you need that week
What law did MA pass?
ICU specific requiring 1:1 or 1:2 nurse: patient ratio depending on the stability of the patient
Which 5 states require some form of disclosure and/or public reporting?
IL, NJ, NY, RI, VT
What influences classification system?
Internal or external forces Known as world management
Who came out with a new safe nurse staffing position statement?
International Council of Nurses (ICN) based on evidence-based safe nurse staffing
Why is scheduling so difficult in nursing?
It does not fit traditional business cycle. There is an erratic and unpredictable health-care demand. High-level expertise is required 24/7. Stress of job requires balanced work-recreation schedule.
What is an organization-wide view of staffing needs an advantage?
It encourages optimal utilization of staffing resources
What sharing is done?
Job string
What does cyclic staffing allow for?
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. Decreases flexibility (says Gary)
What are the cons of 8 hour shifts?
Longer workweek
What is the con of 8 hour shifts?
Longer workweek
What are the pros of 12 hour shifts?
Lower staffing requirements Lower costs per patient-day Increased knowledge of patients Ability to get new admissions settled Less feeling of being rushed Better continuity of care Possibly for team development Less daily reporting Less time spent in staffing Reduced travel time Lower personal expenses for gas, meals, babysitting
State staffing laws may want legislators to do what?
Mandate specific nurse to patient ratios in regulation or legislation (make laws about it)
How do you compute total nursing-care hours worked in 24 hours?
Multiplying the total number of individuals on duty each shift by the hours each worked in their respective shift. Each shift total is then added together to get the total number of nursing hours worked in all three shifts or 24 hours.
What is required from 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.
When handling understaffing issues what must decisions be made in line with?
Must meet state and federal labor laws and organizational policies.
How do you calculate nursing care hours per patient day?
NCH/PPD = Nursing hours worked in 24 hours / patient census
Is it possible to transfer a PCS from one hospital to another?
NO, due to variables within the system
What could you compare your scheduling to to determine staffing pattern?
National/regional benchmarks
What ratio can you use to determine staffing pattern?
Necessary ratio of staff to patients then calculate nursing hours and total FTEs
Does PCS mean staffing is adequate or perceived as inadequate?
No
Is centralized and decentralized staffing synonymous with centralized and decentralized decision making?
No
Is mandatory overtime efficient or effective long term?
No but it has an even more devastating short-term impact in terms of staff perceptions of a lack of control and its subsequent impact on mood, motivation, and productivity
What does the ICN recommend promotion of?
Nurse staffing research that includes economic analysis
What is critical for using the patient classification system?
Ongoing review
What staffing is used for weekend shifts and holidays?
Part-time staffing pool
What is considered when making schedules for patient assignments in nursing?
Patient acuity Nursing practice required and experience of staff Procedures, tasks and volume of nursing work
What must not be jeopardized when handling understaffing issues?
Patient care must not be jeopardized
What system is used to staff by acuity?
Patient classification system
Why is centralized staffing more fair?
Policies tend to be employed more consistently and impartially.
When are PCSs filed out?
Prior to each shift
What public awareness for the ICN recommend?
Public awareness of the impact that safe nurse staffing has on patients, families and communities
A nurse-manager notes how often a patient takes his medication to determine scheduling. This is an example of using which of the following systems? A. Critical indicator PCS B. Summative task PCS C. Staffing by acuity
Rationale: Summative task patient classification looks at the frequency of specific activities, whereas critical indicator PCS uses broader, more general measures. Staffing by acuity groups patients according to specific characteristics.
A common option is for staff to have what involvement in scheduling?
Self-scheduling
What else besides specialty pay may be available for specific unit/specific shift?
Short term contracts f
When is specialty pay given?
Specific unit/specific shift
What should staff not feel when handling understaffing issues/what should you avoid doing to nurses?
Staff must not be demoralized or excessively fatigued by frequent or extended overtime requests.
What is now used to assist with staffing?
Staffing clerks and computers to assist with staffing
State staffing laws may require facilities to disclose what?
Staffing levels to the public and/or regulatory body
What three factors affect the relationship between staffing and quality of care?
Staffing mix (who is there) Staffing ratios Numbers of staff
What role does the ICN recommend an end to?
The creation of substitute roles for registered nurses
Calculate the NCH/PPD using the second step from the first example
The patient census in this case is 5 patients. Therefore, 96 divided by 5 = 19.2. The NCH/PPD is 19.2
How are staffing and scheduling policies communicated?
They should be written for all staff
What are the pros of 10 hour shifts?
Time to complete work Long weekends Extra days off Decreased overtime
What is the primary purpose of PCS?
To have subjectivity give way to objective data
What are the pros of 8 hour shifts?
Traditional
Staffing in a busy physicians office is performed by the unit manager. This is an example of an office managed using the decentralized model.
True - Rationale: In the decentralized model, staffing is often done by the unit manager, whereas under the centralized model, it is done at a central office, often by computer.
When is premium pay given?
Weekend work
When does closed-unit staffing occur?
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
Calculate the NCH/PPD The first step in this calculation requires
a computation of total nursing-care hours worked in 24 hours
Decentralized scheduling and staffing lead to increased ___________ and ____________ but, centralized staffing is ________ to all employees
autonomy and flexibility fairer
A review of the literature consistently and overwhelmingly demonstrates that as RN hours ___________ in NCH/PPD, adverse patient outcomes increase
decrease
The ICN recommends sufficient health care _________ to deliver _______-based safe nurse staffing
funding needs
What are five scheduling alternatives?
o Agency nurses o Travel nurses o Flextime o Self-scheduling o Float pools
The ICN recommends that safe nurse staffing systems are based on
real-time patient information
What are summative task PCSs?
requires the nurse to note the frequency of occurrence of specific activities, treatments, and procedures for each patient
What are three adverse patient outcomes that increase when NCH/PPD decreases?
§ Increased medication errors § Patient falls § Decreased patient satisfaction with pain management
How can staffing patterns be generated?
§ Obtaining national/regional benchmarks § Determining the necessary ratio of staff to patients, then calculating nursing hours and total FTEs § Determining the nursing care hours needed for a specific patient or patients, then generating the FTEs and staff-to-patient ratio needed to provide that care Using a combination of both methods
