Ch. 17 Staffing Needs and Scheduling Policies
common scheduling options in health-care organizations
-10- or 12-hr shifts -premium pay for weekend work -part-time staffing pool for weekend shifts and holidays -job sharing -cyclical staffing -allowing nurses to exchange work hours amongst themselves -use of supplemental staffing from outside registries and float pools -shift bidding
patient classification systems (PCSs)
-aka workload management or patient acuity tools -groups patients according to specific characteristics that measure acuity of illness to determine both the number and mix of staff needed -hours of nursing care assigned for each patient classification -unique to specific institution -ongoing review critical
limitations of decentralized staffing
-can result in more special pleading and arbitrary treatment of employees -may not be cost-effective for organization because staffing needs are not viewed holistically -more time consuming for unit manager
Why is scheduling so difficult in nursing?
-does not fit traditional business cycle -erratic and unpredictable health-care demand -high-level expertise is required 24/7 -stress of job requires balanced work-recreation schedule -staffing mix varies with acuity
decentralized staffing
-each department is responsible for its own staffing -unit manager responsible for covering all scheduled staff absences, reducing staff during periods of decreased patient census, adding staff during periods of high patient census, preparing monthly unit schedules, and preparing holiday/vacation schedules
mandatory overtime
-employees forced to work additional shifts, often under the threat of patient abandonment -negative impact on staff perceptions of a lack of control, mood, motivation, and productivity
workload measurement system
-evaluates work performance as well as necessary resource levels -examines specific number of care hours needed to meet a given a population's care needs -capture census data, care hours, patient acuity, and patient activities
limitations of centralized staffing
-less flexibility for the worker and may not account for a specific worker's desires or special needs -managers may be less responsive to personnel budget control in scheduling and staffing matters
strengths of decentralized staffing
-managers retain greater control over unit staffing -staff able to take requests directly to manager -provides greater autonomy and flexibility for individual staff member
minimum staffing criteria
-must meet state and federal labor laws and organizational policies -staff must not be demoralized or excessively fatigued by frequent or extended overtime requests -patient care must not be jeopardized
self-scheduling
-nurses in a unit work together to construct their own schedules -typically given 4- to 6-wk schedule worksheets to fill out in advance
nursing care hours per patient day (NCH/PPD)
-nursing hours worked in 24 hrs / patient census -unit of measurement for productivity -may show incomplete or inaccurate picture of nursing needs
float pools
-per diem staff have flexibility to choose if and when they want to work -receive higher rate of pay with no benefits -increased risk to patient safety -cross-train on multiple units -must be to perform core competencies of the unit to meet legal/moral obligations
strengths of centralized staffing
-provides organization-wide view of staffing needs, which encourages optimal utilization of staffing resources -staffing policies tend to be employed more consistently and impartially -more cost-effective -frees middle-level manager to complete other management functions
benefits of centralized staffing
-provides organization-wide view of staffing needs, which encourages optimal utilization of staffing resources -staffing policies tend to be employed more consistently and impartially -more cost-effective than decentralized staffing -frees the middle-level manager to complete other management functions
staffing policies should address..
-sick leave -vacations -holidays -call offs for low census -on-call pay -tardiness and absenteeism -shift work
centralized staffing
-staffing decisions are made by personnel in a central office or staffing center -manager's role limited to making minor adjustments and providing input
agency nurses
-travel nurses -usually directly employed by external nursing broker and work for premium pay without benefits -provide scheduling relief in response to unanticipated increases in census -risks: insufficient work setting familiarity, inadequate orientation, costly
fiscal accountability
accountability for a pre-negotiated budget
cyclical staffing
allows long-term knowledge of future work schedules because a set staffing patter is repeated every few weeks
shift bidding
allows nurses to bid for shifts rather than requiring mandatory overtime
cross-training
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
summative task PCS
requires nurse to note the frequency of occurrence of specific activities, treatments, and procedures for each pt
closed-unit staffing
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
flextime
system that allows employees to select the time schedules that best meet their personal needs while still meeting work responsibilities
critical indicator PCS
uses broad indicators, such as bathing, diet, IV fluids, medications, and positioning to categorize pt care activities
