Module 4: Staffing

Advertising Word of mouth Employee recommendation

3 modes of recruitment

1: minimal care/self-care (1.5) II: moderate care/intermediate care (3.0) III: maximum care/ total complete intensive care (6.0) IV: highly specialized critical care (7)

4 categories and their NCH/PT/DAY

Centralized Scheduling

A large number of decisions are made by upper- level management and passed down through the ranks. • One person, usually the Chief Nurse or her designate, (probably passed down to the assistant chief nurse) assign the nursing personnel to the various units of the hospital • The manager's role is continuous to have ultimate responsibility for seeing that adequate personnel are available to meet the needs of the organization. It allows for the most use of resources because the more units that can be considered together, the easier it is to deal with variations in patient census and staffing needs. Advantages: ü The chief nurse or the designate would have a wide view of staffing needs which encourages maximum or optimum utilization of staff resources ü Staffing policies tend to be employed more consistently and impartial or there is fairness ü Itmaybecosteffectivethandecentralized ü Whoisthemiddlemanagerofspecificmanagement functions such as scheduling Disadvantages/Limitations: ü It could provide less flexibility for the worker and may not account for a specific worker's desire or special needs (shy to plead to the chief nurse/boss) ü Managers may be less responsive to personnel budget control in scheduling and staffing matters

Patient acuity systems

A patient classification system is a means of categorizing present patients on the basis of certain care needs that can be clinically observed by the nurse. This is a measurement tool used to articulate the nursing workload for a specific patient or group of patients over a specific period of time. Sometimes, this is referred to as _______ which use patient needs to determine workload requirements and staffing needs objectively.

Highly Specialized Critical Care

An acute or critically ill patient who is in constant danger of death or serious injury would require THIS. Patients need continuous assessment and treatment because of many IV medications on titration, VS every 15 to 30 minutes and hourly output measurements, frequent significant changes in doctor's orders that need to carry out.

Mentors

An informal process where an "older", expert nurse (have power) advise, share her wisdom & support, monitor and nurture the progress of a younger less experienced novice nurse. = coach a novice nurse and helps to develop skills and provide career direction

Staffing plan

Assigning available staff to meet patient care needs.

Team Nursing Method

Based on a philosophy that supports the achievement of goals through group action. • A group of nurses assigned to a group of patients wherein there is a team leader. The team leader will assess the specific client (there will be conferences) • Each team member is encouraged to make suggestions and share ideas. When team members see their suggestions implemented, their job satisfaction increases, and they are motivated to give even better care. • The team is led by a professional nurse who plans, interprets, coordinates, supervises and evaluates the nursing care. Team leaders assign team members to patients by matching patient needs with staff's knowledge and skills. They set goals and priorities for patient care; centralizes information through the use of a Kardex; direct the planning of care by directing care conferences and developing care plans; fix responsibility for the work and provide for coverage during absences. Advantages: ü It involves all team members in planning patients' nursing care, through the use of team conferences and writing nursing care plan. ü Itprovidesthebestcareatthelowestcost,accordingtosome advocates. ü Each member's capabilities are maximized so job satisfaction should be high. Disadvantages: ü It can lead to fragmentation of care if the concept is not implemented totally. ü Itcanbedifficulttofindtimeforteamconferencesandcare plans. ü It allows the RN who is the team leader to have the only significant responsibility and authority.

Patient

Classification of Factors affecting staffing: census fluctuations (high/low), patient acuity,level of care, degree of dependence, patient age group, special treatment or procedure, communicability of the disease, rehabilitation needs, patient and family care demand as well as their expectations

Staff

Classification of Factors affecting staffing: number of nursing personnel available, ratio of professional to non-professional, number of leaves, turnover rate, proficiency level or experience, span of supervision

Nursing Service

Classification of Factors affecting staffing: nursingcaremodalitythatisusedwhether it is case method, functional or primary nursing; types of services; patient classification system; patterns of work schedule like an 8- or 12-hour shift; training and staff development program; research activities

Health Care Organization

Classification of Factors affecting staffing: type of hospital services, population served (pay, charity, private), work time policy, administrative policies on weekend and holidays, presence of support services, nursing unit architectural designs or layout, availability of resources (equipment, materials, supplies), technology anticipated, projected unit of services, budget limitations

Patient Staff Nursing service Health care organization

Classification of factors affecting staffing

Baby boomers

Displays traditional work values; however, they tend to be more materialistic and thus are willing to work long hours on their jobs in an effort to get ahead. = workaholic; love doing overtime; caring for the family; may volunteer time to advance in environmental, cultural, or educational courses

Generation Y to Millennials

Global citizens, optimistic, with self-confidence, relationship orientation, volunteer mindedness and social consciousness. = highly sophisticated with the use of technology; may even test the patience of their baby boomer leader because they appear inpatient and often come with sense of entitlement and can be afront to older workers; known to work together with the other teams; may exhibit high degree of altruism or service; higher eco-awareness and far greater multiculturalists than the older co- worker (adaptable); may change job more frequently; has to do with their growth and expansion since their work ethic is intense and committed; innovators, entrepreneurs; bold-risk takers

40 hr/week 48 hr/week

How many hours for personnel working in hospitals with 100 bed capacity or over or which are located in a 1 m population. How many hours for personnel who work in agencies with lesser bed capacity or which are located in communities with less than 1 m populations.

Identify work-force requirements Inventory recruiting, selecting, placing, promoting, appraising, planning their careers Compensate Train

How to determine the Number and Types of Personnel Needed

organizing

It is clear that staffing must be closely linked to _________, that is, to the setting up of intentional structure of roles and positions. o Intentionally sets up the organization structure. o Show the positions, roles and responsibilities of the nursing workforce.

Career path

It is the progression of jobs linked together - each furnishing the skills and experience necessary for advancement to the next job.

job title Job summary Qualifications (educ, license, training skill, work experience, ph qualification framework) Training and experience Reporting relationship Specific and actual fxns and activities Position classi Salary grade Job duties Nature of supervision Equipment, machines, tools to be used Working environment

JOB DESCRIPTION USUALLY CONTAINS (BUT NOT LIMITED TO)

Generation X

Lack interest in lifetime employment at one place that prior generations have valued, instead valuing greater work hour flexibility and opportunities for time off. = have their parents working outside their home as they were growing up; want to put emphasis on family and leisure time with their old family; less economical (economically driven than prior generations); may define success differently than past generations?

RA 5901 Late 1940s

Law that says 40 hours per week The 5-day forty-hour workweek became popular during the

Case method Functional nursing Team nursing method Primary Nursing Modular or District Nursing Case Management Innovative/ Contemporary Method

MODALITIES OF NURSING PRACTICE

Alternating or Rotating Work Shifts Permanent Shifts Block Scheduling Variable Staffing 8-hour shift / 5-days work/week 10-hour day shift / 4 days work/week Twelve (12) hour shift, 7-day workweek

MODIFIED APPROACHES TO NURSE STAFFING AND SCHEDULING

staffing of organizational roles includes knowledge and approaches making staffing a separate function allows us to give even greater emphasis to the human element in selection, appraisal, career planning, and manager development important body of knowledge and experience has been developed in the area of staffing managers often overlook the fact that staffing is their responsibility - not that of the personnel department

Many writers on management theory discuss staffing as a phase of organizing. However, several reasons have been identified by the writer why staffing is a separate managerial function:

Advertising Word of mouth Employee recommendation Walk in / Consult-in / Tele-recruit Internal sourcing External sourcing

Modes of recruitment

Staffing

Most crucial, complex, and time-consuming management function of a nurse manager in every level of healthcare because the quality of nursing personnel and their performance will determine the degree by which the goals of the nursing service are achieved.

149, 97 216, 268 1728, 2144

Non-working days/year Total working days/year Hours/year In both 4o-hr and 48-hr sched

nursing care conference

One of the main features of team nursing is the _________. Its primary purpose is the development and revision of nursing care plans by providing an opportunity to identify and solve problems. Precision in the identification of problems is increased through information sharing.

Employee recommendation

Referrals from employees should be sought and in - house applicants encouraged; however, favoritism should not be shown. Nurses may recommend fellow nurses whom they have previously worked within the past and who they know are competent and reliable.

personal history, educational background and work experience

Resume and Curriculum Vitae includes

Centralized Decentralized Mixed

SCHEDULING AND STAFFING SYSTEMS

1 Ward Supervisor (Nurse III) = 50 staff nurses 1 Senior Nurse (Nurse II) = 15 staff nurses 1 Staff Nurse (Nurse I) = 12 beds/patients/shift 1 Nursing Attendant = 24 beds/shift 1 Ward Supervisor (Nurse III) = 30 staff nurses 1 Senior Nurse (Nurse II) = 15 staff nurses 1 Nursing Attendant = 15 beds/shift

Staff distribution for government hospitals for WARD and CRITICAL CARE

Veteran (1925-1942) Baby boomers (1943-1960s) Generation X (early 1960s-1980s) Generation Y to Millennials (early 1980s-2000)

Stokowski (2013) notes that social scientists maintain that this is the first time in history that four generations of nurses worked together. In previous years, early retirement from nursing and shorter life spans kept the workforce to three generations. Some researchers suggest that the different generations that are presented in nursing today have different values system that may have impact in staffing. What are these generations and their years?

Descriptive Checklist of nursing tasks methos Patient needs method

THREE METHODS OF CLASSIFYING PATIENTS

containing costs

The more accurate the assessment, the higher the probability of __________ while providing high-quality care.

Advertising

This is the most common method of informing the public of vacant positions. Can be seen in the local newspapers, professional publications, bulletins, newsletters, radio, or television offer the employer a broader field for selecting personnel.

Planned arising from changes Anticipated by studying trends Unexpected due to accidents

Types of recruitment

Info sa goals, philosophy, policies, standards ng institution § Descriptionoftheorganizational structureoftheinstitution. § Jobdescription/responsibilities § Introductiontoco-workers § Atourofthephysicalfacilities

WELL-DESIGNED PROGRAM INCLUDE

Recruit ® Interview ® Select ® Hire ® Orient ® Assign/Schedule - develop KSA (knowledge, skills, attitudes)

What is RISHOA - KSA in Recruitment and Selection of Personnel

Reputation of nurses in the organization = nurses in a specific organization will speak on how that organization provides quality nursing services

What is the best recruitment strategy?

Proximity to home is a key factor in choosing a job - own geographic area of the organization = does not need to spend for board and lodging (d/t shortage, some hospitals would provide housing - free board and lodging; others would apply in their vicinities so that it would be a walking distance or may have their relatives within the area near the hospital) b. Collaboration with local schools of nursing in the locality = job fair for graduating students c. Spouses of newly recruited nurses

Where is the best place to look for workers?

Veteran

Which generation? More risk averse, highly respectful to authorities, supportive of hierarchy and disciplined. (e.g., consultants) = less likely to question organization practices and are more likely to seek employment in structured structure; work values are traditional; very loyal to employees

Lack of: (1) fairness and positive atmosphere, (2) feedback, autonomy involvement in decisions, and (3) rewards and benefits High: (1) stress and (2) market demand

Why do employees leave? Lack of what? High what?

Preceptors

are liaisons between students and the agency (role models). They help students learn skills and how to organize their work. They provide real-life experiences for students before graduation to help reduce the difficulties of transition from school to work.

Collaborative practice

cooperative interdisciplinary practice.

Orientation

familiarization with and adaptation to an environment.

Staff development

is a continuing liberal education of the whole person to develop his potentials to the fullest. The nurse should engage in professional education activities such as attending conferences, seminar workshops, in-service training programs, reading professional publications, and engaging in other activities that will enhance his competencies as a nurse and develop his aesthetic sense and personality.

Primary Nursing

is a distinct modality, a one-to-one relationship and a professional commitment which requires the nurse to practice accountability and full responsibility to the care of group of patients, whom are the central to their focus from admission to his discharge.

Patient classification system

is a means of categorizing present patients on the basis of certain care needs that can be clinically observed by the nurse.

Job Description

is a statement that sets the duties and responsibilities of a specific job.

Career mapping

is a strategic plan (route or way) for one's career. • It provides direction for formal education or administration (clinical or education, clinical practice, nursing research), experience, continuing education, professional associations, and networking. • It is the nurse's lifelong learning that allows them to develop, maintain, and expand competence in professional nursing practice, and so to support achievement of one's career goals.

Nursing care plan

is another main feature of team nursing. This identifying present and potential problems and long and short-term objectives should be developed for each patient. The care plan should be realistic to prevent morale problems that result from setting unattainable objectives. Care plan should be individualized, reflecting the interrelatedness of psychosocial and physiological needs and involving patient and family participation.

Staffing

is defined as filling, and keeping filled, positions in the organization structure through identifying work - force requirements, inventorying the people available, recruiting, selecting, placing, promoting, appraising, planning the careers, compensating, and training or otherwise developing both candidates and current job holders to accomplish their tasks effectively and efficiently.

Minimal care/self-care

is given to patients who are convalescing and who no longer require intensive, moderate or maximum care. These patients still may need supervision by a nurse in the course of a day, even if only at infrequent intervals. This care group also includes patients who require diagnostic studies, minimal therapy, less frequent observations, and daily care for minor conditions, and who are awaiting elective surgery or have difficulty arranging transportation between home and hospital, or whose home environment temporality makes discharge undesirable or impractical.

MODERATE/INTERMEDIATE CARE

is given to patients who are moderately ill or are recovering from the immediate effects of a serious illness and/or an operation. These patients require nursing supervision, or some assistance related to ambulating and caring for their own hygiene. They may be ambulatory for short periods. • Ex. Can feed, bathe, toilet and dress himself without help but requires some assistance from the nursing staff for special treatment or certain aspects of personal care, wound debridement or dressing, catheterization, colostomy irrigation, IVT, IM subcutaneous injections, chest physiotherapy

MAXIMUM/TOTAL COMPLETE INTENSIVE CARE

is given to patients who need close attention throughout the shift, that is, complete care for patients who require nursing to initiate, supervise, and perform most of their activities or who require frequent and complex medications or treatments. • Ex. Bedridden patient who lacks the strength or mobility, needs nursing assistance for all of the patient's ADL, feeding, bathing, dressing, moving, positioning, eliminating, comfort-seeking and injury avoidance (risk for falls)

Staffing

is the process pf determining and providing the acceptable number and mixture of nursing personnel to produce a desired level of care and to meet the patient's demand for care.

Career path

it is a progression of jobs linked together, each of which furnishes the skills and/or experience necessary for advancement to the next job.

In-service education training programs

may also be conducted along with orientation to prepare the beginning nurse practitioner to assume bigger responsibilities

Preceptorship

may be used to help recruit, retain, orient, and develop staff. They may be used before students graduate to orient them to the agency and to recruit them for hire. • During the _______, faculty facilitate, monitor, and evaluate student learning. The preceptor is responsible for the quality of patient care and facilitates the student's learning.

Patient Acuity

measure of nursing workload that is generated for each patient based on the seriousness of the condition of the patient. = minimal/full attention?

Word of mouth

o This can be a very effective method of recruitment, but it can also lead to hiring of friends and relatives of the current workforce; this practice may foster nepotism and violate equal opportunity employment requirements.

o to obtain information, o to give information, and o to determine if the applicant meets the requirements for the position.

purposes of the interview are:

1. Determine the Number and Types of Personnel Needed 2. Recruitment and Selection of Personnel 3. Interview 4. Orientation and Job Offer

steps in staffing?

Career mapping

strategic plan for one's career.

Retention

the capacity to retain employees once they are hired.

Recruitment

the development of a pool of applicants for a job. The first step in the selection of personnel

Recruitment

the process of enlisting personnel for employment.

Screen out applicants who do not fit the agency's image. (VMG) Try to fit the job to a promising applicant. = look at educational background, experiences, educational qualification and emotional quotient Try to fit the applicant to the job. = specific area for the applicant to be placed

three underlying philosophies during the screening process and these are:

Staff development

training and continuing education of the employee to develop his potential fully.

Training Needs Assessment

where personnel are asked what training is needed and is also based on the performance and own observation

Patient care coordinator

with no obligation to assign nurses to the same patient, supervises and evaluates all of the care given on the unit.

Goals of staffing

§ Provide appropriate number and mixture of nursing staff to match actual or projected patient care needs. § To provide effective and efficient or high-quality nursing care. § Toprovidehighsatisfactiontoclients/patients(aswellasto their families).

Modular nursing

• A modification of team and primary nursing. • It is sometimes used when there are not enough registered nurses to practice primary nursing. Modular nursing uses a mini team (2 or 3 members with at least 1 RN). • Each registered nurse, assisted by paraprofessionals, delivers as much care as possible to a group of patients. The registered nurse plans the care, delivers as much of it as possible, and directs the paraprofessionals for the more technical aspects of care. This is important in taking care of the sick, in case-finding and contact-tracing. • _____ decreases the sense of isolation and unrealistic expectations often associated with primary nursing.

Case method

• Each patient is assigned to a nurse for total patient care while that nurse is on duty. • The patient has a different nurse each shift and no guarantee of having the same nurses the next day. • The patient care coordinator, with no obligation to assign nurses to the same patient, supervises and evaluates all of the care given on the unit. • Popular during the 1920s (oldest method) along with private duty nursing and ICU (1:1), emphasized following physician's orders. Advantages: ü Consistencyincarryingoutthenursingcareplan ü Patient needs are quickly met as high number of RN hours are spent on the patient ü RelationshipbasedontrustisdevelopedbetweentheRNand the patient's family Disadvantages: ü Mayignoreotherpatientsthatarenotunderyourcare. ü Itcanbeverycostly

Primary Nursing

• Expensive to utilize • Primary nursing features a registered nurse who gives total patient care to four to six patients (1:5 or maximum of 1:6). The RN remains responsible for the care of those patients 24 hours a day throughout the patient's hospitalization. The associate nurse is expected to contact the primary nurse regarding changes in the care plan. • The number of patients assigned to one nurse varies according to length of hospitalization, complexity of care; number of medical and paramedical personnel involved with the patient's care, availability of support systems, and the shift worked.

o 45% for the morning shifts (busy hours are usually in the morning) o 37% for the afternoon shifts o 18% for the night shifts

• In the Philippines, the distribution usually followed is:

Functional Nursing

• It can best be described as a task-oriented method in which a particular nursing function is assigned to each staff member. • It can best be described as a task-oriented method in which a particular nursing function is assigned to each staff member. Advantages: ü Averyefficientwaytodeliverycaremostespeciallyforalarge number of load and when there is a shortage of nurses ü Could accomplish a lot of tasks in a small amount of time because they may implement classic specific scientific management which emphasizes efficiency, division of labor and rigid control ü Staff members do only what they are capable of doing (little confusion on their roles) ü LeastcostlyasfewerRNsarerequired Disadvantages: ü Since there will be different nurses assigned for specific tasks, care of patients become fragmented and depersonalized ü Patientsdonothaveoneidentifiablenurse ü VerynarrowscopeofpracticeforRNs ü Leads to patient and nurse dissatisfaction (work will be routined)

Decentralized Staffing

• Shift and off duties are arranged by the Supervising Nurse or Head Nurse or Senior Nurse of the particular unit • Authority and responsibility are given to the staff in own units • The unit manager is often responsible for covering all scheduled staff, reducing or adding during periods of patient census or acuity. This means that many nurse managers have some control over factors that affect cost on their specific unit. Advantages: ü Managerretainsgreatercontroloverherunit ü Staff are able to make requests to the nurse manager ü It may provide greater autonomy and flexibility for an individual staff member Disadvantages: ü It can result in more special pleading and arbitrary treatment of employees (staff are closer to the head nurse as compared to the chief nurse) ü May not be cost-effective for the organization because staffing needs are not viewed holistically ü Moretime-consumingfortheunitmanager

Innovative/Contemporary Method

• The nurse navigator assists (specific assistance) patients and families to navigate the complex health care system by providing information and support as they transverse their illness. • Examples are nurses who are having their specialization, those who are in telehealth, nurse practitioners • The Clinical Nurse Leader is an experienced nurse possessing a graduate degree who provides clinical leadership in all health care settings, implements outcomes- based practice and quality improvement strategies, engages in clinical practice and creates and manages micro systems of care that are responsive to the health care needs of individuals and families.

Self-Scheduling

• This is a system that is coordinated by staff nurses. • It is a process by which staff nurse in a unit collectively decide and implement the monthly work schedule. • Given the criteria for adequate unit staffing for each 24 - hour period by the head nurse, each staff nurse chooses which day and shift she will work. Advantages: ü Maysavemoretimeforthemanager ü Maydevelopaccountability ü Mayimprovethemorale ü Maydecreaseabsenteeism ü Mayincreaseinteamspirit,perceptionofautonomy and job satisfaction ü May be an effective way to recruit and retain employees Disadvantages: ü Time-consuming for the staff because they will be deciding on their schedule ü Therecouldbeconflicts

Case Management

• Uses a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet individual health needs through communication and available resources to promote cost effective outcomes. • The case manager helps patient access community resources, helps patients learn about medication regiment and treatment plan and ensures that they have recommended tests and procedures. This works well if the population requires significant case management services, there needs to be enough RN time allocated for this activity. Disadvantages: • ü It requires the entire staff to be RN's which increases staffing and costs. ü Can be intimidating for RNs who are less skilled and • knowledgeable 5. Modular or District Nursing • A modification of team and primary nursing. • It is sometimes used when there are not enough registered nurses to practice primary nursing. Modular nursing uses a mini team (2 or 3 members with at least 1 RN). • Each registered nurse, assisted by paraprofessionals, delivers as much care as possible to a group of patients. The registered nurse plans the care, delivers as much of it as possible, and directs the paraprofessionals for the more technical aspects of care. This is important in taking care of the sick, in case-finding and contact-tracing. • Modular nursing decreases the sense of isolation and unrealistic expectations often associated with primary nursing. • More on utilizing the healthcare delivery system wherein the goals are to deliver quality care in order to promote quality of life and to decrease fragmentation and contain costs Examples include those in the home care, nursing homes, rehabilitation