Staffing Needs and Scheduling Policies

•ANA issued a report _____________________________________ to address outcome- based staffing

"The Business of Caring; Proving Optimal Allocation of Nursing Resources"

Benefits of centralized staffing

1. Centralized staffing is generally fairer to all employees because policies tend to be employed more consistently and impartially. 2. frees the middle- level manager to complete other management functions. 3. allows for the most efficient (cost-effective) 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.

Disadvantages of decentralized scheduling?

1. carries the risk that employees will be treated unequally or inconsistently. 2. the unit manager may be viewed as granting rewards or punishments through the staffing schedule. 3. time consuming for the manager and often promotes more "special pleading" than centralized staffing. However, undoubtedly, the major difficulty with decentralized staffing is ensuring high-quality staffing decisions throughout the organization.

Disadvantages of centralized staffing

1. does not provide as much flexibility for the worker, nor can it account as well for a worker's desires or special needs. 2. managers may be less responsive to personnel budget control if they have limited responsibility in scheduling and staffing matters.

Advantages of decentralized staffing?

1. unit manager understands the needs of the unit and staff intimately, which leads to the increased likelihood that sound staffing decisions will be made. 2. the staff feels more in control of their work environment because they are able to take personal scheduling requests directly to their immediate supervisor. 3. lead to increased autonomy and flexibility, thus decreasing nurse attrition.

_______________ supports a legislative model in which nurses are empowered to create staffing plans specific to each unit. This approach aids in establishing staffing levels that are flexible and account for changes including: •intensity of patient's needs, •the number of admissions, discharges, and transfers during a shift, •level of experience of nursing staff, •layout of the unit, •and availability of resources (e.g., ancillary staff, technology). •Establishing minimum, upwardly adjustable staffing levels in statute will also help the committee in achieving safe and appropriate staffing plans.

ANA

ANA issued a report "The Business of Caring; Proving Optimal Allocation of Nursing Resources" to address outcome- based staffing: •Highlights successful productive relationships between _____________ and ______________ •Emphasizes a _____________, _____________ approach •Demonstrates increase ______________ and improved _________________ --> decreased _____________________ •_____________ fiscal impact •Interprofessional _______________ teams

CNO's and CFO's patient first, inter-professional nurse staffing patient outcomes preventable hospital readmissions. Positive nursing-finance

_________________ staffing is generally fairer to all employees because policies tend to be employed more consistently and impartially.

Centralized

Advantages/Disadvantages of 12 hour shift?

DISADVANTAGES •Continued debate about 12 hour shifts that result in fatigue with judgement errors and slower reaction times by nurses •Nurses who work longer hours have higher instances of burnout and job dissatisfaction as well as cardiovascular disease, hypertension, diabetes and mood disorders. •Studies show long shifts lead to increased sick time ADVANTAGES •Nurses continue to report increased satisfaction with 12- hour shifts •Less work days = improved work/life balance and solutions to child care

T/F Fiscal accountability to the organization for staffing is incompatible with ethical accountability to patients and staff.

False Fiscal accountability to the organization for staffing is not incompatible with ethical accountability to patients and staff. It should be possible to stay within a staffing budget and meet the needs of patients and staff.

T/F Float pools are considered a solution for staffing issues

False Float pools 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 since they result in a lack of staff continuity.

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

Flextime

_________________ 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.

Float pools

Disadvantages in the Nursing Care Hours Per Day formula

In this formula, all nursing and ancillary staff are treated equally for determining hours of nursing care, and no differentiation is made for differing acuity levels of patients. These two factors alone may result in an incomplete or even inaccurate picture of nursing care needs, and the use of NCH/PPD as a workload measurement tool may be too restrictive, since it may not represent the reality of today's inpatient care setting, where staffing fluctuates not only among shifts but within shifts as well.

•At the national level, the use of a PCS is a condition for participation in ______________ and is required by _________________ for certification.

Medicare The Joint Commission

•Staffing can blow a budget—_______________ accounts for most of an acute facility's total payroll.

Nursing

Formula for Calculating Nursing Care Hours Per Day

Nursing hours worked in 24 hours /patient census

________________ 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.

Self-scheduling

•Staffing can make — or break—the relationship between finance and nursing. Although we've come far, ___________ remains subjective.

acuity

Another increasingly common staffing and scheduling alternative is the use of supplemental nursing staff such as ____________________. These nurses are usually directly employed by an external nursing broker and work for premium pay (often two to three times that of a regularly employed staff nurse), without benefits. While such staff provide scheduling relief, especially in response to unanticipated increases in census or patient acuity, their continuous use is expensive and can result in poor continuity of nursing care.

agency nurses and travel nurses

•Staffing affects the cost of _____________—The costs of mortality, readmission and compromised safety are high so staffing plays a role in reducing the incidence, and cost of each

care

In _______________ staffing, the manager's role is limited to making minor adjustments and providing input

centralized

Limitations of ________________ staffing Provides 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

centralized

Strengths of _______________ 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 the middle-level manager to complete other management functions

centralized

•The most fiscally responsible method for determining staffing needs is an agreed upon staffing formula based on ________________

client acuity

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

core competencies

•The __________________ PCS uses broad indicators such as bathing, diet, intravenous fluids, medications, and positioning to categorize patient care activities.

critical indicator

Limitations of _______________ 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 the unit manager to oversee if sufficient coverage

de-centralized

Some organizations _____________ staffing by having unit managers make scheduling decisions.

decentralize

Some organizations ______________ staffing by having unit managers make scheduling decisions. Other organizations use ____________ staffing, where staffing decisions are made by personnel in a central office or staffing center.

decentralize centralized

In organizations with ________________ staffing, 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.

decentralized

Strengths of _________________ staffing Manager retains greater control over unit staffing Staff can take requests directly to their manager Provides greater autonomy and flexibility for the individual staff member

decentralized

The Nurse Manager should be involved in policies that are written to allow _____________- for the staff

flexibility

•The goal of the nurse manager is to ensure there is adequate staff to __________________________

meet the needs of each client

achieving the optimum balance between ________________ and ______________ is key to a health- care organization's financial viability.

nurse staffing patient acuity

•Staffing matters to _______________—staffing is everything and determines whether you will stay in their workplace or even the profession.

nursing

ANA continues to advocate for safe staffing approaches that: • provide assurance that RNs are not forced to work without ________________ in units in which they are not adequately trained or experienced; • establish procedures for receiving and investigating __________________; • allow for civil monetary penalties for known _______________; • include ________________ protections; and • require _______________ reporting of staffing information.

orientation complaints violations whistleblower public

•Staffing affects the quality of care—Studies have shown a correlation between optimum levels of staffing and optimum _______________.

outcomes

Some hospitals have created their own internal supplemental staff by hiring ______________ and creating _____________. 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.

per diem employees float pools

The challenge for the future is to look beyond the traditional staffing model ratios used to allocate nursing as a cost and instead use nursing as a _______________! This is an example of current work being done .

resource

One of the newer methods of reducing staff shortages and also allowing nurses some control over scheduling extra shifts and to reduce mandatory overtime is _______________. In most organizations that use shift bidding, the organization sets the opening price for a shift.

shift bidding

The costs of mortality, readmission and compromised safety are high, so ____________ plays a role in reducing the incidence, and cost of each

staffing

•Fiscal accountability to the organization for staffing is not incompatible with ethical accountability to patients and staff. It should be possible to stay within a _________________ and meet the needs of patients and staff.

staffing budget

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

summative task

T/F It is possible and not uncommon to have adequate staffing one day and inadequate the next day with the same number of patients/staff

true

T/F the manager in centralized staffing continues to have ultimate responsibility for seeing that adequate personnel are available to meet the needs of the organization.

true

__________________ 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.

•Closed-unit

What occurs with using a patient classification system (PCS) based on acuity?

•Groupings of patients according to specific characteristics •Hours of nursing care assigned for each patient classification •Unique to a specific institution •Ongoing review critical

•A review of the literature consistently demonstrates that as RN hours decrease in NCH/PPD, adverse patient outcomes increase. This includes:

•Increased medication errors •Patient falls •Decreased patient satisfaction with pain management

Organizational staffing policies need to address:

•Sick leave •Vacations •Holidays •Call offs for low census •On-call pay •Tardiness and absenteeism •Shift work