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Chapter 13

Staffing and Scheduling

Integrate current research into principles to effectively manage nurse staffing.

Use technology to plan, implement, and evaluate staffing, scheduling, and the effectiveness of a unit’s productivity.

Examine personnel scheduling needs in relation to patients’ requirements for continuity of care and positive outcomes, as well as the nurse manager’s need to create a schedule that is fair and equitable for all team members.

Learning Outcomes (1 of 2)

Relate floating, mandatory overtime, and the use of supplemental agency staff to nurse satisfaction and patient care outcomes.

Evaluate the impact of patient and hospital factors, nurse characteristics, nurse staffing, and other organizational factors that influence nurse and patient outcomes.

Learning Outcomes (2 of 2)

Staffing

Scheduling

Patient outcomes

Fixed staffing

Flexible staffing

Safe staffing

Optimal staffing

Introduction of Terminology

Framework is needed.

Multiple factors for planning

Patient outcomes must be considered.

Staffing Process

Insert Fig. 13-1

Insert Conception Framework of Nurse Staffing and Patient Outcomes Fig. 13-1

Patient acuity

Budget-based

Nurse-patient ratio

Models for Nurse Staffing

Patient Acuity

Severity of patients’ conditions multifactorial

Patient classification types

Prototype evaluation system

Factor evaluation system

Staffing developed with budget plan

Based on the Nursing Hours Per Patient Day (HPPD)

Budget-Based Staffing

Requires set number of patients cared for by one nurse.

Mandated nurse-patient ratios.

Some state have legislation for this staffing.

Nurse-Patient Ratio

ANA opted to support nurse staffing committee.

Safe staffing principles

Based on:

RN educational level

RN certifications

RN level of experience

Number of healthcare personnel

Geography of unit

Technology

Intensity, complexity, and stability of patients

Alternative to Nurse-Patient Ratio Staffing

One component in evaluating effectiveness of staffing process

NDNQI opportunity to compare effectiveness in specific nursing service unit

Comprehensive national nursing database

18 Quality indicators to use for benchmarking

Nurse-sensitive data

National Database of Nursing Quality Indicators

Prevention of mortality is priority

Hospital readmissions

Nurse work environment

Hospital-acquired conditions

Missed Care

Evaluation of Effective Staffing

Education

Overtime

Agency/float Pools

Factors in Staffing that Influence Patient Outcomes

Structure and Philosophy of the Nursing Services Department

Organizational support

Services offered

Organizational Factors that Affect Staffing Plans

Forecast workload to calculate number of FTE (full-time equivalents)

Productive time

Direct care hours

Indirect care hours

Benefit time

Developing a Staffing Budget

Distribution of the FTEs

Based on budget

Includes the following:

Hours of operation of unit

Basic shift length

Activity patterns for unit

Shift rotation

Weekend requirements

Personal and professional requirements

Developing Staffing Plan

Function of the staffing plan

Assigning days to personnel to work

Developed 1 to 3 months in advance

Constructed based on unit/facility policy

Constructing the Schedule

Decentralized scheduling

Staff self-scheduling

Centralized scheduling

Schedule Development Methods

Managers must justify staffing

Provide productivity reports

Average daily census projects potential workload

Percentage of occupancy

Average length of stay

Nursing productivity

Evaluating Unit Staffing and Productivity

Satisfaction of staff important

Patient outcomes important

Collaborative between manager and staff

Must meet needs

Conclusion