Chapter 17

1. Chapter 17 Staffing Needs and Scheduling Policies

2. 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 • Staffing mix varies with acuity

3. Although many organizations now use staffing clerks and computers to assist with staffing, the overall responsibility for scheduling continues to be an important function of first- and middle-level managers Staffing Clerks

4. Strengths and Limitations of Decentralized and Centralized Staffing

5. Question Tell whether the following statement is true or false: 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 • False

6. Answer Answer: Rationale:

7. It is important to remember that centralized and decentralized staffing is not synonymous with centralized and decentralized decision making Fair and uniform staffing and scheduling policies must be written and communicated to all staff Decentralized scheduling and staffing lead to increased autonomy and flexibility but centralized staffing is fairer to all employees because policies tend to be employed more consistently and impartially Staffing and Decision Making

8. Common Staffing and Scheduling Options in Health-Care Organizations • 10- or 12-hour shifts • Premium pay for weekend work • Part-time staffing pool for weekend shifts and holidays • Cyclical staffing, which allows 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 • Job sharing • Allowing nurses to exchange hours of work among themselves • Flextime

9. Common Staffing and Scheduling Options in Health-Care Organizations—(cont.) • Use of supplemental staffing from outside registries and float pools • Staff self-scheduling • Shift bidding, which allows nurses to bid for shifts rather than requiring mandatory overtime

10. Organizational Staffing Policies Need policies that address: • Sick leave • Vacations • Holidays • Call-offs for low census • On-call pay • Tardiness and absenteeism

11. Scheduling Alternatives • Agency nurses • Travel nurses • Flextime • Self-scheduling • Float pools • 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

12. Question What are some advantages to an organization of using travel nurses? • They command premium pay • They provide scheduling relief • They offer good continuity of care • All of the above

13. Answer Answer: Rationale:

14. Formula for Calculating Nursing Care Hours Per Patient Day

15. Staffing by Acuity—Using a Patient Classification System • Groupings of patients according to specific characteristics • Hours of nursing care assigned for each patient classification • Unique to a specific institution • Ongoing review critical • Internal or external forces affecting unit influence classification system

16. The critical indicator PCS uses broad indicators such as bathing, diet, intravenous fluids, and medications, and positioning to categorize patient care activities The summative task PCS requires the nurse to note the frequency of occurrence of specific activities, treatments, and procedures for each patient At the national level, the use of a PCS is a condition for participation in Medicare and is required by the Joint Commission for certification Patient Classification System (PCS)

17. Question A nurse-manager notes how often a patent takes his medication to determine scheduling. This is an example of using which of the following systems? Critical indicator PCS Summative task PCS C. Staffing by acuity

18. Answer Answer: Rationale:

19. The Relationship Between Staffing and Quality of Care • Staffing mix • Staffing ratios • Numbers of staff

20. Effect of Decreased Hours A review of the literature consistently and overwhelmingly demonstrates that as RN hours decrease in NCHPPD, adverse patient outcomes increase. This includes: • Increased medication errors • Patient falls • Decreased patient satisfaction with pain management

21. Generational Diversity in Nursing Generation Year of Birth • Silent Generation 1925 to 1942 • Baby Boomer 1943 to early 1960s • Generation X Early 1960s to 1980 • Generation Y 1980 to present Source: Adapted from Hill (2004), McNeese and Crook (2003), and Martin (2003).

22. Question The Silent Generation comprises people born from: • 1943 to early 1960s • 1965 to 1975 • Early 1960s to 1980 • 1917 to 1925 • None of the above

23. Answer Answer: Rationale:

24. Closed-unit 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 Staffing

25. Criteria to Meet When Handling Understaffing Issues • Decisions made must meet state and federal labor laws and organizational policies • Staff must not be demoralized or excessively fatigued by frequent or extended overtime requests • Long-term as well as short-term solutions must be sought • Patient care must not be jeopardized

26. Mandatory Overtime • Employees are forced to work additional shifts, often under threat of patient abandonment • While mandatory overtime is neither efficient nor effective in the long term, 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

27. Question The effects of mandatory overtime are most detrimental in the: • Short-term • Long-term

28. Answer Answer: Rationale:

29. 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 Fiscal Accountability

30. Unit Checklist of Employee Staffing Policies • Name of person responsible for staffing schedule • Type and length of staffing cycle used • Rotation policies if shift rotation is used • Fixed shift transfer policies • Time and location of schedule posting • When shift begins and ends; day of week schedule begins • Weekend off policy; tardiness policy • Low census procedures

31. Unit Checklist of Employee Staffing Policies—(cont.) • Policy for trading days off; days off request procedures • Absenteeism policies • Policy regarding rotating to other units • Procedures for vacation time and holiday time requests • Procedures for resolving conflicts regarding time off • Emergency request policies • Transfer request policies • Mandatory overtime policy