Staffing and Scheduling

“One of the most critical issues confronting nurse executives today is nurse staffing“. “The major goal of staffing and scheduling systems is to identify the need for and provide the number and type of personnel required to deliver care”.

Staffing is a human resources function that is targeted at creating the personnel and favorable work conditions for optimal productivity and the professional practice of nursing.

" Staffing and scheduling are complex, multifaceted responsibilities that are central to nursing efforts to effectively integrate organizations and systems. Staffing and scheduling affect the jobs, positions, workload, personal lives, and morale of nurses. Staffing and scheduling decisions impact the organization or unit's financial management plan, impinge on productivity, and affect patient outcomes. Staffing and scheduling are both frustrating and time-absorbing for nurse managers.

Issues of safety and quality of client care may arise due to specific staffing and scheduling. "Staffing policies and needs affect the nursing department budget, staff productivity, quality of care provided to clients, nursing staff morale, and even nurse retention’’.

Regulatory agencies such as the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) have a standard that calls for “a sufficient number of qualified registered nurses( RNS) to be on duty at all times to give clients nursing care that requires the specialized skill and judgment of an RN”.

with qualified personnel. Nurse staffing has three main components: DEFINITION OF TERMS Staffing: is defined as human resources planning to fill positions in an organization with qualified personnel. Nurse staffing has three main components: Planning. Scheduling. Allocation.

Planning refers to determining the number of nursing personnel needed over a long term period. Scheduling is assigning nursing staff for specific time periods by shift. Allocation refers to making adjusted assignments or reallocations on a daily or shift-by-shift basis.

The staffing plan is a written plan that specifies the number and classification type of staff personnel who are needed to implement a care delivery model for each unit on a shift-by-shift basis. Short-term plans involve filling existing positions. Long-term plans are concerned with determining the gap between the present and a desired future human resources status.

A staffing strategy is a set of actions undertaken to determine the organization's future human resources needs, recruit qualified applicants, and select the best of the applicants as new employees. Staffing activities need to mesh with other organizational strategies and the mission.

Scheduling: is defined as the ongoing implementation of the staffing pattern by assigning individual personnel to work specific hours, days, or shifts and in a specific unit or area. Scheduling generally means the actual preparing of work hour assignments according to the staffing plan and mix. Staff mix is defined as the skill level of individuals delivering the required care. Staff mix in nursing includes RNs, LPNs, nursing assistants, and unlicensed assistive personnel.

Skill mix: is the proportion of RNs to total nursing staff Skill mix: is the proportion of RNs to total nursing staff. It is usually expressed as RN/ total nursing personnel. Nursing resources: refers to the number and types of employees designated to provide nursing services to clients. -There are many ways to distribute resources within any organization. - Workload is defined as the volume of work for a unit or department. - Nursing workload is defined as the nursing care needs of clients. It refers to the nursing resources required for delivering nursing services to individuals or groups of clients.

STAFF MIX AND SKILL MIX

Nursing workload is a measurement of the nursing work activities and the dependence of the clients on nursing care. Thus both direct and indirect nursing care activities are a part of nursing workload Nursing workload in a hospital is a function of two variables: Number of patient days Hours of nursing care required per patient day. Workload is the use of time, and time is the basis of nursing workload measurement.

“WORKLOAD”

Acuity is defined as the severity of illness or client condition. Acuity can translate into volume (census, visits, or encounters) or severity or intensity. Nursing intensity is defined as both the amount of care and the complexity of care needed by patients in hospitals.

Nursing Care Intensity Indicators of nursing care intensity: Patient acuity Patient turnover

"The real driver of nurse staffing is patient demand for care”.... “Nurse staffing intensity which is expressed as the ratio of RNs to patient census in hospitals, has been associated with lower mortality in hospitals”. e.g (1 RN : 10 patients)…. "The real driver of nurse staffing is patient demand for care”....

Prescott (1991) identified four major dimensions to nursing intensity (Box 33.1) Severity of illness Client dependency on nursing. Complexity of nursing care. Time the four components are related to each other and have been combined into a 10-item for nursing intensity scale, called the Patient Intensity Nursing Index (PINI).

Severity of illness: The medical condition and how ill the person is in relationship to abnormality and instability of physiological parameters: Client dependency: need for assistance with activities of daily living. Complexity of nursing care. Time: The hours of direct and indirect care received by a client.

Staffing and scheduling are a fine balance of competing interests and needs. There are predetermined standards, budget constraints, personal preferences, legal aspects, and individuals to please. Staffing and scheduling are two aspects of the allocation of scarce and expensive personnel resources.

To increase the chance of successful and appropriate allocation of resources, the administrative function of planning is involved in staffing and scheduling. The planning may be simple or complex. It may be as simple as deciding what is wanted,(e.g.. an all-RN staff). And then as complex as determining what must be done to obtain it (e.g. budgeting.. recruitment, and retention).

Staffing methodology needs to be based on quantifiable and measurable data. The following three variables are central to the staffing methodology (Abdoo, 2000): 1. Assessment of patient needs for care (patient classification) 2. Assessment of required nursing time to meet needs (workload determination) 3. An algorithm that uses the first two variables

The following indicate a need for better staffing: Adverse drug reactions Family complaints( criticism) Injuries to patients Long length of stay Patient complaints Patient falls Postoperative infections

Indications of a need for better staffing (cont.): Shock/cardiac arrest Skin breakdown Upper gastrointestinal bleeding Urinary tract infections

To determine the number of staff to hire, one must consider: Hours for which coverage is required Vacations Holidays Absenteeism Staff development time

Types of scheduling: Centralized scheduling Decentralized scheduling Computerized scheduling Self-scheduling Permanent shifts

Centralized scheduling: Centralized scheduling: staffing coordinator created schedules based on the approved staffing plans for individual units. Advantage: Fairness Cost control Disadvantage: lack of individual treatment -Unrecognized organizational and managerial problem

Decentralized scheduling: Decentralized scheduling: nurse manager develop the schedule for their units in isolation from all other units. The managers approves all schedule changes Advantages: managers have authority - staff get personalized attention staffing is easier staffing is less complicated

Disadvantage: schedule used to punish and reward - time consuming for manager -less efficient use of resources - cost control is more difficult

Self-scheduling A grid is developed and the nurses sign up for the shifts they want to work in conformity the policies of the unit and the organization

Advantages & disadvantages of Self-scheduling -coordinated by staff nurses +saves managers scheduling time + helps develop accountability +increased perception of autonomy + increase job satisfaction + improve team spirit + improve self-esteem + decrease absenteeism + reduced turnover + effective for recruitment and retention

Disadvantage increase amount of time staff spends on scheduling

Permanent shifts Nurses assigned for one shift and do not rotate

Permanent shifts Advantages can participate in social activities + job satisfaction + commitment to organization + few health problem + less tardiness( delay lateness) + less absenteeism + Less turnover

Disadvantage most people want day duty - new graduated mostly staff evenings and nights - Difficulty evaluating evening and night staff - Nurses may not appreciate the workload or problems of other shifts