Chapter 9 Effective Staffing

Objectives Upon completion of this chapter, the reader should be able to: Discuss how staffing needs determined Calculate full-time equivalents (FTEs) needed to staff typical inpatient nursing unit Discuss appropriate units of service used to measure nursing need by unit type (continues)

Objectives Upon completion of this chapter, the reader should be able to (cont’d): Identify patient classification systems Review considerations in developing staffing pattern Discuss staff scheduling on patient care unit Discuss role of nurse staffing in achieving quality nurse-sensitive outcomes (continues)

Determination of Staffing Needs Historically, patient census used to determine staffing needs Proven to be inaccurate Patient care needs vary greatly Understanding of key terms related to staffing patterns and needs E.g., FTEs, productive time, nonproductive time, direct and indirect care, nursing workload, units of service

FTEs Measure of work commitment of full-time employee Hours are total of all paid time (continues)

FTEs Productive hours Nonproductive hours

Variables in Staffing Knowledge and expertise of staff Acuity of patients Complexity of care Patient dependency for daily activities Care delivery model Care management tools Organizational supports

Employee Classifications Direct care Indirect care

Scheduling Responsibility of nurse manager Manager must ensure schedule places appropriate staff on each day and shift for safe, effective care Even number of staff should be available across the week

Shift Variations Traditional staffing patterns Shift variations occur to meet needs of patients and staff

Self-Scheduling Process in which unit staff take leadership in creating and monitoring work schedule while working within defined guidelines Major factor in nurse job satisfaction and retention due to increased staff control over scheduling (continues)

Total Patient Care Nurse responsible for total care of patient assignment for shift working Advantages Disadvantages

Functional Nursing Care Divides nursing work into functional roles

Team Nursing Assigns staff to teams Advantages Disadvantages (continues)

Primary Nursing Clearly delineates responsibility and accountability of RN Places RN as primary provider of care to patients (continues)

Primary Nursing Patients assigned to primary nurse who: Has authority, accountability, and responsibility to provide care for group of patients Is responsible for developing plan of care with patient which other nurses caring for patient will follow (continues)

Patient-Centered or Patient-Focused Care Designed to focus on patient needs Care teams established for group of patients (continues)

Clinical Pathways Care management tools that outline expected clinical course and outcomes for specific patient type Should be evidence-based

Case Management Strategy to improve patient care and reduce hospital costs through coordination of care Typically, case manager: