16 Staffing and Scheduling

Learning Outcomes Determine staffing needs. Demonstrate how to use patient classification systems to calculate nursing care hours necessary. Calculate FTEs.

Learning Outcomes Determine the appropriate staffing mix and distribution of staff. Describe the various ways to schedule staff. Explain how to supplement staff when needed.

Staffing Goal Managers To provide appropriate numbers and mix of nursing staff to match actual or projected patient care needs to provide effective and efficient nursing care Managers Examine workload pattern for the designated unit, department, or clinic

Staffing Guidelines Joint Commission American Nurses Association (ANA) Provide the right number of competent staff to meet patient's needs based on organization-selected criteria American Nurses Association (ANA) Focus on the level of nursing competency required to provide quality nursing care Individual state boards of nursing

Patient Classification Systems Also known as patient acuity systems It used patients needs to objectively determine workload requirements and staffing needs. Data collected at midpoint for every shift and analyzed before next shift

Patient Classification Systems Problems Nurses may call in sick Patient's condition may change Demand management: uses best practice staffing protocol to predict and control the demand for nurses based on patient outcomes. Based on historical data patients progress pattern typifies expected pt outcome throughout a stay Deviations are tracked and staffing adjusted accordingly

Nursing Care Hours (NCH) Patient workload trends analyzed for each day of the week and each hour in critical care If 26 patients required 161 nursing care hours, an average of 6.19 nursing hours per patient per day (NHPPD) are required

Nursing Care Hours (NCH) NHPPD Total nursing care hours divided by total census (number of patients) NCHs may vary on the average from five to 7hrs of care for pts on medical/surgical, 10-12 hrs of care for ICU, CCU

Calculating FTEs One full-time staff works 80 hours (ten 8-hour shifts) in a 2-week period To staff an 8-hour shift takes 1.4 FTEs, one person working ten 8-hour shifts (1.0 FTE) and another person working four 8-hour shifts (0.4 FTE) to provide for the full-time person's 2 days off every week

Calculating FTEs Staff working all 8-hour shifts (1.4 FTEs × 33 shifts = 4.2 FTEs)

Calculating FTEs 2.1 FTEs are needed to staff one 12-hour shift each day, each week—two people each working three 12-hour shifts and one person working one 12-hour shift each week (0.9 FTE + 0.9 FTE + 0.3 FTE = 2.1 FTEs) Staff working 12-hour shifts (2.1 FTEs × 32 shifts = 4.2 FTEs)

Determine Staffing Mix Hygiene care, feeding, transferring, turning patients–LPNS or UAPs Assessments, patient education, or discharge planning–RNs High RN skill mix allows for greater staffing flexibility Block staffing Scheduling a set staff mix for every shift

Distribution of Staff Staff needs vary by shift or day of the week Surgery patient census fluctuates Higher census Monday through Thursday

Distribution of Staff Surgery patients Shorter length of stay than medical patients Medical patient census rarely fluctuates Monday through Friday, less on weekends (diagnostic tests not done)

Scheduling Creative and flexible scheduling Self-staffing and self-scheduling Shared schedule Open shift management Baylor plan for weekend staffing Supplemental staff

Supplemental Staff PRN staff Part-time staff Scheduled as needed Part-time staff Internal float pools provide staffing at substantially lower cost than agency nurses External pools Outside agency nurses; require orientation to facility and unit