1. Chapter 9
Effective Staffing

2. 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)

3. 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)

4. 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

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

6. FTEs
Productive hours
Nonproductive hours

7. 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

8. Employee Classifications
Direct care
Indirect care

9. 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

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

11. 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
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12. Total Patient Care
Nurse responsible for total care of patient assignment for shift working
Advantages
Disadvantages

13. Functional Nursing Care
Divides nursing work into functional roles

14. Team Nursing Assigns staff to teams Advantages Disadvantages
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15. Primary Nursing
Clearly delineates responsibility and accountability of RN
Places RN as primary provider of care to patients
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16. 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
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17. Patient-Centered or Patient-Focused Care
Designed to focus on patient needs
Care teams established for group of patients
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18. Clinical Pathways
Care management tools that outline expected clinical course and outcomes for specific patient type
Should be evidence-based

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