STAFFING

Part 1- Selection and development of the personnel

This is the process of personalizing or manning the organization. Management consists of getting work done through other people, hiring (acquiring) & retaining (keeping) the right people is one of the managers' most critical responsibilities. Furthermore, since certain time may require retaining or relocation at a later date. The staffing function includes all activities involved in supplying an adequate number of the types of workers (quantities & qualities) to each unit on every shift of each day of the year.

Selection of personnel : Managers share responsibility for recruitment and retention of well- qualified people. 1. They help establish criteria for selection of personnel. 2. Structure interviews to increase validity and reliability of recruitment.

 II-Attraction of qualified application: The acquisition of qualified people in any agency is critical for the establishment, maintenance, and growth of the organization. *Therefore active recruitment is very important, and the attraction of qualified applicants are the first step in selection of personnel.

Modes for active recruitment

1. word of mouth, and 2. Advertisement in local news papers, organizations bulletins, and nursing journals, recruitment literature, posters, 3. Contact with schools graduation classes. Word of mouth can be very effective, but it can also lead to the hiring of friends and relatives of the current workforce, this practice may foster nepotism and violate equal opportunity employment requirements. Advertisement provides more opportunities to hire from minority groups.

 Each institution school has some one who is responsible for recruitment called recruiter who should know employee qualifications and the needs of the institution. The recruiter should respond to inquiries immediately.

 The major sources of personnel are 1. Persons seeking their first job 2.Dissatisfied employees, and 3. The unemployed. Note : Hiring an unemployed worker who has been released from a previous job because of an infraction or a quarrel with the previous employer demands careful assessment.

 The recruiters would not want to hire a nurse who was terminated because of high absenteeism and irresponsibility

Retention strategies
It is very important to apply because the cost of recruitment process. So 1. Continuous surveillance and focus group can be used to identify and solve problem. 2. Stressors are identified, strategies to reduce them can be planned. It is important to meet personnel's psychosocial needs for advancement, responsibility, achievement, and recognition. Nurses want input into decision making and control over their own lives.

III-Screening of Potential staff

There are three underlying philosophies in the screening process: 1. Screen out applicants who do not fit the agency's image. 2. Try to fit the job to promising applicants. 3. Try to fit the applicant to the job.

Application forms and resumes

A. Biographical data ; B. Educational background, C. work experience and D. Other pertinent information. letters of reference; letters of recommendation may be requested from references listed on the application form, previous employers or both. it is better to take the accurate capabilities of the new employee from the personnel file because of rabid turnover of the nurses or other health personnel

V- Interview
It is conducted with the most qualified applicants. The purpose of interview is to obtain information, to give Information, and to determine if the applicant meets the requirements for the position.

 The interviewer judges 1. The applicants dependability, 2. Willingness and ability to work with others, 3. Interest in the job, 4. Adaptality, 5.Consistency of goals with available opportunities 6.The interviewer answer questions, explains policies and procedures, and help acquaint the applicant.

The interview has definite purpose and should avoid social chitchat.

The main aim of the interview is to learn about the prospective employee.

 $-The manager should not give clauses about what pleases or not pleases them $ -Should not be argumentative and should try to avoid premature judgment . $-Should avoid hallo effect (e.g. judging upon appearance) $-Use the job description in determining the important functional aspects that considered as leading questions to detect the employee capabilities.

 $-Standardizing the flow of interview is helpful to avoid discriminatory hiring practice or in case of when more than one person who conduct the interview $-The heading of the form contains the date, name of the applicants, position desired, and the interviewers names. $- Are applicants cooperative and able to get along with others and work well as team members.

 $- The interviewer greets the applicant, introduces to the applicant, and make brief comments about the agency and the position for which the person is applying. The information in the applicants are discussed.. $- Discussion through the interview preferably structure interview format. the question should non directive questions. actually the funnel techniques that incorporates both open ended and closed ended question is preferable.

VI- Testing
Personality and interest testing is some times done but does require a trained psychologist. Ability test rarely used. Estimates the rate at which the applicant can acquire the Knowledge and skills required for the position.

VII- Equal opportunity and affirmative: 1964 Civil right 1972 Education amendments. 1963 Equal pay 1973 Affirmative action Prohibit discrimination because of race, color, religion, sex, or national origin
prohibit discrimination because of handicapped.

 VIII-Job analysis, job description and job Specification (job design) Before it is possible to recruit, select, and introduce new employees into the organization, there should be a guide to indicate what types of skills and training is required for each job.

 All information regarding the job to be filled and the persons filling it is obtained through job analysis. involves analyzing each job to come out with the information required to determine the job description and job specification which consists of Observing and studying a job to determine its content (duties and Responsibilities), the conditions under which the work is performed, its relationship to other jobs, and the skills, training, attitudes and abilities necessary to perform the job.

 There are 5 basic ways by which job information can be gathered for analysis: A. Observation. B. Questionnaires C. Interviews D. Literatures A combination of two or more of the above IS MORE RELIBLE

 The information obtained through the job analysis becomes the source for the development of the documents on the job description (which describes the person filling the job).

 X) Job Description : Describes the job itself, it usually includes: job title objective of each positions Authorities and responsibilities Tasks and duties to be performed. Relationship between this position and other positions (superiors , Subordinates and peers).

 Advantages of the job descriptions: It is useful for recruitment, placement, and transfer decision. To guide and evaluate personnel. Help prevent conflict, frustration, and overlapping of duties.

 $- Job description should arrange the duties in logical order. Separately and concisely Use verb to describe the action More specific in statements and if it is quantitative is more favorable.

Staff Development
Continuing liberal education of the whole person to develop there potential fully.

 It include orientation, preceptor ships, mentorship, skill checklists, internships, inservice education, courses, conferences, seminars, journal or book clubs, programmed learning, and independent study and refresher courses.

The role of nurse manager

1. Support of staff development and have responsibility to review the goals for the programs. 2. To provide budget for those activities. 3. Participate in needs identification. 4. Analyze how education effects change in nursing service.

5. They must differentiate staff development needs from administrative needs. 6. Positive reinforcement through recognition, such as oral praise on the unit or acknowledgement of accomplishments in a newsletter, is useful.

Orientation
Is the process of informing new employees about the existing work environment & their place in it, so that they can relate quickly to their new surroundings.

A. General part, which includes information given to all new employees to acquaint them with the overall purpose, function & structure of the organization as well as introduction to the rules Policies & procedures that apply to all employees (induction training). The induction is the first 2-3 days of orientation, it can be done by personnel department employee for all new employees.

B. Special part ,which relates to the specific job the employee is to fill (job orientation). There is considerable variation regarding the length, from and content of job orientation .In some institutions it may be a four-week period in others it may be a four- month period or even 6-12 months (inter ships) which are provided to newly graduated doctors and nurses during job orientation employees should be adequately informed about their job description.

 $- It is appropriate to use an orientation time schedule .and documentation of the orientation and it can retained in the personnel file. $-Frequent visits to see that the nurse is comfortable and that the Orientation is progressing satisfactorily are helpful.

 $- internship programs as in-service education program for role adjustment as educational and training session is useful. This will help the new nurse to built their confidence, lower frustration level, increase nursing care planning,,,,,,,,, and then improve job satisfaction then it reduces the job burnout and turnover. Near the end of the probationary period, it is advisable to adopt a Systematic evaluation this is considered a big indicative for the Success of the selection process.

 11-Preceptor ship: It helps recruit, retain, orient, and develop staff. They may be used before students graduated to orient them to the agency and recruit them for hire. They evaluate strengths and determine if they are suitable for employment.

 The preceptor is responsible for the quality of patient care and facilitates the students learning. Preceptors are liaisons between students and agency. * They provide real-life experiences for students before graduation to help reduce the difficulties of transition from school to work.

*The preceptor is responsible for the quality of patient care and facilitates the students learning. * Preceptors are liaisons between students and agency. *They provide real-life experiences for students before graduation to Help reduce the difficulties of transition from school to work.

 Note: the faculty member serves as a preceptor of preceptors. So they need practical evaluation tools of the students, preceptor, and faculty Should be developed. A workshop to prepare preceptors is desirable.

 111.Mentorship gives their time, energy, and material, support to teach, guide, assist, counsel and inspires a younger nurse. it is consider nurturing relationship

The mentor is a confident who personalizes role modeling and serves as a sounding board for decision. the mentor is a resource person who supports the development of the younger person through influences and promotion.

 Mentor ship stages: First: Invitational stage; mentors must be willing to use their time and energy to nurture some one who is goal directed, willing to learn, and respectfully trusting of the mentor. Second: Period of questioning; manatee experiences self-doubt and questioning of goals. Mentors help clarify goals and provides.

 Third: Transitional phase; mentor helps students personalize learning and become a ware of own strengths and uniqueness. after this final stage the manatee is now prepared to be a mentor.

Career planning: - Deciding what type of nursing one wants to do and the geographical area where one wants to practice, one needs to locate job openings.

Career mapping
Is a strategic planning for ones formal education, experience, continuing education, professional association and net working. - Nurses need to assess their own values and define success for themselves. - Job security, sense of accomplishment, and opportunities for advancement is after considered important. -Other issues are work hours, salary, fringe benefits, retirement plans, organizational and geographical climate and location.

 Group process and team development: It critical for group development, how the group functions, communicates, and sets and achieve objectives are all related to group dynamics. The teams, who typically form, organize, solve problems, implement solutions, and disband.

Forming stage: individuals are likely to feel anxious, fearful, doubtful, and self proactive. The leader concentrates on putting the members at ease, explaining the purpose, developing a workable climate, and exerting leadership.

Storming phase: tension tends to be higher and resistance is common and disagreement is obvious. In this phase the group needs for help and clarification of misunderstandings and fears. Norming: The group is structured and there purpose becomes clarified and cohesiveness develops during this phase.

Performing: help the group to focus in issues, behaviors, or problems not in a person. Help the group members to maintain constructive relationship, and take initiative to make things better. The leader should lead by examples. until the group resolve the problem and achieving the objective of the team forming.

Adjourn or disbanding: the members may have positive or negative feeling about the disbanding. The leader should express appreciation and give positive reinforcement.

 *** DAVID CLEMAN...et al (1995) have described individualism like Sprinters who are uncoordinated individuals and run independent effort for each. While the coordination level and team and independent effort is like a relay. ONE AUTHER STATED that group dynamics level is like rowing crew that puts a concerted effort toward a goal.

 The roles of the manager in building a team are: Show a willingness to help establish the team Set goals and expectations Monitor performance. Give continuous feed back

5- Build relationship 6-Train and educate team members. 7-Offer resources and time. 8- Documenting and communicating success 9-Should enhance the concepts of autonomy

 Planning for staff development program Needs assessment: Identify the desired knowledge and skills and compare the results with the available knowledge and skills of the target population. The type of speaker and the language that is used and the suitable time should be assessed.

Identify the appropriate resources that meet the needs. Plan and implement learning strategies. Evaluate the results. In terms of reactions and response to the learning process, the behavior changed the impact in the organization.

Notes: 1- Diversity in styles of learning should be considered (variety in teaching methods). There are numerous teaching methods and tools available, including but not limited to lecture, discussion, role play, case study.and hand out. 2-Cultural variable should be considered. Immediate and specific feed back improves performance and enhance competency.

Performance appraisal

It is a periodic formal evaluation of how well personnel have performed their duties during a specific period.

 Purposes: To determine job competence. To enhance staff development and motivate personnel toward higher achievement. To discover the employees aspirations and to recognize accomplishment.

To improve communications between managers and staff associates and to reach an understanding about the objectives of the job and agency. To determine training and development needs. To select qualified nurses for advancement and salary increases. To identify unsatisfactory employees.

Common errors in evaluation:

Criteria involving judgments are used for performance evaluation. Hallo error: Is result of allowing one trait to influence the evaluation of other traits or of rating all traits on than basis of a general impression. A logical error: Is a rating a nurse possesses another chch that is logically related.

Horns error: the evaluator is hyper perfectionist may rate personnel lower than they should. Contrast error: Tendency of managers to rate the nurse opposite from the way they receive themselves. Central tendency error: A small range of scores was applied in evaluation.

Methods of performance management

Anecdotal notes: Are objective description of behavior recorded on plain paper or a form. The notation include who was observed, by whom, When, and where. It comprises a description setting or background and the incident, and interpretation and recommendations may be included. Value laden words such as good and bad should be avoided. It is advisable to make several brief observations over a time span to allow for temporary Variables and to identify patterns of behaviors. An advantage of anecdotal note readings is that not coerced into a rigid structure.

Check list: The manager categorically assess the presence or absence of desired chch or behaviors. Checklists are mostly for tangible variables, Such as inventory of supplies, and may be used to evaluate nursing skills also.

 Rating scale: It does more than just note the presence or absence of desirable behavior. It locates the behavior at a point on a continuum and notes quantities and qualitative abilities. The numerical rating scale usually includes numbers against which a list which a list of Behaviors are evaluated. Ranking: It forces managers to rank the staff in descending order from highest to lowest even if they do not think there is deference.

Assignment systems for staffing

Case Method : In the case method each patient is assigned to a nurse for total patient care while that nurse is on duty. The patient has a different nurse each shift and no guarantee of having the same nurses the next day. Popular during the 1920s along with private duty nursing , the case method emphasized following physicians order.

 Functional Nursing: When few registered and only some practical nurses were available, nurses aides gave much patient care. The functional method implements classic scientific management, which emphasize efficiency, division of labor, and rigid control. It is an efficient system that is the least costly and requires few registered nurses. RNs keep busy with managerial and non nursing duties, and nurses aides deliver the majority of patient care..

 Team Nursing Team nursing was introduced to improve nursing services in hospitals and nursing homes by using the knowledge and skills of professional nurses and to supervise the increasing numbers of auxiliary nursing staff. Team nursing is based on a philosophy that supports the achievement of goals through group action. each member is encouraged to make suggestions and share ideas. When team members see their suggestions implemented, their job satisfaction increases and they become motivated to give better care.

 Team leader assign team member to patients by matching patient needs with staff knowledge and skills. One of the main features of team nursing is the nursing care conferences. The team leader is responsible for planning and conducting the team conferences, which should be limited in time and scope. Meeting for 15 to 30 minutes at the same time each day helps the conference become a part of the daily routine. The nursing care plan is another feature of team nursing.

 Primary Nursing: It is based on the philosophy that patients, instead of tasks, should be the focus of professional nurses, primary nursing features an RN who gives total patient care to four to six patients. The RN remains responsible for the care of those patients 24 hours per day throughout the patient hospitalization. The associate nurse cares for the patient by using the care plan developed by the primary nurse while the primary nurse off duty.

 The associate nurse is expected to contact the primary nurse regarding changes in the care plan. The primary nurse does the admission interview and develops the nursing care plan, including teaching and discharging planning, which is shared with the associate nurse. Primary nurses have the autonomy and authority for the care of their patients. Consequently, accountability is placed and continuity of care is facilitated.

Staffing Schedules
Centralized scheduling: The schedule done by the upper manager for all nurses in all departments manually or by computer. The advantages: fairness to employees through consistent, objective, and impartial application of policies and opportunities for cost containment through better use of resources. relieves nurse managers from time-consuming duties, freeing them for other activities.

Computer can be used for centralized scheduling. The advantage of this include cost-effectiveness through the reduction of clerical staff and better use of professional nurses by decreasing the time spent in non-patient care activities; unbiased, consistent scheduling; equitable application of agency policy; developed in advance so employees know what their schedule are and can plan their personal live accordingly. Disadvantages: 1.Lack of individualized treatment of employees is a chief complaint.

 Decentralized scheduling When managers are given authority and assume responsibility, they can staff their own units through decentralized scheduling. Advantages: Personnel feel that they get more personalized attention with decentralized scheduling. Staffing is easier and less complicated when done for a small area instead of for the whole agency. Managers can work together to solve chronic staffing problems.

 Disadvantages: Some staff members may receive individualized treatment at the expense of others. Work schedules can be used as a punishreward system.

Because it is consuming time, takes managers away from other duties or forces them to do the scheduling while off duty. it may use resources less efficiently and consequently make cost containment more difficult.

 Self scheduling Self scheduling is a system that is coordinated by staff nurses. Staff may negotiate before and after work and during break and lunchtime. They may also write notes to each other and Waite for responses.

 Advantages: 1. Help create a climate where professional nursing can be practiced. 2. Saves the manager considerable scheduling time and changes the role of the manager from supervisor to coach.

Increases staff members ability to negotiate with each others. Increased perception of autonomy, increased job satisfaction, increased cooperative atmosphere, improved team spirit, improved morale, decreased absenteeism, reduced turnover.

 Alternating or rotating work shifts Some nurses may work all three shifts within 7 days. Create stress for staff nurses. Body rhythms need time to adjust to the discrepancy between the persons activity cycle and the new demands of the environment. The ability of the body functions to adjust varies considerably among individuals. It may take 2-3 days to 2 weeks for a person to adjust to a different sleep-wake cycle.

it effect the health of nurses and the quality of their work. Anorexia, digestive disturbances, disruption in bowel habits, fatigue, and error proneness.

 Permanent shift Advantages: 1. Permanent shift relieve nurses from stress and health related problems associated with alternating and rotating shifts. 2. provide social, educational, and psychological advantages. 3. staff can participate in social activities.

 4. they can continue their education by planning courses around their work schedules. 5. child care arrangement can be stable. 6. fewer health problems and less tardiness, absenteeism, and turnover.

 Disadvantages: Managers may have difficulty in evaluating the evening and night shifts. the staff of permanent shift not develop an appreciation for the workload or problems of other shifts.

 Block, cyclical, scheduling Block, or cyclical, scheduling uses the same schedule repeatedly. The schedule repeat itself every 6 weeks. Advantages: personnel know their schedules in advance and consequently can plan their social live. Absenteeism will be less. establish stable work groups and decrease floating, thus promoting team spirit and continuity of care.

Variable staffing Eight hour shift in a five day workweek 5-day, 40-hours workweek The shift usually 7am to 3:30pm, 3pm to 11:30pm, and 11pm to 7:30 am and a half hour overlap time between shifts to provide fro continuity of care.

 Ten hour shift in Four day workweek The main problem was fatigue. The long weekends and off were attractions. There is time to finish work, peak work loads can be covered, and there is decreased overtime and decreased costs.

 Twelve-hour shift in seven day workweek The better use of personnel lower staffing requirements; this consequently lowers the cost per patient day. Fewer communication gaps and better continuity of care. Improved nurse-patient relations, job satisfaction, and morale. Working relations are improved. Team development is possible. No blames for problems. Total time off is increased, with an increased usefulness fro other duties. Travel time is reduced. Overtime pay has been of some concern.

 Staffing to meet fluctuation needs/ adjustment to workload Transfer staff from a less busy area to the overloaded area.
economical to the agency, but disrupts the unity of work groups, causes transferred nurse to feel insecure, and contributes to job dissatisfaction and turnover. Some units require specialized knowledge and skill that not every nurse has(cross training is helpful).

Companion floor system, two units relieve each others.

Float nurse; full time staff nurses who are oriented to many areas and like the challenge of different types of patients and settings. But all of nurse prefer stability. fulltime staff work a double shift. Over time.

part time staff. temporary help for the summer to give relief fro vacations. External temporary help agencies are available in some areas. Mandatory overtime is requiring staff to stay on duty after their scheduled shift ends. Some managers are believe on that using a tired nurse is better than no nurse at all.

1. Declining inpatient activity and changing patient care patterns have caused some to right size or down size.