119.
04 Roles and Functions in Staffing
Ma’am Leny Baguio || September 2021
Transcribers: zz, rben, vidabest, shami
Week #7
OUTLINE
Chapter 15-17
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EMPLOYEE RECRUITMENT, SELECTION, PLACEMENT, AND
INDOCTRINATION
STAFFING
 The process of assigning competent people to fill the roles
designated for the organizational structure through recruitment
selection and development
 In staffing, the leader-manager recruits, selects, places,
indoctrinates personnel to accomplish the goals of the organization.
 Third phase of the management process
o Important because such organizations are usually labor
intensive (many employees are required to accomplish
organizational goals)
 Large workforce must reflect an appropriate balance of highly skilled,
competent professionals and ancillary support workers
o Workforce should reflect the gender, culture, ethnicity,
age, and language diversity of the communities that the
organization serves
 Sequential Steps in Staffing
1. Determine the number and types of personnel needed to fulfil
the philosophy, meet fiscal planning responsibilities, and carry
out the chosen patient care delivery system selected by the
organization.
a. Done through interviews or daily observations
2. Recruit, interview, select, and assign personnel based on
established job description performance standards.
a. Opportunity to attract the best, and brightest
applicant needed in the organization
3. Use organizational resources for induction and orientation.
a. Allows parties to back out before an offer is made
4. Ascertain that each employee is adequately socialized to
organization values and unit norms.
5. Use creative and flexible scheduling based on patient care
needs to increase productivity and retention.
a. Timetable of planned workdays
A. Predicting Staffing Needs
 A crucial management skill = enables the manager to avoid staffing
crises
 Manager should know the:
o Source of their nursing pools
o Number of the students enrolled in local nursing schools
o Usual length of employment of newly hired staff
o Peak staff resignation periods
o Times when the patient census is highest
 Manager must consider:
o The patient care delivery system in place
o The education and knowledge level of needed staff
o Budget constraints
o Historical staffing needs and availability
o The diversity of the patient population to be served
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NCM 119 - LECTURE
 Manager must understand third-party insurer reimbursement
o Example: as government and private insurer
reimbursements declined in the 1990s, many health-care
organizations—hospitals in particular—began downsizing
by replacing registered nurse (RN) positions with
unlicensed assistive personnel.
o Contributed to an acute shortage of RNs in many health-
care settings in the late 1990s
 Hospital downsizing and short-sightedness regarding recruitment
and retention contributed to the beginning of an acute shortage of
RNs in many health-care settings by the late 1990s.
 Manager should be aware of the role that national and local
economics play in staffing
o Economy improves = nursing shortages occur
o Economy declines = nursing vacancy rate declines
B. Is there a current nursing shortage?
 Numerous factors are contributing to significant future nursing
shortages:
o Aging of the nursing workforce
o Accelerating demand for professional nurses
o Inadequate enrolment in nursing programs of study
o The aging of nursing faculty
 Shortage of human resources = poses the greatest challenge to most
health-care organization
 Global recession (nursing employment bubble)
o Many nurses who planned to retire have put off their
retirements
o Many nurses who were working part time increased their
employment to full time
o Some nurses who had been out of the profession for 5
years or more returned to the workforce
 Leaders should seek to proactively recruit and hire staff with age,
gender, cultural, ethnic, and language diversity to better mirror the
rapidly increasing diversity of the communities they serve
o Diversity also brings new perspectives to thinking and
problem solving
C. Recruitment
 The process of actively seeking out or attracting applicants for
existing positions
 Should be an ongoing process
 The organization’s ability to meet its goals and objectives relates
directly to the quality of its employees
 Nonmonetary factors are important in recruiting new employees
 Before recruiting begins, organizations must identify reasons a
prospective employee would choose to work for them over a
competitor.
1. Factors That Affect Recruitment
 Financial resources
 Adequate nursing pool
 Competitive salaries
 The organization’s reputation
 The location’s desirability
 The status of the national and local economy
2. Recruitment Methods
 Advertisements
 Career days
 Literature
 Word of mouth by satisfies employees
119.04 STAFFING – Ma’am Leny Baguio
3. Recruitment and Retention
 Recruitment = not the key to adequate staffing in the long term
 Retentions = is the key but it only occurs when the organization is
able to create a work environment that makes staff want to stay
o Healthy work environments – A place of physical, mental,
and social well-being supporting optimal health and
safety
 Where the nursing staff feel supported
physically and emotionally, and where one feel
safe, respected and empowered
 Turnover
o Normal and desirable
o Infuses organization with fresh ideas and reduces the
probability of groupthink (so encouraged na everyone
shares similar thought processes, values, goals)
o Excessive and unnecessary turnover reduces the ability of
the organization to produce its end product and is
expensive
 Human resources expenses for advertising and
interviewing
 Recruitment fees (sign-on bonuses)
 Increased use of travelling nurses, overtime,
and temporary replacements for lost worker
 Lost productivity
 Costs of training time to bring new employee
up to desire efficiency
 The leader-manager recognized the link between retention and
recruitment
 The closer the fit between what the nurse is seeking in employment
and what the organization can offer, the greater the chance that the
nurse will be retained
D. Interviewing as a Selection Tool
 A verbal interaction between individuals for a particular purpose
 Frequently accepted as the foundation for hiring, despite its well-
known limitations in terms of reliability and validity.
 Old-school interviewing (traditional)
o Bad at assessing soft skills and applicant weaknesses
o Leave room for bias
o Take a lot of time
o Rely on the questions ask in order to get a clear picture of
the candidate
 Most time-consuming and thus one of the costliest selection tools
 Generally requires an interviewee to use judgements biases, and
values to make decisions based on a short interaction with an
applicant in an unnatural situation
o Reliability and validity are always suspected
1. Purposes of the selection interview
a. The interviewer seeks to obtain enough information to determine the
applicant’s suitability for the available position
b. The applicant obtains adequate information to make an intelligent
decision about accepting the job, should it be offered
c. The interviewer seeks to conduct the interview in such a manner that
regardless of the interview’s result, the applicant will continue to
have respect for and goodwill toward the organization
2. Types/Formats of Interviews
 Unstructured Interview
o Requires little planning
 The goals for hiring may be unclear
 Questions are not prepared in advance
 The interviewer does more talking than the
applicant
o The most common selection tool in use today
 Semi structured Interview
o Require some planning since the flow is focused and
directed at major topic areas although there is flexibility in
the approach
 Structured interview
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o Much better predictor of job performance and overall
effectiveness than the unstructured interview
o Requires greater planning time
 Questions must be developed in advance that
address the specific job requirements
 Information must be offered about the skills
and qualities being sought
 Examples of applicant’s experience must be
received
 The willingness or motivation of the applicant
to do the job must be determined
o Interviewer would ask the same essentials questions of all
applicants
3. Limitation of Interviews
 Subjectivity – major defect of the hiring interview
 Old-school interviewing (traditional)
o Bad at assessing soft skills and applicant weaknesses
o Leave room for bias
o Take a lot of time
o Rely on the questions ask in order to get a clear picture of
the candidate
 “There is also a belief that interviewing is all about talking to people,
and interviewing is just about good conversation. The selection
interview is much more than a conversation, and good
conversationalists aren’t necessarily good interviewers”
 Many people think they are better interviewers than they really are.
 Research findings regarding the validity and reliability of interviews
o Validity increases with team approach
o The altitudes and biases of interviewers greatly influence
hot candidates are rated (subjectivity can never be totally
eliminated)
o Negative information is weighed more heavily than
positive information
o The same standards should be used for all applicants
o Personal bias should be minimized because negative
feelings likely have no relation to the criteria necessary for
success in the position
o Interviewers tend to make up their minds about hiring
applicants very early in the job interview
o High interview assessments are not related to subsequent
high-level job performance
o Mixed reliability and validity
 Interrater reliability is high – same interviewer
will consistently rate the interviewee the same
 Interrater reliability is low in unstructured
interviews
 Interrater reliability is better if the interview is
structured and the same format is used by both
interviewers
 Interviewers may be overly impressed with superficial signs such as
composure, manner of speech, and physical appearance
 Interviewer may have poor communication skills and be unable to
generate a discussion
 Physical appearance often contributes substantially to an
interviewer’s opinion about an applicant
 Interviewers frequently ask questions that demonstrate a self-
fulfilling prophecy regarding their first impression of the applicant
4. Overcoming Interview Limitations
 Use a team approach
o More interviewer = lesser individual bias
 Develop a structured interview format for each job classification
o Managers should obtain a copy of the job description and
know the educational and experiential requirements for
each position prior to the interview.
o Interviews must be structured to fit the position
o A well-developed structured interview:
 Uses open-ended questions
119.04 STAFFING – Ma’am Leny Baguio
 Provides ample opportunity for the interviewee
to talk
 Use scenarios to determine decision-making ability
o Designing scenarios that require problem-solving and
decision-making skills
 Conduct multiple interviews
o Candidates should be interviewed more than once on
separate days
o The person should be interviewed until all the interviewers’
questions have been answered, and they feel confident
that they have enough information to make the right
decision
 Provide training in effective interviewing techniques
o Focus on communication skills and advice on planning,
conducting, and controlling the interview
o Unskilled interviewers:
 Often allow subjective data rather than
objective data affect their hiring evaluation
 May ask questions that could be viewed as
discriminatory or illegal
5. Planning, Conducting, and Controlling the Interview
 Planning the interview in advance is vital to its subsequent success
as a selection tool
 Consistently using a planned sequence in the interview format will
eventually yield a relaxed and spontaneous process
 Suggested Interview Format:
o Introduce yourself and greet the applicant.
o Make a brief statement about the organization and the
available positions.
o Clarify the position for which the person is applying.
o Discuss the information on the application and seek
clarification or amplification as necessary.
o Discuss employee qualifications and proceed with the
structured interview format.
o If the applicant appears qualified, discuss the
organization and the position further.
o Explain the subsequent procedures for hiring, such as
employment physicals, and hiring date. If the applicant is
not hired at this time, discuss how and when he or she will
be notified of the interview results.
o Terminate the interview.
 Try to create and maintain a comfortable environment throughout the
interview, but do not forget that the interviewer is in charge of the
interview.
o Remember that the interviewer should have control of the
interview and set the tone.
E. More About Interviews
1. Common Job Interview Mistakes of Applicants
 Arriving so early you appear overanxious
 Saying too much
 Wearing a coat/hat during the interview
 Wearing psychologically intimidating colors or patterns
 Sitting down before the interviewer does or addressing the
interviewer by his or her first name
 Asking about salary, vacation, or promotions too early in the interview
 Bad-mouthing or revealing confidential information about a former or
current employer
 Not having any questions
 Overstating your accomplishments
 Having a “what can you do for me?” attitude
 Being vague, rambling, or evasive; all show poor communication
skills
 Lacking clear direction regarding what you want in your career
 Showing apathy or lack of motivation
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2. Tips for the Applicant During the Interview
 Avoid a bad first impression!
 Don’t be late
 Don’t avoid eye contact
 Avoid cold, clammy handshake
 Don’t sit down until the interviewer does
 Don’t fidget with personal belongings
 Do your homework about the organization you are applying to
 Practice the interview and rehearse answers to foreseeable questions
about your education and experience
 Be prompt on the day of the interview
 Look your best for the interview. Dress conservatively and make sure
you are neatly groomed
 Do not slouch or fidget
 Do not chew gum or smoke cigarettes
 Bring a paper and pencil to take notes
 Answer the questions with confidence and watch the interviewer for
nonverbal cues
3. Practice Interview Questions
 MOTIVATION
o Why did you apply for employment with this organization?
 PHYSICAL
o Do you have any physical limitations that would prohibit
you from accomplishing the job?
o How many days have you been absent from work during
the last year of employment?
 EDUCATION
o What was your grade point average in nursing school?
o What were your extracurricular activities, offices held, and
awards conferred?
o For verification purposes, are your school records listed
under the name on your application?
 PROFESSIONAL
o In what states are you licensed to practice?
o Do you have your license with you?
o What certifications do you hold?
o What professional organizations do you currently
participate in that would be of value in the job for which
you are applying?
 MILITARY EXPERIENCE
o What are your current military obligations?
o Which military assignments do you think have prepared
you for this position?
 PRESENT EMPLOYER
o How did you secure your present position?
o What is your current job title? What was your title when
you began your present position?
o What supervisory responsibilities do you currently have?
o How would you describe your immediate supervisor?
o What are some examples of success at your present job?
o How do you get along with your present employer?
o How do you get along with your present colleagues?
o What do you like most about your present job?
o What do you like least about your present job?
o May we contact your present employer?
o Why do you want to change jobs?
o For verification purposes only, is your name the same as it
was while employed with your current employer?
 PREVIOUS POSITION(S)
o Ask similar questions about recent past employment.
Depending on the time span and type of other positions
held, the interviewer does not usually review employment
history that took place beyond the position just previous to
the current one.
 SPECIFIC QUESTIONS FOR REGISTERED NURSES
o What do you like most about nursing?
o What do you like least about nursing?
o What is your philosophy of nursing?
119.04 STAFFING – Ma’am Leny Baguio
 PERSONAL CHARACTERISTICS  It seeks to:
o Which personal characteristics are your greatest assets? o Establish favorable employee attitudes toward the
o Which personal characteristics cause you the most organization, unit, department
difficulty? o Provide the necessary information and education for
 PROFESSIONAL GOALS success in the position
o What are your career goals? o Instil a feeling of belonging and acceptance
o Where do you see yourself 10 years from now?  Process begins as soon as a person has been selected for a position
 CONTRIBUTIONS TO ORGANIZATION and continues until the employee has been socialized to the norms
o What can you offer this organization? This unit or and values of the work group
department? 1. Induction
 GENERAL QUESTIONS  First phase
o What questions do you have about the organization?  Takes place after the employee has been selected but before
o What questions do you have about the position? performing the job role
o What other questions do you have?  Includes all activities that educate the new employee about the
4. Illegal interview Inquiries organization and employment and personnel policies and procedures
 Age  The most important factor is to provide the employee with adequate
 Marital Status information.
 Children  The most important link in promoting real understanding of personnel
 Race polices is the first-level manager.
 Sexual Preference 2. Orientation
 Financial or credit status  More specific for the position
 National origin  SD department orientation
 Religion o Concern to all employees such as fire safety, accident
5. After the Interview prevention, and health promotion would be presented
 Send a thank-you note to the interviewer  Individual orientation for each dept
 If offered the job, send a formal letter accepting or rejecting the job o Specific departments are responsible for developing their
 Personally critique the interview experience. Review in your mind own programs
what you did well and what you would do differently the next time  The purpose of the orientation process is to make the employee feel
like a part of the team. This will reduce burnout and help new
F. Selection employees become independent more quickly in their new roles.
 The process of choosing from among applicants the best-qualified
individual or individuals for a particular job/position EDUCATING & SOCIALIZING STAFF IN A LEARNING ORGANIZATION
 Selection should be based on the requirements necessary for the job; A. Philosophy of Learning Organizations
these criteria should be developed before beginning the selection  Learning organization (LO) - promotes a shared vision and collective
process learning in order to create positive and needed organizational change.
 Involves: o Organizations that incorporate lifelong learning as a major part of
o Verifying applicant’s qualifications their philosophy will be more successful
o Checking his or her work history o View learning as the key to the future for individuals & organizations
o Deciding if a good match exists between the applicant’s o Development of a learning culture in an org must include continuous
qualifications and the organization’s expectations education of all its members
 First introduced by Senge (2006)
G. Placement o Define LO as a place where people continually expand their capacity
 The astute leader is able to assign a new employee to a position to create the results they truly desire
within his or her sphere of authority, where the employee will have a o New and expansive patterns of thinking are nurtured where collective
reasonable chance for success aspirations is set free and where people are continually learning to
 Appropriate placement is as important to the organization’s see the whole together
functioning as it is to the new employee’s success.  Collective learning (knowledge building) goes beyond the boundaries of
 Faulty placement can result in: individual learning and releases gains for both the individual and the
o Reduced organizational efficiency organization.
o Increased attrition  A premise of the learning organization is that learning itself enhances the
o Threats to organizational integrity team.
o Frustration of personal and professional ambitions o Promote recruitment and retention by giving employees an
 Proper placement: environment to continue to grow and learn
o Fosters personal growth o Initiatives = feelings of recognition, pride & autonomy; & time
o Provides a motivating climate for employee savings
o Maximizes productivity o Reduction in stress at work standardization of practices continuous
o Increases the probability that organizational goals will be support to nurses and reflection
met 1. Senge’s Five Disciplines of a Learning Organization
 These disciplines allow for the criterion of an infrastructure that promotes
H. Indoctrination continuous learning, adaptation, and growth in organizations
 Refers to the planned, guided adjustments of an employee to the  Key Characteristics of Senge’s Model of LOs:
organization and the work environment  Systems thinking.
 3 phases: o Organization encourages staff to see themselves as connected to the
o Induction whole organization, and work activities are seen as having an impact
o Orientation beyond the individual; creates a sense of community and builds a
o Socialization commitment on the part of individual workers not only to the
organization but also to each other.
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119.04 STAFFING – Ma’am Leny Baguio
o Consequently, one of the main goals of the learning organization (LO)
is to construct an organizational culture of learning (Tsai, 2014).
 Personal mastery.
o Each member has a commitment to improve his or her personal
abilities; this personal and professional learning is then integrated
into the team and organization.
 Team learning.
o Through collaboration of team members that LOs achieve their goals.
o Values (trust and openness, commitment to one another’s learning,
and acknowledgement that mistakes are part of the learning process)
are important characteristics of an LO (Little, 2015).
 Mental models.
o Set of assumptions and generalizations (even picture/images) that
influence how we understand the world and how we take actions.
o Goal = to foster organizational development through diverse thinking.
o Assumptions held by individuals then are challenged because this
releases individuals from traditional thinking and promotes the full
potential of individuals to learn.
 Shared vision.
o When all the employees of the LO share a common vision, they are
more willing to put their personal goals and needs aside and instead
focus on teamwork and collaboration.
B. Training Versus Education
 Two components of SD; managers had a greater responsibility for seeing
that staff were properly trained than they did for meeting educational
needs
 Training
o An organized method of ensuring that people have knowledge and
skills for a specific purpose; have acquired the necessary knowledge
to perform the duties of the job.
o Has an immediate use
o To assist employees (training needs), manager must determine what
those needs are
 Requires careful observation – deficiencies are identified and
corrected before they handicap the employees socialization
o Leadership role: includes future planning needs related to product
line development and implementation of best practice exemplar
 When deficiencies are not corrected early or lack of support =
climate of non-acceptance can develop that prevents
assimilation of the new employee
 Education
o More formal and broader in scope than training.
o Designed to develop individuals in a broader sense.
o Leader’s roles and responsibilities: recognizing educational needs
and encouraging educational pursuits
o Managers may be requested to teach classes or courses (if they have
specific expertise); not normally responsible for an employee’s formal
education
 Managers and education department staff have a shared responsibility for
the education and training of staff
 In some organizations, the responsibility for SD is decentralized; occurred
as a result of fiscal concerns
o Awareness of the need to socialize new employees at the unit level
and recognition of the relationship between employee competence
and productivity
o Difficulties associated with centralized SD: conflict created by the
rule ambiguity when 2 people share responsibility
 Reduced when SD personnel and managers delineate the
difference between training and education
C. Learning Theories
 All managers have a responsibility to improve employee performance
through teaching, thus they must be familiar with basic learning theories
 Understanding learning theories allows managers to structure training and
use teaching techniques to change employee behaviour and improve
competence
o Goal for all SD
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 Adult learning theory (Knowles, 1970): Pedagogy versus andragogy
o Many managers attempt to teach adults with pedagogical learning:
 usually ineffective for mature learners because adults have
special needs
o Developed to separate adults learners strategies from pedagogy or
child learning
o Suggested that the point at which an individual achieves a self-
concept of essential self-direction is the point at which they
psychologically becomes an adult
 Social learning theory (Bandura, 1977): learning from interactions with
others in a social context
o Part of the teamwork and mental model development in LOs
o Direct reinforcement could not account for all types of learning,
instead most people learn their behaviour by direct experience and
observation (observational learning/modelling)
 Other learning concepts: readiness to learn; motivation to learn;
reinforcement; task learning; transfer of learning; span of memory;
chunking; knowledge of results
D. Implications of Knowles’s Work for Trainers and Educators
 Adult learners:
o Mature, self-directed people who have learned a great deal from life
experiences
o Focused towards solving problems that exist in their immediate
environment; need to know why before they are willing to learn
o Adult learning theory strongly influenced how adults are currently
thought in SD programs (based on individual needs and combination
of approaches may be required)
 A climate of openness and respect will assist in the identification of what
the adult learner wants and needs to learn.
o Enjoy taking part in and planning their learning experiences.
o Should be involved in the evaluation of their progress.
o Experiential techniques work best
o Mistakes are opportunities for adult learning.
 If the value of the adult’s experience is rejected, the adult will feel rejected.
 Adults’ readiness to learn is greatest when they recognize that there is a
need to know (such as in response to a problem).
 Need the opportunity to apply what they have learned very quickly after the
learning; assessment of need is imperative in adult learning.
E. Obstacles & Assets for Adult Learning
 Learning tends to become problem-centered as we age; adults often miss
out on opportunities to enjoy learning for the share sake of learning itself
 Obstacles to Adult Learning
o Institutional barriers
o Time
o Self-confidence
o Situational obstacles
o Family reaction
o Special individual obstacles
 Assets for Adult Learning (driving forces)
o High self-motivation
o Self-directed
o A proven learner
o Knowledge experience reservoir
o Special individual assets
F. Chunking as a Learning Strategy
 Chunking
o Presenting two independent items of information and grouping them
together into one unit.
o Although the mind can remember only a limited number of chunks of
data, experienced nurses can include more data in those chunks than
can novice nurses.
o Concepts may be helpful to the leader-manager in meeting the
learning needs of staff in learning organizations
119.04 STAFFING – Ma’am Leny Baguio
o Ex: experienced nurses are typically better able to recognize changes
in a pt’s condition based on the assessment or changes in lab values;
whereas novice nurse may take a bit longer to connect pieces of info
G. Assessing Staff Development Needs
 Managers may not be involved in implementing all educational programs,
but are responsible for identifying learning needs
 If educational resources are scarce, staff desires for specific educational
programs need to be sacrificed to fulfill competency & new learning needs
 Educational needs assessment – carried out before developing programs
bc managers and staff may identify learning needs differently
 Three Reasons for SD
1. To establish competence
2. To meet new learning needs
3. To satisfy interests the staff may have in learning in specific areas
 SD activities are generated to ensure that workers at each level are
competent to perform the duties assigned to the position
o Competence – having the abilities to meet the reqs for a role
o HC organizations use many resources to determine competency
 State board licensure
 National certification
 Performance review
 Self-administered checklist record audits direct observation
and peer review
o Deficient competencies – SD activities must be implemented to
correct the deficiencies
H. Sequence for Developing an Educational Program
1. Identify the desired knowledge or skills that the staff should have.
2. Identify the present level of knowledge or skill.
3. Determine the deficit of desired knowledge and skills.
4. Identify the resources available to meet needs.
5. Make maximum use of available resources.
6. Evaluate and test outcomes after use of resources.
 Use of an assessment plan will be helpful in meeting learner needs
I. Evaluation Criteria for Staff Development Activities
 SD includes participation & involvement from many depts. = may be very
difficult to control the evaluation of SD activities effectively
o Very easy for the personnel dept, middle level managers and
education dept to pass the bar among one another for accountability
 Evaluation of SD must consist of more than merely having class
participants fill out an evaluation form at the end of the class session:
signing employee handbook form or signing a preceptor for each new
employee
 Must include the ff:
o Learner’s reaction
 How the learner perceive the orientation, class, training/
preceptor
o Behavior change
 What change occurred as a result of the learning, was the
learning transferred?
 Testing someone at the end of a training or educational
program does not confirm that the learning changed behaviour.
 Needs to be some method to follow up to observe if behaviour
change occurred
o Organizational impact
 Efforts should be made to measure criterion
 Ex: assessing quality of care, medication errors accident,
quality of clinical judgement turnover and productivity
o Cost-effectiveness
 All SD activities should be quantified in some manner
 Most neglected aspect of accountability in SD
 All SD activities are evaluated for quality control, impact on the institution
and cost effectiveness
o True regardless whether the education & training activities are
carried out by manager, preceptor, personal dept or education dept
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J. Evidence-Based Practice
 Facilitating evidence-based practice is a shared responsibility of the
professional nurse, the organization, leader-managers, and the education
or SD department.
 Nurses often find that barriers to EBPs exist w/in organizations; but much
progress has been made in developing research experts to collect and
critique findings to adapt EBP
 Organizational cultures often do not support the nurse who seeks out and
use research to change long-standing practices routed in tradition
 Integrated-leader manager – must create and support an organizational
culture that values and uses research to improve clinical practice
 Barriers to implementation of EBP
o Time, organizational culture, and lack of EBP knowledge and skills
(Arzouman, 2015)
o Identifying inadequate access to research findings and poor
administrative support (Prevost and Ford, 2017)
 Strategies for Promoting Evidence-Based Practice
o Develop and refine research-based policies and procedures.
o Build consensus from the interdisciplinary team through
development of protocols, decision trees, standards of care,
institutional clinical practice guidelines, etc.
o Make research findings accessible through libraries and computer
resources.
o Provide organization support (time to do research and educational
assistance) to teach staff to interpret research statistics and use
findings.
o Encourage cooperation among professionals.
o When possible, hire nurse researchers or consultants to assist staff.
K. Responsibilities of the Leader-Manager
 Socialization
o Learning the behaviors that accompany each role by instruction,
observation, and trial and error
o Ensure that the new nurses’ values and supported are encouraged so
that work and academic values can blend
o New professionals need to understand the universal nature of role
transition (not limited to nursing)
o Involves a sharing of the values and attitudes of the organization
o Creates a fit between new staff members and the unit by introducing
them to the norms of the group
o The first socialization to the nursing role occurs during nursing school
and continues after graduation.
 Administrators and faculty may hold different values & priorities
 Resocialization
o When individuals are forced to learn new values, skills, attitudes, and
social rules as a result of changes in the type of work they do, in the
scope of responsibility they hold, or in the work setting itself
o Assumptions maybe made that such individuals already have
expertise that they do not bc the knowledge and skills to assume the
new role may be very different
o Experienced nurses who change work settings (w/in the same
organization or new) and nurses who undertake new roles
 Role Change
o Several mechanisms exist; anticipatory socialization carried out in
education settings can help prepare new nurses for their
professional role
 Managers should not assume that such anticipatory
socialization has occurred; must build opportunities for sharing
and clarifying values and attitudes about the nursing role in the
orientation programs
 Use of group process – excellent mechanisms to promote the
sharing that provides support for new graduates and assist
them in recovering from reality shock
 Managers should be alert for s/sx of role stress and role
overload in new nurses
 Intervene by listening to these gadgets and helping them
to develop appropriate coping behaviours
119.04 STAFFING – Ma’am Leny Baguio
 Leadership shadowing experience may be helpful to
novice nurses; can explore how nurse leaders deal with
stress
 Managers must recognize the intensity of new nurses’ practice
experience:
 Encourage to have a balanced life,
 Foster a work environment that has zero tolerance for
disrespect
 Strive to create work relationship models that promote
interdependency of physicians and nursing staff
o Organizations often fail to address socialization problems that occur
in job, position, or status changes.
o Role overload occurs when the demands of the role are excessive.
1. Team Building via Role Models, Preceptors, and Mentors
 These roles help to clarify role expectations through the use of social
interaction and educational processes.
 Each role has a different focus and uses different mechanisms.
 Role Models
o Usually effective or inspiring in some social role/job
o Experienced, competent employees
o Behavior you want to emulate
 Role model may not seek this emulation
o May be a passive or nonexistent relationship
o A person can have many role models.
o There is a cumulative effect.
 Greater the # of excellent role models available = greater
possibilities for new employees to perform well
o They are often unaware that students and even other staff might see
them as role models; not all model behaviour is positive or beneficial
 Bad role model: can have detrimental effect on others,
potentially harmful to the profession as a whole and to the pts
 Preceptor
o An experienced nurse who provides knowledge & emotional support,
as well as a clarification of role expectations, on a one-to-one basis
o Effective preceptors can role model and adjust teaching to each
learner as needed.
o Occasionally, the fit between the preceptor & preceptee is not good
 Risk is lower if preceptors willingly seek out this responsibility
and if they have attended educational courses outlining
preceptor duties and responsibilities
o Need to have adequate knowledge of adult learning theory and that
organizations use preceptors to help new employees clarify rules and
improve their skill level
o Be careful not to overuse preceptors (become tired/demotivated)
 Workload be decreased whenever possible  adequate time
can be devoted to helping preceptee problem-solve and learn
o Incentive pay – reinforces that the org values this role
 Mentoring
o Mentors take on even greater role in using education as a means for
role clarification
 Distinctive interactive relationship bet. 2 individuals occurring
most commonly in a professional setting (Madison, 2014)
 Can help light the way to career goals instill professionalism
provide encouragement and open opportunities for networking
and leadership
 Having one or more mentors is a vital component of a young
person's professional journey
o Preceptors are usually assigned but mentorship involves choice
 Mentor makes a conscious decision to assist the prodigy in
attaining expert status and in furthering their career; & mentee
chooses to work with a mentor.
 Preceptors = relatively short relationship with the person
 Mentor and the mentee = longer and more encompassing
o An in-depth supportive and nurturing relationship between an expert
and a novice
o Formal relationship typically lasts 2 to 5 years, with mentor being one
generation older than mentee
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o Many nurses have limited opportunities to have a true mentoring
relationship in their lives.
o Phases of the Mentoring Process
1. Exploring whether to begin a mentoring relationship
 Finding & connecting with more experienced person in the
workplace; mentoring relationship can be established
when chemistry is present that fosters reciprocal trust and
openness
 Not automatic, it is intentional
 Common reasons for not having a mentor (Goodbar,
2015): never thinking about it, not knowing how to find
one, & not knowing the benefits
2. Negotiating a mentoring agreement, with a goal(s) and
deadline(s)
 Teaching modelling and insider knowledge that fosters a
sense of competence and confidence
 Having mutual respect and understanding of one another
creates the foundation for a successful relationship
 Intensity of relationship can escalate to high levels during
this learning listening & sharing phase (Sinclair et. al,
2015)
3. Implementing the agreement and periodically reviewing
progress made
 Sense of change and growth as the mentoring relationship
begins to move the conclusion
 Intensity wanes as the mentee begins to move towards
independence
4. Summarizing and formally concluding the mentoring
relationship
 Finds both the mentee and the mentor achieving a
different independent relationship (hopefully based on
positive collegial characteristics)
L. Overcoming Motivational Deficiencies
 Difficulties in socialization or re-socialization occur because an employee
lacks the motivation to overcome the educational and personal challenges
inherent in learning a new role
 Behavioral Sanctions
o Planned program should be implemented to correct the deficiencies
by using positive and negative sanctions
o Positive sanctions
 Used as interactional or educational process of socialization
 If deliberately planned, become educational
 Sanctions given informally through the group process or
reference group use the social interaction process
 Reference group – sets norms of behavior and then applies
assumptions to ensure that new members adapt the group
norms before acceptance into the group
 These informal sanctions offer an extremely powerful tool for
socialization and re-socialization in the workplace
 Managers should become aware of what role behavior they
reward and what new employee behavior the senior staff is
rewarding
o Negative sanctions
 Provide cues that enable people to evaluate their performance
concerns consciously and to modify behavior when needed
 Often applied in very subtle and covert ways
 Inappropriate negative sanctions is bullying and should never
be condoned
 Should be constructive and not destructive
 New employees should be told when their behavior is not an
acceptable part of their role
o To be effective they must result in the role learning internalizing the
values of the organization
o The bestowing of rewards and punishments
o Used to show employees what behavior is rewarded or eschewed in
an organization
o Rarely carried out on a systematic and planned basis
119.04 STAFFING – Ma’am Leny Baguio
 Group Norms
o Manager should know what the group norms are and should be
observant of sanctions used by group to make newcomers conform.
o The manager should take appropriate intervention if group norms are
not part of the organizational culture.
 Meeting the Educational Needs of a Culturally Diverse Staff
o 3 main types of diversity in the workforce
 Ethnicity
 Gender
 Generational
o Creating an organization that celebrates a diverse workforce rather
than merely tolerating it is a leadership role and requires well-
planned learning activities.
o There should be sufficient opportunity for small groups so that
personnel can begin recognizing their own biases and prejudices
o Respect cultural diversity—recognize its desirability.
 Open to exploring and be aware that learners with diverse
learning styles and cultural backgrounds
o Recognize different perceptions of classroom & instruction learning
o Also consider the learning styles of more mature nurses and
preceptor needs (respond well to sharing & anecdotal case histories);
often learn best in a different manner than the new graduates
 Unique Socialization Needs of International Nurses
o One solution to nursing shortages = active recruitment of nurses from
overseas
o Ethical obligation to the foreigners does not end with his or her arrival
in a new country, instead the sponsoring country must do whatever it
can to see what the migrant nurse is assimilated into the new work
environment (and new work culture)
o Differing interpretations of non-verbal behavior may further cloud the
picture
o Foreign born nurses may find it difficult to establish a sense of
community life within the organization
o Often experience cultural, professional, & psychological dissonance
o Communication problems
 Ex: language skills are often a significant issue for foreign
nurses; use of American slang and abbreviations
o Anxiety, homesickness, and isolation
 Coaching
o Means to develop a trained employees
o A teaching strategy rather than a learning theory
o Most difficult role for a manager to master
o One person helping another to achieve an optimal level of
performance
o Tool for empowering subordinates, changing behavior, and
developing a cohesive team
o Emphasis on assisting the employee to recognize greater options, to
clarify statements, and to grow
o May be long term or short term
 Short-term
 Effective as a teaching tool for assisting with socialization
and for dealing with short-term problems
 Frequently involves spontaneous teaching opportunities
 Long-term
 Tool for career management and in dealing with
disciplinary problems is different
Page 8 of 10
STAFFING NEEDS AND SCHEDULING POLICIES
A. Why Scheduling is difficult for Nursing?
 It does not fit the traditional business cycles
 There is an erratic and unpredictable health-care demand
 High-level expertise is required 24/7
 Stress of job requires balanced work-recreation schedule
 Staffing mix varies with acuity
 Although many organizations now use staffing clerks and computers to
assist with staffing, the overall responsibility for scheduling continues to
be an important function of first and middle level managers
 In centralized staffing, staffing decisions are made by personnel in a
central office or staffing center. In decentralized staffing, each
department is responsible to its own staffing.
B. Types of Staffing
 Not synonymous with centralized and decentralized decision making
C. Common Scheduling Options
 10- or 12-hour shifts
o 12-hour shifts have become common in acute care hospitals,
though there continues to be debate about extending length of
shifts resulting in increased judgment errors r/t fatigue and
increased sick time
o Both longer shifts and working overtime are significantly
associated with lower quality of care
o Nurses working long hours are more likely to describe nursing care
as poor or fair, with significant increases in concerns about patient
safety
 Premium pay for weekend work
 Part-time staffing pool for weekend shifts and holidays
 Job sharing
 Cyclical staffing – allows long-term knowledge of future work schedules
because a set staffing pattern is repeated every few weeks; allows nurses
to exchange hours of work among themselves
 Use of supplemental staffing from outside registries and float pools
o Per diem staff generally have flexibility of choosing when to work
but have no benefits with a higher rate of pay  often receive less
orientation to organizational policies and procedures increasing
risk toward patient safety
o Float pools - generally composed of employees who agree to cross-
train on multiple units so that they can work additional hours
during periods of high census or worker shortages
 Shift bidding – allows nurses to bid rather than requiring overtime; allows
control for scheduling extra shifts and reduce mandatory overtime
o Generally, organizations will choose the nurse with the lowest bid
to work the shift, but some organizations may deny bids to nurses
who work too much overtime
 Closed-Unit Staffing
o Occurs when staff members on a unit make a commitment to cover
all absences and needed extra help themselves in return for not
being pulled out in times of low census
119.04 STAFFING – Ma’am Leny Baguio
D. Workload Measurement Tools - Traditional but more
 Calculating nursing care hours per patient-day (NCH/PPD) materialistic, willing to work
o Simplest formula in use and continues to be used widely long hours to get ahead
o All nursing and ancillary staff are treated equally for determining - Caring for family members
hours of nursing care, and no differentiation is made for differing - Volunteer to advance
acuity levels of patients personal causes
o May be too restrictive – does not represent reality of inpatient care Generation X Early 1960s to 1980
setting, where staffing fluctuates - Much smaller cohort
- May lack the interest in life-
time employment
- Greater work hour flexibility
and opportunities for time off
- Had both parents working
 Patient Classification Systems (Workload Management) outside their home as
o Provides language that nurses need to make their work visible at all growing up
levels of the organization - Family and leisure time in
o Groups patients according to specific characteristics that measure own families
acuity of illness to determine the number and mix of staff needed to - Less economically driven and
adequately care for all may success differently
o Are unique to a specific institution - About 40% of workforce
 Critical indicator PCS uses broad indicators such as bathing, Generation Y (Millennials) 1980 to mid-1990s
diet, intravenous fluids and medications, and positioning to - Represents first cohort of
categorize patient care activities. global citizens
 Summative task type requires the nurse to note the - Known for optimism, self-
frequency of occurrence of specific activities, treatments, confidence, relationship
and procedures for each patient orientation, initiative, and
o A review of literature demonstrates that as RN hours decrease in social consciousness
NCH/PPD, adverse patient outcomes increase including: - Highly sophisticated in
 Increased medication errors technology
 Patient falls - “digital natives”
 Decreased patient satisfaction with pain management - Represents only 15% of
workforce but will increase
E. Minimum Staffing Criteria rapidly
 Decisions must meet state and federal labor laws and organizational Generation Z 1996 to 2015
policies  Have different value systems that may affect staffing
 Staff must not be demoralized or excessively fatigued by frequent or  Receive care from both most experienced and greater technology
extended overtime requests expertise
 Patient care must not be jeopardized
H. Fiscal Accountability
F. Mandatory Overtime
 Base unit staffing on PCS, manager is accountable to the organization for
 Employees are forced to work additional shifts, under the threat of patient appropriate staffing
abandonment, if they refuse  Not incompatible with ethical accountability to patients and staff
 Done by organizations to reduce the number of employees on the pay roll  Possible to stay within a staffing budget and meet the needs of both
 Neither efficient nor effective, has devastating short-term impacts in staff patients and staff
perceptions of a lack of control and its subsequent impact on mood,
motivation, and productivity I. Organizational Staffing Policies
 Should be a last resort, not standard operating procedure because an
 Clearly communicated and fairly applied to all members of the
institution does not have enough staff
organization
 California  enacted legislation requiring mandatory staffing ratios in
 Provide means for consistency and fairness
hospitals and long-term care facilities
 Need policies to address:
o Sick leave
G. Generational Diversity
o Vacations
Generation Year of Birth o Holidays
Silent Generation or Veteran or 1925 to 1942 o Call offs for low census
Traditionalist (about 5%) o On-call pay
- More risk averse o Tardiness and absenteeism
- Highly supportive of authority  Employee Staffing Policies (Sample)
- Hierarchy and discipline o Name of person responsible for staffing schedule
- Supports the status quo o Type and length of staffing cycle used
- Less likely to question o Time and location of schedule posting
practices and more likely to o When the shift begins and ends; day of week that schedule begins
seek employment in o Policies
structured settings  Rotation policies if shift rotation is used
- Often recognized for loyalty to  Fixed time transfer policies
employers  Weekend off policy; tardiness policy
Baby Boomer 1943 to early 1960s  Absenteeism policies
- Represent 40% of the current  Policy for trading days off; days off request procedures
workforce  Policy regarding rotating to other units

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119.04 STAFFING – Ma’am Leny Baguio
 Emergency request policies
 Transfer request policies
o Procedures
 Low census procedures Example: 65 patients (minimal); 30 patients (intermediate); 5 patients
 Procedures for resolving conflicts regarding time off (intensive)

J. Formula to Determine Staffing Patterns  Step 3: Find the NCH needed per day by each patient and get the sum
1. Full-Time Equivalent (FTE) Type of Care NCH
a. Uses NCH and annual hours of work provided; measure of work Minimal Care 1.5
commitment of full-time employee Intermediate Care 3
b. Full-time employee works 5 days/wk; 40hrs/wk; 52 wks/yr Intensive Care 4.5
c. 2080 hours of work time Example: 97.5 NCH (minimal); 90 NCH (intermediate); 22.5 NCH
(intensive) = 210 NCH/day (total)

2. Forty-hour Week Law  RA 5901  Step 4: Find the total NCH * 365 days
Example: 210 NCH per day*365 days=76.650 NCH per year

 Step 5: Find the number of working hours per year

a. Standard Value for NCH
Area NCH
Surgery 3.4
General Ward 3.5
Pediatrics 4.6  Step 6: Find the nursing personnel needed
Mixed Medical-Surgical 3.4
Nursery 2.8
Medical 3.4
OB 3.0
b. Percentage (%) of Professional and Non-Professional (in ratio
Area Ratio
Surgery 60:40
General Ward 60:40
Pediatrics 70:30
Nursery 55:45
ICU 80:20
OB 60:40
c. Distribution per shift
Shift Percentage
A.M. 45%
P.M. 37%  Step 7: Categorize into Professional and Non-Professional
Night 18% Type of Institution Ratio
Primary 45%
Secondary 37%
Tertiary 18%

 Step 8: Distribute by shifts

d. 40 hour/week
i. Hospitals with 100 bed capacity or more
ii. More than 1 million population
e. 48 hour/week
i. Personnel who work in agency with less bed capacity
ii. Communities with less than 1 million
K. Guidelines for Determining the Nursing Personnel Needed
 Step 1: Determine the Type of Hospital (Primary, Secondary, or Tertiary)
Example: Hospital A is a 100-bed capacity secondary level hospital
 Step 2: Categorize patients according to levels of care
Example: 9 NA (AM), 7 NA (PM), 3 NA (Night)
 Special Considerations
o Above personnel are for in-patient
o Additional for administrative and supervisory positions, and in
special units (OR, DR, ER, OPD)
o Head nurse in each nursing unit, Nursing Supervisor to cover each
shift in area
o For each area in hospitals beyond 100 beds and for functional
areas (training, research, infection control, locality management)
o Roomed-in babies are not included in patient census, given
services like bathing  additional staff are needed
o Additional personnel for health education classes at in-patient and
out-patient units

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