STAFFING

SCHEDULE
• STAFFING
• Process of determining and providing the
acceptable number and mix of nursing
personnel to produce a desired level of care to
meet the patients’ demand.

• SCHEDULING
• Process of assigning working days and days-off
to the nursing personnel so that adequate
patient care is assured.
 Factors to Cosider in Making Schedules

• Different levels of nursing staffs

• Adequate coverage for 24 hours, seven days a
week
• Staggered vacations and holidays
• Weekends
• Long stretches of consecutive working days
• Evening and night shifts
• Floating
TYPES of SCHEDULING
 CENTRALIZED SCHEDULING
• One person, usually the chief nurse or her designate, assigns
the nursing personnel to the various units of the hospital. This
includes the shift on duty and off-duty.
• Based on master staffing pattern

• Advantages:
• Fairness to employee
• Impartial application of policies
• Opportunities for cost containment

• Disadvantages:
• Lack of individualized treatment of employees
 DECENTRALIZED SCHEDULLING

• The shift and off-duties are arranged by the Supervising Nurse or

Head or Senior Nurse of a particular unit.
Advantages:
• Personnel feel that they get more personalized attention
• Staffing is easier and less complicated
• Form a support system
• Develop managerial skills
Disadvantages:
• Individualized treatment
• Time-consuming
• Difficulty in Cost containment
 SELF SCHEDULING

• Process by which staff nurses in a unit collectively

decide and implement the monthly work schedule.

• Advantages:
• Practice of professional nursing
• Save the managerial time
• Increased cooperative atmosphere
• Decreased absenteeism
 ALTERNATING/ ROTATING WORK SHIFT

• Work shift that changes its hours of work at stated

intervals. Rotating shifts work around the clock.
• Create stress for the staffs
• Associated with lower job performance and error
proneness
• Some nurses use the rotation model of Federal
Aviation Agency (FAA) in their teams of airport
personnel wherein they plan the schedule a year in
advance. This makes the team member plan their
personal lives with confidence.
 PERMANENT SHIFTS

• Relive nurses from stress and health-related problems

associated with alternating and rotating shifts.
• cause the least disruption to circadian rhythms
• Better social activities for the nurses
• Child-care arrangement can be stable
• Disadvantage:
• Nurses may not develop appreciation for the workload or
problem of the other shifts
• Most people want day shift
• New graduates predominantly staffs evenings and nights
 BLOCK or CYCLICAL SCHEDULING
• Covers a designated number of weeks called cycle length and is
repeated thereon.
• It assigns the required number of nursing personnel to each
nursing unit consistent with the unit’s patient care requirements,
the staff’s preference, their education, training and experience.
• Advantage:
• Same schedule repeatedly
• Sick time reduced
• Personnel know schedule in advance
• Personnel can schedule social events
• Staff treated fairly
• Disadvantage:
• Rigidity
 VARIABLE STAFFING

• Method that uses patient needs to determine

the number and mix of staff
• A patient classification system is developed
and tables are designed to determine the
number of nursing hours required.
• Advantages:
• Use census to determine number and mix staff
• Little need to call in unscheduled staff
 8-HOUR SHIFT, 5-DAY WORKWEEK

• The 5 day, 40 hour workweek become popular

during the late 1940’s.
• The shifts are usually 7am to 3:30pm, 3pm-
11:30pm, and 11pm-7:30am
• Allowing for a half hour lunch break and a half
hour overlap time between shifts to provide
for continuity of care.
 10-HOUR, 4-DAY WORKWEEK

• 10 hour day, 4day workweek with an every-

other-weekend-off staffing pattern.
• The shifts are 7am-5:30pm, 1pm-11:30pm,
and 9pm-7:30am
• A cyclical schedule allows at least 14 hours off
between shifts and a 4-day weekend every 6
weeks
 10-HOUR DAY plus 5- or 6-HOUR SHIFT

•  Time is 7am-5pm, 5pm-10pm, and 9pm-7am.

• A 2-week cyclical schedule posts 2 days on,
2days off, 3 on, 2 off, 2 on, and 3off with 2
teams working complementary schedules.
• Social opportunity is a major benefit
 10-HOUR SHIFT, 7-DAY WORKWEEK

• Plan that includes a 10-hour shift, 7 days a

week, followed by 7 consecutive days off.
• There are no rotations of shifts; each team
contains permanent day, evening, and night
shifts.
• The shifts are 6:45am-5:15pm, 12:45pm-
11:15pm, and 9:15pm to 7:45am.
Advantages:
• Increased continuity of care
• Improved communications
• Better understanding of the patients needs
resulting from longer time with patients
• Consistent patient teaching
• Improved job satisfaction
• Prolonged rest periods
• More normal home and personal life
Disadvantage:
• Nurses are tired at the end of the 7-day workweek.
 12-HOUR SHIFT, 7-DAY WORKWEEK

• The 12 hour shift starting at 7 or 7:30am and

ending at 7 or 7:30pm, has been adopted by
some institution.
• The better use of nursing personnel lower
staffing requirements this consequently lowers
the cost per patient day.
• Nurses find they get to know their patient
better because they have more time to study
charts and can visit patients more frequently.
• Advantages:
• Better collaboration
• Saves time
• Less personal expense
• Travel time reduced
• Disadvantages:
• Overtime pay has been of some concern
• Nurses complaint that the extra time they
have for learning and research become boring
 BAYLOR PLAN

• Baylor University Medical Center in Dallas,

Texas, started a 2-day alternative plan. Nurses
have the option to work two 12-hour days on
the weekends and be paid for 36hours for day
shifts, or 40 hours for night shifts, or work 8
hour shifts Monday-Friday.
• This plan requires a larger nursing staff but has
filled weekend positions and reduced turnover.
 VARIATIONS

• Medical College of Virginia Hospitals in Richmond has

combined two 8 hour shifts and two 12-hour shifts per
week for a total of 40 hours in a 4-day week.
• Intensive care nurses at Baptist Medical Center
Montclair in Birmingham, Alabama, have worked 7
consecutive 8-hour nights from 10:30pm-7pm
followed by 7 nights off.
• At the Valley Medical Center at Fresno, California, they
designed a 3-day workweek with two 13-hour days,
one 14-hour day, and 4 days-off.
PATIENT CLASSIFICATION SYSTEM
 3 Basic Styles of Patient Classification System

• Descriptive – Nurse classifies the patient in the category

that most closely describes the care received. Category 1
may be self care and category 4 complete care.
• Checklist – Divides descriptions of care routines into
activity categories, such as eating and bathing
• Time of Relative Value Unit Standard - Assign a value
unit (usually a measure of time) to various activities of
patient care. The activities are usually clustered
according to categories, such as diet, bathing, and
mobility.
Classification Categories
• Category 1: Minimal Care
• Given to patients that are convalescing and who
no longer intensive, moderate, or maximum care.
• Still may need supervision by the nurse in the
course of the day.

• Category 2: Moderate Care

• Given to patients who are moderately ill or are
recovering from immediate effects of illness
and/or an operation.
• Category 3: Maximum Care
• Given to patients who need close attention
throughout the shift that is, complete care for
patients who require nursing to initiate,
supervise and perform most of their activities.

• Category 4: Intensive Care

• Given to acutely ill patients who have a high
level of nurse dependency.