STAFFING

STAFFING

 Staffing is the process of determining

and providing the acceptable number
and mix of nursing personnel to
produce a desired level of care to
meet the patient’s demand.
 Staffing process involves the
selection of qualified and competent
personnel , a system of assignment
and staffing schedules
PURPOSE
 The purpose of all staffing activities is
to provide each nursing unit with an
appropriate and acceptable number of
workers in each category to perform
the nursing tasks required.
 Too few or an improper mixture of
nursing personnel will adversely affect
the quality and quantity of work
performed.
 Such situation can lead to high rates
of absenteeism and staff
turn over resulting to low
morale and dissatisfaction
FACTORS AFFECTING
STAFFING
1. The type, philosophy and
objectives of the hospital
2.The population served or kind
of patients served whether pay
or charity.
3.The number of patients and
severity of their illness-
knowledge and ability of nursing
personnel are matched with
actual care needs of patients.
 4.Availability and characteristics
of the nursing staff. Including
education, level of preparation,
mix of personnel, number and
position
5.Administrative policies such
as rotation, weekends and
holidays off-duties
6.Standards of care desired
which should be available and
clearly spelled out.
Factors

7. Layout of the various nursing

units and resources available within
the department such as adequate
equipment , supplies and materials
8. Budget including the amount
allotted to salaries, fringe benefits,
supplies materials and equipment.
9.Teaching program or the extent of
staff involvement in teaching activities.
Factors

10. Expected hours of work per

annum of each employee. This is
influenced by the 40 hour week
law.
11. Professional activities and
priorities in non-patient activities.
 12. Patterns of work schedule
– traditional 5 days per week, 8
hours per day; 4 days a week; ten
hours per day and three days off;
or 3 ½ days of 12 hours per day
and 3 ½ days off per week.
 STAFFING FORMULA
1. Categorize the number of
patients according to the levels
of care needed. Multiply the total
number of patient by the
percentage of patients at each
level of care (whether minimal,
intermediate, intensive , or
highly specialized).
 2. Find the total number of
nursing care hours needed by the
patients at each category level.
a. find the number of patients at
each level by the average number of
nursing care hours needed per day.
b. get the sum of the nursing care
hours needed at the various levels.
 3. find the actual number of
nursing care hours needed by the
given number of patients. Multiply
the total nursing care hours
needed per day by ther total
number of days in a year.
 4. find the actual number of the
working hours rendered by each
nursing personnel per year.
Multiply the number of hours on
duty per day by the actual working
days per year.
 5. Find the total number of
nursing personnel needed:
a. divide the total number of
nursing care needed per year by
the actual number of working
hours rendered by an employee
per yar.
 b. find the number of relievers .
Multiply the number of nursing
personnel needed by 0.15 ( for
those working 40 hours per week )
or by 0.12 ( for those working 48
hours per week ).
c. add the number of relievers of
the total number of nursing
personnel needed.
 6. categorize the nursing
personnel into professionals and
non professionals. Multiply the
number of nursing personnel
according to the ratio of
professionals to non
professionals.
7. distribute by shifts.
Selection of Personnel

 RECRUITMENT
 The process of enlisting
personnel for employment
 Methods of recruitment
 Advertising- most common,
advertisement s in local
newspapers, tv, word of mouth
employee recommendation
Screening

 It is best to keep in mind 3

philosophies during screening
process.
 Screen out applicants who do
not fit the image of agency
 Try to fit the job to a promising
applicant
 Usually, try to fit the applicant to
the job
The screening process

 The applicants submit their ;

 Biographical data to include
information on personal history,
educational background, work
experience.
 The recruiter can use the data to
determine whether the applicant
is qualified and meets the
minimum requirements
Interview

 Pre-employment interview is
conducted
 The purpose of the interview is
to obtain further information
about the applicant is qualified
and meets the minimum
requirements
Orientation
 Is the process of becoming familiar with a
new environment and adapting well to it.
 Part of staff development .
 Well designed orientation program would
include;
 A tour of the physical facilities
 Introduction to co-workers
 Description of the organizational structure
of the institution
 Information on the philosophy, goals,
policies and standards of the institution
 Functions of the members of the health
team
STAFF DEVELOPMENT

 The nurse should engage in

professional education activities
 Attending conferences,
seminars-workshops, in-service
training programs, reading
professional publications and his
or her competencies as nurse
and develop his or her aesthetic
sense and personality.
Patient care classification
system (PCCS)
 Is a method of grouping patients
according to the amount and
complexity of their nursing care
requirements and the nursing time
and skill they require.
 This assessment can serve in
determining the amount of nursing
care required, generally for 24 hours,
as well as the category of nursing
personnel who should provide that
care
Patient care classification
system
 It is a measurement tool used to
articulate the nursing workload for a
specific patient or group of patients
over a specific period of time.
 Patient Acuity- is the measure of
nursing workload that is generated
for each patient. As a patient
becomes sicker, the acuity level
rises, meaning the patient requires
more nursing care. As a patient
acuity level decreases, the patient
requires less nursing care.
Purposes for classifying
patients
1. For staffing so that perceived
patient needs can be matched with
available nursing resources
2. For program costing and
formulation of nursing budget.
3. For tracking changes in patient
care needs.
4. To determine values for the
productivity equation output divided
by input .
5. To determine quqlity.
Types of patient classification
system
 Descriptive classification is a
narrative description of various
degrees of care required by
particular patient
 Checklist lists down patient problems
according to patient acuity
 Self care
 Minimal care
 Moderate care
 Extensive care
 Intensive care
Types

 Time based lists patient needs

according to level of acuity and
describes the amount of nurse
time needed to meet the needs,
 Minimal
 Acute
 Partial
 complex
Factor system
 Factor system uses unit of measure that
equate to nursing time. Nursing tasks are
assigned time is weighed to reflect the
amount of time needed to perform the task.
 It captures the cognitive functions of
assessment , planning, intervention, and
evaluation of patient outcomes along with
written documentation process.
 Prototype system allocates nursing time to
large groups based on an average of
similar.
 To develop a workable patient
classification system, the nurse
manager must determine the
following;
 1. The number of categories into which
the patients should be divided
 2. The characteristics of patient in each
category;
 3. The type and number of care
procedures that will be needed by a
typical patient in each category;
 The time needed to perform these
procedures that will be required by a
typical patient in each category
CLASSIFICATION
CATEGORIES
 LEVEL 1-SELF CARE OR MINIMAL
CARE
 Patient can take care of themselves
and perform ADL
 Patients about to be discharge,
those non-emergency newly
admitted requires little treatment
observation/instruction .Average
amount of nurse /pt./day is 1.5 of
professional to non-professional.
nursing personnel is 55.-45
LEVEL II –MODERATE CARE
OR INTERMEDIATE CARE
 Pts. need some assistance in
bathing, feeding or ambulating for
short periods of time.
 May have slight emotional needs,
vital signs ordered up 3. 3x/ shift, IVF
or BT .
 Are semi-conscious and exhibiting
psychosocial problems ,periodic
treatment /observation / instruction
 Average nursing care/pt/day is 3 and
ratio of professional. to non-
professional personnel is 60;40
LEVEL III TOTAL COMPLATE
OR INTENSIVE CARE
 Patients are completely dependent
upon nursing personnel ., may or
may not be unconscious, VS 3x /
shift, with continuous oxygen, with
chest or abdominal tubes,
 They require close observation at
least every 30 min. for impending
hemorrhage, hypo-hypertension or
cardiac arrhythmia.
 The nursing care hours per hour
/pt./day is 6 with professional. to
non-professional ratio of 65;35
LEVEL IV- HIGHLY
SPECIALIZED CRITICAL CARE
 Patients in this level need maximum
nursing care with ratio of 80 professionals
to 20 non-professionals
 Patients need continuous treatment and
observation; with medications, IV piggy
backs, VS every 15-30 min. ,hourly input
 There are significant changes in doctor
orders and care hours per patient per day
may range from 6 to 9 or more and ratio of
professionals to non-professional also
range from 70;30 to 80 ;20.
Level of care
PERCENTAGE OF NURSING
CARE HOURS
 The percentage of nursing care hours
at each level of care .
 For primary hospitals, about 70
percent of their patients need minimal
care , 25 percent need moderate
care. Patients needing intensive care
are given emergency treatment and
when their condition becomes stable
or immediate treatment is necessary
and the hospital has no facilities for
this is transferred to secondary or
tertiary hospital.
Percentage of Nursing care
hours
 In secondary hospital 65 percent of
the patients need minimal care; 30
percent need moderate care and
only 5 percent need intensive care.
 In tertiary care; 45 percent need
moderate care,15 percent need
minimal care, while 10 percent will
need highly specialized intensive
care.
Percentage of nursing care

 In specialized tertiary hospitals

about 10 percent will need
minimal care, 25 percent need
moderate care, 45 percent need
intensive care, while 20 percent
will need highly specialized
intensive care.
Level of care
Levels of care NCH Ratio of Prof. to
needed /pt/day non-professional

Level 1 self care

or minimal care 1,50 5:45
Level II moderate
or intermediate 3.0 60:40

Level III Total or 4.5 65:35

Intensive care

Level IV highly
specialized or 6.0 or 7 or 70:30
Critical care higher *0:20
Staffing Formula

 Categorize the number of

patients according to levels of
care needed. Multiply the total
number of patients by the
percentage of patients at each
level of care( whether minimal,
intermediate, intensive or highly
specialized)
Staffing Formula

 2. Find the total number of nursing

care hours needed by the patients at
each category level.
 A. Find the number of patients at
each level by the average number of
nursing hours needed at the various
levels.
 Get the sum of the nursing care
hours needed at the various levels.
Staffing Formula

 3. Find the actual number of nursing

hours needed by the given number
of patients. Multiply the total nursing
care hours needed per day by the
total number of days in a year.
 4. Find the actual number of working
hours rendered by each nursing
personnel per year. Multiply the
number of hours on duty per day by
the actual working days per year.
Staffing Formula
 5. Find the total number of nursing
personnel needed.
 A. Divide the total number of nursing
care needed per year by the actual
number of working hours rendered
by an employees per year
 B. Find the number of relievers .
Multiply the number of nursing
personnel needed by 0.15 (for those
working 40 hours working 48 hours
per week.
Staffing formula

C. Add the number of relievers to the

number of nursing personnel
needed.
6. Categorize the nursing personnel
into professional & non-
professionals. Multiply the number of
nursing personnel according to the
ratio of professionals to non-
professionals.
7. Distribute by shifts
Staffing formula

 Find the total number of nursing

hours needed by the patients at each
level category.
 a,. Find the number of patients at
each level by the average number of
nursing hours needed per day
 B. Get the sum of the nursing care
hours needed at the various levels
STAFFING AND
SCHEDULING
 Staffing and n the process of
determining and providing
acceptable number and mix of
nursing personnel to produce a
desired level of care to meet the
patient’s demands/needs.
 SCHEDULE is a timetable
showing planned work days and
shifts for nursing personnel
Scheduling Objectives

 To assign working days and days-off

to the nursing personnel so that
adequate patient care is assured
 A desirable distribution of off-duty
days can be achieved and the
individual members of the nursing
team will feel that they are treated
fairly. They will also know their
schedule in advance.
Objectives

 Provide adequate patient care

while avoiding overstaffing.
 Achieve a desirable distribution
of days off.
 Treat individual members of the
nursing staff fairly.
 Let the personnel know well in
advance what their schedule
are.
Guidelines
 Let it represent a balance between needs of
employee and the employer .When conflict
arise, patient care should have priority.
 Distribute fairly the all “ good and bad” days off
among all employees.
 Make all employees adheres to the established
rotation. Exception should be rare and granted
only if employee is requesting two workdays off
(working every weekend). All requests and
exception should be in writing and should
specify the period of time off requested.
 Advance posting of time schedules on so as to
allow employees plan their personal lives, Doing
so reduces absenteeism and requests for
changes.


Guidelines
 Do not make time schedules a mystery nor
use them as a tool of control or discipline.
 Come up with a mechanism for emergency
changes to accommodate both employee
and employer.
 Make schedule conform with all labor laws,
and hospital and department policies.
 Provide correct numbers and mix of
personnel , allowing continuity, which is
essential for quality care.
 Be consistent in scheduling to enable work
groups develop teamwork, which
contributes to quality care.
Assessing

 In assessing staffing needs- we have

3 selected 3 concepts that seen to
include most of the factors
considered of significance in
determining nursing staff and staffing
mix- or ratio of licensed and
unlicensed personnel
 1. Valuing– approached used the
standard met, the quality of care
reflect the values implemented.
Assessing
 Refers to the philosophical belief and
opinions about the level of nursing
care to be provided.
 Nursing generally maintained a
humanistic philosophical perspective
of focusing this care on client and
meeting the health care needs of
individual.
 Term described as individualized
patient centered, comprehensive ,
holistic and similar level for
personalized care.
Assessing

 2.Forecasting– The accuracy of

to methods used to determining
the number and mix of staff
varies according to methods
used to forecast needs.
 3. Budgeting- the realities of
what one can actually offered
must eventually be included in
process of assessment.
Assessing a Scheduling
System
 Scheduling may vary from
agency to agency but
scheduling system must function
smoothly in terms of;
 Ability of cover the needs of the
unit- a minimum required
number of staff must meet the
nursing needs of the patients in
the units at all shifts
Assessing a scheduling
system
 Quality to enhance the nursing
personnel’s knowledge, training
and experience - many nurses
who have future plans of going
into teaching, or specialization
or even working abroad would
prefer to experience being
assigned to various units before
settling down to a particular unit
of choice.
Assessing a scheduling
system
 Fairness to the staff- all nursing
personnel should get a fair share of
weekends , holiday offs, rotation
patterns for the whole year including
assignment to “difficult” or” light ”or
“undesirable” units or shifts.
 Stability- The nursing personnel
would like to know in advance their
personal schedules (whether at
home, social and civic
responsibilities) are in harmony with
each other.
 Flexibility- means the ability to
handle changes brought about
by emergency leaves,,
scheduled or unscheduled
leaves of absence.
Terms
 PRODUCTIVE HOURS- include
hours worked and available for
patient care.
 Nonproductive hours include benefit
time such as vacation, sick time, and
education time.
 Direct care includes time spent
providing hands-on care to patients.
 Indirect care includes time spent on
activities that support patient care
but are not done directly to the
patient.
Terms

 Nursing Hours per patient day

(NHPPD)is the amount of
nursing care required per patient
in a 24 –hours period and is
usually based on midnight
census and past unit need
expected unit practice trends
national benchmarks,
professional staffing standards
and budget negotiations.
 Nursing Mix is the ratio of staffs,
the professionals and
nonprofessionals staffs, the type
of staff necessary to perform the
work of the organization
Staffing Policies
 Staffing policies are best derived
through consultation with clinical
nurses, Written staffing policies
should be readily available for at
least the following areas;
 Vacation, holidays and sick
leave
 Emergency leave
 Weekend shifts number
workdays conducted weekend
 Shift rotation, overtime,
 Schedule changes. Use of
educational time
 Request of personnel and
management
 The work week.
Type of staffing
 CENTRALIZED STAFFING
SYSTEM is done by the nursing
director or her designate who
develops a master plan for
nursing personnel. It is an
impersonal approach. This
includes the shifts on duty and
off-duty.
-Advantages :
1.It conserves time
 2. It is easier to handle need for
help in times of illness, absence or
emergency with qualified
personnel
3. Less frequent requests for
special privileges.
4.Compatible with
computerization
 5.Fairness to employees thru
consistent objectives and impartial
application of policies
6.Cost containment of better
used of resources
Centralized staffing system

DISADVANTAGES
1. It denies head nurse the right to
make staffing decisions
2. There is minimal opportunity for
personal contact with staff.
3. Knowledge of workers abilities,
interest and needs is limited.
4. Knowledge of nursing care needs
in other departments is limited.
5.Lack of individualized treatment
Decentralized staffing

 Decentralized staffing involves

middle and lower first levels of
management in determining staffing
it is a more personal approach.
Advantages :
1. Head nurse is accountable for
staffing decisions
2. Scheduling is based on
knowledge of personnel and client
needs
Decentralized staffing

3. There is greater control of

activities . Schedule can be rearranged
as quickly as needed.
4. Fresh ideas are generated for
improvement of system.
5. Nursing personnel feel that they
get personalized attention because you
are aware of their clinical and personal
needs and take these into
consideration when planning for
staffing.
Self -Scheduling
 It is the process by which staff
nurses in a unit collectively
decide and implement the
monthly work schedule.
 Given the criteria for adequate
unit staffing for 24 –hours period
by the head nurse, each staff
nurse chooses which day and
shift he or she will work.
 About 2 weeks are needed for
negotiation s to finalize a
schedule that accommodates
both the staffs and the unit’s
needs
 A process might allow about 2
weeks for staff to indicate the
days, shifts, weekends.
Holidays and vacation days that
they want.
Self Scheduling

Advantages :
Coordinated by staff nurses
Saves manager scheduling time
Help develop accountability
Increased perception of
autonomy.
 Improved team spirit
 Increased job satisfaction
 Improved morale
 Decreased absenteeism
 Reduced turnover
 Effective for recruitment and
retention
Self Scheduling

 Disadvantage
 Increases amount of time staff
spends on scheduling.

 Changes the role of the

manager from supervisor to
coach.
Alternating or Rotating Work
Shifts
 The frequency of alternating rotating
shifts between days and evenings or
days and nights, or rotating through
all three shifts varies among
institutions, Some nurses may week
all three shifts within 7 days.
 It is desirable that here be equal
share of morning, afternoon and
night shifts as prolonged night shifts
may affect the health of personnel.
ROTATING WORK SHIFT
 Affect the health of nurses and
quality of work, Rapid shift of work
schedule schedules causes stress.
 Nurses complain of restlessness and
nervousness while trying to sleep,
wakefulness or sleepiness at
inappropriate times anorexia,
digestive disturbance, disruption in
bowel habits, fatigue slower reaction
time, lower job performance and
error prunes
Rotating work shift
 There are changes in the patterning
of body bio-rhythms possible
lowered resistance to disease.
 Resultant increase in medication
errors, equipment failures and errors
in problem solving are
probable .Body rhythms need time to
adjust to the discrepancy between
the person’s activity cycle and the
new demands of the environment. It
take 3 days or 2 week to adjust to
different sleep wake cycle.
Rotating work shift
 The rotation of personnel on
individual basis is disruptive to the
development of work groups.
 It could contribute to team
development .If a a group of
personnel work together
consistently, they can help each
other through the dependence of
orientation phase of phase of group
development and conflict
experienced during organizational
phase when , when negotiations of
who will be responsible for what
occur.
 The staff has a chance to
become an interdependent,
cohesive group with good
communication and effective
problem-solving abilities.
 There is usually a high turnover
of nursing personnel, which
complicates team development.
Permanent shift

 Can participate in social ach

problems.
 Job satisfaction
 Commitment to organization
 Fewer health problems
 Less tardiness
 Less absenteeism
 Less turnover
Permanent shift

 Most people want day shift.

 New graduates predominately
staff evenings and nights
 Difficulty evaluating evening and
night staff.
 Nurses may not appreciate the
workload or problems of other
shift
 Rigidity
Cycling Scheduling

 Cycling scheduling is one way of

staffing to meet the
requirements of equitable
distribution of hours of work and
time off.
 A basic time pattern for certain
number of weeks is established
and then repeated in cycles.
Advantages
 Once developed, it is relatively
permanent schedule, requiring only
temporary adjustment.
 Nurses no longer have to live in
anticipation of their time off, because
it may be scheduled for as long as
six months in advance.
 Personal plans may be made in
advance with a reasonable degree of
reliability.
 Request for special time off are kept
to minimum.
Advantages
 It can be used with rotating,
permanent or mixed shifts and can
be modified to allow fixed days off
and uneven work periods based on
personnel needs and work period
preferences.
 It can be modified to fit known or
anticipated periods of heavy
workloads and can be temporarily
adjusted to meet emergencies or
unexpected shortages of personnel.
Staffing board

 Because cyclic scheduling is

relatively inflexible it work only
with staff that rotates by policy
and personal choice.
 Personnel who need flexible
staffing to meet their personal
needs such as those related to
family and educational pursuits
do not generally accept it.
Staffing board
 An infinite number of basic cyclic patterns
can be developed and tailored to suit the
needs of each units.
 Patterns should reflect policy, workload
factors and staff preferences.
 Nursing personnel may use staffing board
to develop a pattern and cycle satisfactory
to them.
 A staffing board may be used to show the
number of nursing personnel required for
each day of the week for 6 weeks.
Methods of staffing pattern

 Conventional staffing is the

oldest and most common
pattern. It employs a
centralized-decentralized
combination.
 The 5 day,40 hour workweek
that become popular in late
1940’s
Decentralized staffing
 Disadvantages
 It is time consuming for managers
 It is sometimes results in lack of
sufficient numbers of qualified
personnel necessary to meet
unforeseen needs.
 Number of request for special
privileges is increased.
 Schedule to punish and reward
 Less efficient use of resources
Block or Cyclical Scheduling

 Same schedule repeatedly.

 Nurses not so exhausted
 Sick time reduced
 Personnel can schedule social
events
 Staff treated fairly
 Decrease floating
 Decrease floating
 Promotes team spirits
 Promotes continuity of care
 Decreased time spent in
 Personnel know schedule in
advance
 Helps establish stable work
group
Variable Staffing

 Use census to determine

number and mix of staff
 Little need to call in
unscheduled staff
 Pros and Cons of Variable
Staffing
Pros Cons
8 hours Traditional

10 hours  Time to  Longer

complete work workday
 Long weekends Fatigue

 Extra days off Overlap

 Decreased Difficult to find

overtime substitute
Cover peak
workloads
 Decreases cost
 Pros and Cons of Variable
Staffing
Pros Cons
12 hours  Lower staffing Overtime
requirements Exhaustion
Lowers cost/ increases at
patient/ day end of work –
Increased week
knowledge of Tension
patients increases at
Get new end of
admissions settled workweek
Not so rushed Increases at

Better continuity end of

workweek
of care
Baylor Plan – Weekend
alternative
 Baylor University Medical Center IN
Dallas Texas.
 Started a 2 days alternative plan.
Nurses have the option to work two
12 hour days on the weekends, and
be paid for 36 hours for day shifts.
Or 40hours for night shifts, or to
work five 8 hours shifts Monday to
Friday.
 This plan required a larger staff filled
weekend positions and reduced
turnover.
Baylor plan/weekend option

 Fewer people need to work

weekends
 Weekends off more frequently
 Work fewer hours for greater
pay
 Staffing improved
 Morale improved
Baylor plan/weekend option

 Cons
 Illness increased
 Absences increased
 Staffing to Meet Fluctuating
Needs
 Full-time Staff

 Hired to meet the average staffing

needs of an institution.
 The most common adjustment for
an increased workload is to
transfer staff from a less busy area
to overloaded are.
 This is economical for the
agency but disrupts the unity of
work groups causes the
transferred nurse to feel
insecure, and contributes to job
dissatisfaction and turnover.
 Some units required specialized
knowledge and skill that not
every nurse has.
Cross Training

 In a companion floor system,

two units relieve each other.
 Staff nurses are oriented to the
to the second unit and know that
if they are transferred, it will be
to the companion unit.
 The staff aggravation is
minimized, flexibility is possible
and quality of care is maintained
Complementary or Float Staff

 Composed of full-time staff

nurses who are oriented to
many areas and like the
challenge of different types of
patients and settings.
 Float nurse maybe part-time or
new nurse waiting for a
permanent assignment.
 Staff preferred stability
Staffing to meet Fluctuating
Needs
 Having full time staff work double
shifts and overtime is another option.
 The nurse is already oriented to the
area, and continuity of care is
facilitated.
 Institutional cost increased.
 Nurses become fatigue, tired errors
are likely increased with stress and
overtime may interfere with the
nurses personal lives.
Part-time Staff
 Flexible working hours can be
incentive for inactive nurses to start
part-time employment and can
reduce staffing shortages.
 Part-time job can broaden the
women’s horizons beyond her home.
Increase income, give ego
satisfaction, and help her maintain
her nursing skills.
 Work more in their share of
unpopular hours, some preferred
evening or night shifts.
Part-time Staff

 When part-time nurses’ other

responsibilities decrease, they
are likely candidates for full time
work.
 It is possible for two nurses to
share a job.
Disadvantages
 Educational and administrative expenses
are higher proportionately for part-time
than full-time help. Ex. Cost much to orient
a part-time nurse than a full time, costing
more per hour worked.
 Maintaining continuity of care is
complicated because two or more part-time
people may filled budgeted full time
positions.
 Part-time nurses may not receive benefits
such as paid sick or vacation leave.
 Not likely to be considered for promotion
 Sometimes benefits are prorated for part-
time workers.
Temporary Help
Some institutions hire temporary help
for the summer to give relief for
vacation.
Some hospital used “premium day”
approach to reduce the weekend
staffing shortage.
Staff nurses get extra day off (premium
day) if they work additional weekend
within a 4 week schedule.
Some nurses may be willing to work on
an on call basis the year round.
Flextime
 Nurses often want flexible
scheduling to better accommodate
their personal lives
 Flextime schedule become popular
in 1980
 They have resulted in improve
attitudes and increased productivity
as employees have gained more
control over their work environment.
 Employees are able to adjust to their
bio-locks and have better control of
work activities
Temporary Help
 Some areas External temporary help
agencies are available in.
 Then use such agencies can greatly reduce
the amount of time middle management
must spend on staffing. The supervisor
merely calls the external agency and
requests so many nurses and agency
makes the necessary contacts.
 The agency has a registry of available
nurses to work who could not otherwise and
consequently helps those nurses maintain
their skills.
 Their availability can boost morale and they
may introduce new ideas and stimulate
creativity among regular staff.
The agency has a
registry of available
nurses to work who
could not otherwise and
consequently helps
those nurses maintain
their skills.
Their availability can
boost morale and they
may introduce new
External Agency
Disadvantages
 The matching of nurses credentials and
qualifications with assignments and
orientation to assignment are severe
problems.
 It is likely to take considerable time for the
regular staff to orient the temporary help,
errors are likely to increase, and continuity
of care is jeopardized.
 The temporary nurse get preferred
schedules, leaving the regular staff with
nurse of attractive hours, morale may be
lowered.
Central placement

 The central placement service

run by state board of Nursing or
state nurses; association could
be helpful for matching nurses’
qualifications and interests with
vacancies and anticipated
vacancies throughout the state.
Handling a called-in absence
or otherwise uncovered shifts.
 Using a float, per diem or agency
nurse
 Asking a nurse to work for the sick
person and canceling a shift for that
person later in the week.
 Asking a part-time person to work an
extra shift.
 Substituting one staff member to
stay a few hours early
 Doing without a substitute.
 Covering the shift themselves.
Productivity

 Productivity is the product or work

produced through a specific amount
of resources measured as outputs
divided by inputs. Ex. Productivity
can be measured as required staff
hours divided by provided staff hours
multiplied by 100
 Improvements in productivity involve
more work or product produced for
less overall cost.
Productivity
 Productivity can be increased by
decreasing the staff hours provided
while holding the required staff hours
constant or increasing them.
 It is often measured through the
patient classification system,
average census ,number of patient
days per month, number of patients
treated and number of procedures
performed are productivity
measures. .
Key Concepts
 The manager must plan for adequate
staffing to meet patient care needs,
 Efforts must be made to avoid
understaffing and overstaffing as
patient census and acuity fluctuate.
 Fair and uniform staffing and
scheduling policies and procedures
must be written and communicated
to all staff.
 Staffing and scheduling policies must
not violate labor laws or union
contracts
Key Concepts
 Existing staffing policies must be
examined periodically to determine if
they meet the needs of the staff and
the organization.
 The patient classification system is a
method of grouping patients
according to specific characteristics
that measure acuity of illness. Such
a system should be periodically
reviewed to determine if it is valid
and reliable tool to measure staffing
needs.
Key Concepts
 Continued efforts should be made to use
innovative and creative methods of staffing
and scheduling.
 Team building and developing trust are
effective methods of handling temporary
staffing difficulties.
 Flextime is a concept modern
organizations use to allow employees to
have varying hours of starting and leaving
times.
 Self scheduling allows employees the
opportunity and the responsibility to make
their own work schedule
Key Concepts

 Skill mix has been shown to

have an impact upon patient
outcomes.
 Tools and methods used to
determine staffing need to be
reviewed periodically.
 Inherent in staffing are fiscal and
ethical responsibilities.
Benchmarking

 Benchmarking- is a
management tool for seeking
out the best practices in one’s
industry so to improve
performance. In developing
staffing pattern that leads to a
budget, it is important to
benchmark your plan NHPPD
against other organizations with
similar patient population
Benchmarking

 This kind of date can be helpful

in establishing a starting point
for staffing pattern or as part of
justification for increasing or
reducing nursing hours.
Actions taken to increase outputs
while maintaining or reducing
inputs.
 Recognizing the need to do better involving
staff, seeking staff ideas and
recommendations creating challenges
management interest in staff achievements
and concerns and praise and reward for
goods.
 Evaluating the problems ,resources and
realities in the organization , using
workflow analysis, work simplification
procedures and improving use of time by
helping personnel keep and analyze time
diaries, and decreasing waiting time can
make a difference.
Ways to improve productivity
 Set a climate for productivity by asking
personnel what would help them be more
productive and implementing their ideas.
 Set targets for increasing outputs.
 Have personnel set personal objectives
and measure performance against them.
 Seek new approaches to old problems and
improve products and services.
 Staff development attention to process,
ethics and aesthetics enhance productivity
through attention to doing the right things
the right way.
Major concept and definitions
 Staffing schedules- work schedules
for personnel
 Centralized scheduling- scheduling
done on one location
 Decentralized scheduling-
scheduling done in local areas
 Self- scheduling-staff coordinating
their own work schedules
 Rotating work shifts – alternating
works hours between days, evenings
and nights
Major concepts and definitions
 PERMANENT SHIFTS- personnel working
the same hours repeatedly
 Block staffing- using the same schedule
repeatedly
 Variable staffing- determining the number
and mix of staff based on patient needs
 Patient classification- calculating staffing
needs based on patient acuity
 Staffing formula- calculations to determine
staffing needs
Leadership Roles Associated
with Staffing and Scheduling
 1. Identifies creative and flexible
staffing methods to meet the needs
of patients, staff and the organization
 2. Is knowledgeable regarding
contemporary methods of scheduling
and staffing.
 3. Assumes a responsibility toward
staffing that builds trust and
encourages a team approach.
 4.Periodically examines the unit
standard of productivity to determine
if changes are needed
Leadership Roles

 5. Is alert to extraneous factors

that have an impact on .
 6. Is ethically accountable tp
patients and employees for
adequate and safe staffing.
 7. Plans for staffing shortages
so patient care goals will be met
Management Functions
 1. Provides adequate staffing to
meet patient care needs according to
the philosophy of the organization.
 2. Uses organizational goals and
patients classification tools to
minimize understaffing and
overstaffing as patient census and
acuity fluctuate.
 3. Schedules staff in a fiscally
responsive manner.
Management functions

 4. Develops fair and uniform

scheduling policies and
communication these clearly to
all staff.
 5. Ascertains that scheduling
policies are not in violation of
local and national labor laws,
organizational policies, or union
contracts.
Management Functions

 6. Assumes accountability for

quality process and fiscal
control of staffing.
 7. Evaluates scheduling and
staffing procedures and policies
on a regular basis.