272

-----...... ·----___ ... --------~·--_ .. _ .. --

Managing Resources The Staff

"The best executive is the one who has sense enough to pick good men to do what he wants done, and self-restraint enough to keep

from meddling with them while they do it."

THEODORE ROOSEVELT: QUOTES ON TEAMWORK

LEARNING OBJECTIVES

After completing this chapter, the reader should be able to:

l . Explain the staffing process.

2. Examine staffing methodologies.

INTRODUCTION

.;. Describe management's role in the staffing program.

The combination of continuing constraints on U.S. health care spending and the developing nursing shortage has increased workplace pressures on all nurses, and concern for patient safety is rising. 1 The reduced availability of resources such as personnel and assistive support services, the increasing acuity and age of the patients, expanding roles for registered nurses, and serious economic concerns (both wages and equipment cost) have raised concerns about safe staffing ratios, competency, and regulation.2 Workplace staffing issues are dominating discussions among nurses, administrators, and government officials. Nursing continues to hold quality patient care as a value, and inadequate staffing poses a threat to this concept.

Today's nurse manager has a major responsibility of knowing what personnel are doing and where they spend their time. This allows the manager to justify the appropriate staff mix and ensure that nursing and support staff are being used to the greatest advantage. As decentralization

Chapter 14 • Managing Resources 273

of authority and responsibility continues, managers are mandated to allocate availabl R I. . d d' . h U I k f I . e resources. esources are umte commo 1t1es t at a ow t te wor o t 1e orgamzation to be completed d no resource is a important a the staff. Thi hapter will discuss the management of r·es 'an . . . ources w1th spec1fic attention to the taffing process.

KEY CONCEPTS

Descriptive Methodology is a staffing pattern that results from variables selected by the manager.

Expert Panel is the staffing plan that utilizes a variety of experts to examine service- and unit­specific needs related to structure, process, and outcomes, and subsequently suggests an appropriate staffing plan.

Industrial Engineering is a staffing plan that results from techniques used by industry (e.g., time-and-motion studies).

Management Engineering is the staffing plan that results in a staffing index based on usual managerial data.

Productivity is a measure of how efficient labor resources are used in the production of a good or service.

Productivity Index is a measure of nursing hours per patilnt day.

Resources are commodities, especially human assets, in limited quantities that allow the work of the organization to be performed.

Scheduling Patterns represent the actual assign men~ of personnel by unit or department and the time of assignment.

Skill Mix refers to the type, number, and ratio of staff necessary to perform the established work; this includes the optimum ratio of professional nurses to licensed or certified support per­sonnel for a particular unit of patient service.

Staffing Plan is the actual pattern of staff distribution based on an underlying methodology.

Staffing is a complex process that determines the appropriate number of nursing resources necessary to meet the workload demand for nursing care at the unit or department level.

Workload of nursing is determined through an assessment of the patients' severity and an esti­mate of the indirect and unit-based work requirements.

STAFFING

Process and Staffing Plan

Staffing is both a process and an outcome. Staffing may be expressed as the number of staff members required for providing care to a particular number of patients, or it can describe the way in which human resources are used in a particular setting. Staffing decisions require judg­ments for allocating and juggling personnel between the projects and processes (e.g., delivery of patient care) of the organization.3 This is done by the process of staffing, or the determination of the appropriate number and mix of nursing resources necessary to meet workload demand for nursing care at the unit or department level (see Figure 14.1).

N ....., ~

Weeki Week II

Position Name s M T w T F s s M T w T

Full time RN 1 X X X

Full time RN 2 X X X

Full time RN 3 X X X X

Full time RN 4 X X X

Full time RN 5 X X X

Full time RN 6 X X X

Full time RN 7 X X X X

Full time RN 8 X X X

Part time 8 hrs/wk RN 9 On

Part time 8 hrs/wk RN 10 On On

Part time 8 hrs/wk RN 11 On

Part time 8 hrs/wk RN 12 On On

Total RNs on duty each day 6 7 7 6 6 6 6 6 7 7 6 6

Elements: Every other weekend off Number of split days off each period: 2 Maximum days worked: 4 Operates in multiples of 4, 8, 12 .. . Minimum days worked: 2 Schedule repeats itself every 4 weeks

FIGURE 14.1 Master time sheet: 4-week cycle.

Week Ill Week IV

F s s M T w T F s s M T w T F s X X X X X

X X X X X

X X X I X

X X X X X

X X X X X

X X X X X

X X X X

X X X X X

On On On On

On On

On On On On

On On

6 6 6 7 7 6 6 6 6 6 7 6 7 8 7 6

X: Scheduled day off

Chapter 14 • M · anagmg Resources 275

Staffing decisions consider the Joint Commission on the Accreditation of H II Organizations (JCAH0) 4 for the number of competent staff the organizati.on needs c: t lcarc patient needs. The Principles of Staffing by the American Association ofNurs s (ANA)S \m~~ also be used fqr staffing. ANA recommends thal organization focu n the level of competcn of the staff for providing quality patient care. The nurse manager hould be ognizant f ~~ diverse patient population and have culturally competent staff.

Workload is a function of two elements: the number of patients and the measure of work. Typically, the workload of nursing is determined through the use of a patient classification system, which documents the patient severity and accompanying requirements of care (also called the direct work of nursing), as well as instruments that estimate the indirect and unit­based work requirements.6 The purpose of using such a system is to be able to predict the correct staffing plan.

Staffing needs vary from department to department, as well as according to institutional differences. The requirements of an outpatient surgical center may vary from the staff requirement of the intensive care unit of a hospital. In a skilled nursing facility, more staff may be required during meal times than during other times of the day. Today, staffing is a major, complex, and challenging dilemma for the entire provider community. Staffing prob­lems occur when there is a concentration on cost savings to the detriment of quality patient care. 7 To develop an adequate staff requires taking into account a set of dynamic variables and creating a staffing plan.

The staffing plan is the recommended skill mix of indfviduals needed to provide safe and appropriate nursing care. Skill mix refers to the type, number, and ratio of staff necessary to perform the established work or productivity; this includes the optimum ratio of professional nurses to licensed or certified support personnel for a particular unit of patient service. A skill mix ratio may vary from department to department. However, the factors that generally predict a skill mix are as follows:

• Average daily occupancy trends and fluctuations • Patient classification data • Average length of stay • Staff distribution patterns for the type of health care institution • Type of health care being delivered8

Workload Measures: Productivity Index

Because of the variety of variables necessary to determine adequate staffing, a practical method to quantify workload is a productivity measure. The emphasis on proper skill mix is aimed at using human resources efficiently, thereby increasing productivity. Productivity measures are estimates of how efficient labor resources are used in producing a good or service.9 There are a variety of measures, but there are also inherent difficulties in estimating the ratio of services required (including the level of personnel required to deliver service) and the hours needed to provide service. One such method, a productivity index, approximates the ratio of hours of nursing care needed for what is offered. A nursing productivity measure may be estimated by comparing actual staffing hours with the staffing hours required by the patient classification sys­tem.10 This method provides information about the adequacy of staff available to give care. The competency of the staff in delivering care is not necessarily considered. Other methods incorpo­rate staff level and competency.

276 Unit 4 • Managing Resources

In nursing, the criterion used most frequently is nursing hours per patient day (NHPPD). This value is a productivity standard and reflects what each unit considers a standard of nursing care. For example, the ICU may have a greater NHPPD than a general medical area, based on the acuity sys­tem of those units. The higher the acuity classification of the patient, the more nursing is required. To determine the unit-specific standard NHPPD, a standard number of hours is recommended based on the acuity system. For example, an acuity system ranging from 1 (mostly self-care) to 5 (critically ill) will necessitate the corresponding hours of nursing care. For example:

Acuity System

5 requires 20 hours/day of nursing time

4 requires 15

3 requires 10

2 requires 5

1 requires 2

The formula for estimating the nursing staff productivity index is:

Productivity Formula

Patient days X unit standard = output in work hours

20 patients X lO days each= 200 patient days

Unit standard= 10 NHPPD

200 X 10 NHPPD = 2,000 work hours (output)

8 RNs for 24 hours for 10 days = 1,920 hours worked (input)

output/input= productivity index

2,000/1,920 = 104%

This result means that this was a highly productive staff. 1 1

Productivity, while important, is one consideration for establishing an optimum staff. Proper staffing plans require consideration of diverse and difficult-to-estimate issues, as well as nontraditional and new staffing patterns (the actual way staff is distributed throughout the orga­nization). The American Nurses Association suggests four questions for directing the staffing plan. These questions include:

I. How many patients can one professional nurse properly plan for, supervise, and evaluate in terms of nursing care provided?

2. How many associate nurses can one professional nurse direct, supervise, and evaluate? 3. How many patients will require the direct care of a professional nurse, and how much

nursing time is involved in this care? 4. How can the autonomy of nursing practice and acceptance of accountability for results be

fostered? 12

These questions provide the structure for the database upon which the actual plan will be based. The responsibility of nursing administration, as stated by the ANA, is to develop and exe­cute a rational program. The objective of the staffing plan is to ensure that nursing care is safe, responsive to patient needs, and scientifically and technologically sound.

Chapter 14 • M . anagmg Resources 277

STAFFING METHODOLOGIES

The emphasis on appropriate staff is guided by the development or a staffing plan or 111

lh d 1_

ogy. Within each plan, different criteria are involved, which allow different pr ductivity mea~ 0 ,

to be calculated. Descriptive or consensus methodology, industrial and management engi tleer~r~es and the expert panel method are various ways to begin the pr ces of determining the cone l ta~f configuration. 13

Descriptive methodology refers to a staffing pattern that is based on subjective data. This means that the appropriate staffing pattern is recommended on the basis of the manager's experi­ence and intuition. For example, using the average acuity level of patients on a unit, the manager determines that a particular ratio of staff to patient maintains quality of care, based on institu­tional audits. The information that is gathered to determine the staffing plan is organized around the variables selected by the manager. These variables may vary from department to department within the same institution (see Figure 14.2).

The industrial engineering methodology is a technique, or group of techniques, developed by industry to improve productivity. Typically, these techniques include task analysis, review of work distribution, and measurement of the staff work through work sampling and time-and-motion studies. Work sampling offers the possibility of an ideal staffing pattern and, even more importantly, provides empirical evidence for the establishment of a theoretical basis for staffing procedures. Work sampling combines many of the aforementioned techniques, especially time-and-motion studies. Results of these methods provide information about the time it takesfo do specific work.

Example of a Master Staffing Pattern

33-bed capacity Su ~ M Tu w Th F Sa ----------------------------------------------------------------------DAY SHIFT RN 4 5 5 6 6 5 4 35 LPN 2 2 2 2 2 12 AIDE 2 2 3 3 3 3 2 18 TOTAL 7 9 10 11 11 10 7 65

EVENING SHIFT RN 4 5 5 5 5 5 4 33 LPN 1 1 1 1 1 7 AIDE 1 7 TOTAL 6 7 7 7 7 7 6 47

NIGHT SHIFT RN 3 4 4 4 4 4 3 26 LPN 0 0 0 0 0 0 0 0 AIDE 1 1 1 1 7 TOTAL 4 5 5 5 5 5 4 33

TOTAL NURSING HAS 136 168 176 184 184 176 136 165.7 (average) AVERAGE CENSUS 25 30.5 32 32.8 32.8 32 25 29.9 (average) HOURS OF CARE 5.40 5.50 5.50 5.60 5.60 5.50 5.40 5.54 (average) AVERAGE ACUITY 2.20 2.30 2.40 2.45 2.45 2.40 2.30 2.37 (average)

FIGURE 14.2 Example of a master staffing pattern.

278 Unit 4 • Managing Resources

Nursing departments have used these techniques to develop appropriate staffing plans. The work of the unit is defined in terms of tasks to be accomplished and the level of the employee who is needed to perform the work. The problem with this precise methodology is that the complex nature of professional nursing is not entirely amenable to this type of measurement. Nursing is more than a list of tasks to be performed; rather, it involves use of the nursing process, which is analytic, instru­mental, and evaluative. While aspects of this methodology are useful, relying on this exclusively would be too limiting in light of all that is required of the professional staff.

The management engineering methodology ptimiz.es the nursing workload by developing a staffing index m del. Using techniques simiJar to those of industrial engineering and a variety of information (e.g., qu, lit y nursing care; a general description of the type and volume of patients ser­viced; information ab ut in tituti nal characteristics, such as census, bed capacity, daily visits or admission; and operating budget), a systematic analysis yields a projection for an appropriate and cost-effective staffing pattern. This methodology is as successful as the information that is provided.

This approach, referred to as the expert panel nurse staffing method, can be used to allocate resources and staff. 14 Using this model, a manager is able to examine service- and unit-specific needs related to structure, process, and outcomes. An expert panel, composed of nurse leaders within and related to the organization, is appointed by the chief executive nurse, and the panel examines the separate divisions of the organization. Data (also called minimum unit-based data set) examined by the panel differ by the mission of the organization and unit of care but usually include the patient classification system, tasks, direct and indirect costs to the delivery of care, prospective payment, availability and type of nursing and support staff, and quality-assessment findings. Following analy­sis of the data, staffing needs are predicted to provide coverage of the unit, with calculation of a replacement factor (an estimate of the need for additional staff due to vacation, sickness, or turnover). In addition, staffing requirements are considered that allow existing staff to participate in professional and educational meetings. The outcomes of care are predicted based on increasing or decreasing the staff, and non-unit-based staff (central staff consisting of administrators, advanced practice nurses, and staff development and support employees) are projected, ensuring that all nec­essary nursing care is provided throughout the organization. The expert panel, in essence, recom­mends an ideal, professional support staff for the entire organization.

Nursing administration, with input from lower-level managers, ultimately has the responsi­bility of determining which staffing methodology will be used by the department of nursing. Variables such as occupancy rate, salary scales, the availability of nurses, organization of the department of nursing (structure of authority, centralized or decentralized), and type of institu­tion all influence the subsequent decision about the staffing pattern.

Scheduling Patterns

The number and type of personnel (the skill mix) needed is estimated based on the staffing method­ology used. Scheduling patterns are proposed based on needed staff per unit. Scheduling patterns may be centralized (a member of nursing administration determines patterns for the entire organi­zation), decentralized (scheduling occurs at the unit level), or self-scheduled (employees choose their own work schedules). Scheduling patterns are overall plans intended to provide the correct configu­ration of personnel for the work to be done, eliminating understaffing (not enough staff) or over­staffing (too much staff), while accommodating the individual needs of the staff.

WORK SCHEDULES Work schedules are more specific plans by which personnel are assigned for time periods during which the organization provides service. Proper scheduling requires adequate coverage of staff for the patients needing care.

Chapter 14 • M . anagmg Resources 279

Exam pies of work schedules include:

• The traditional40-hours-a-week, 8-hour shift An effective scheduling plan, this bas been u ed for a long time and provides coverage f, . 1 work to be accomplished. Most flexible plans are in ome way a variation of this part~ 1

tile < ICU ar

model. Often, the manager assigns the full-time staff to the 7-day-a-week and 24-hour-a-da coverage implied by this model. In fact, this pattern of scheduling work has been the impetu~ for the creative and exciting changes that are now occurring in staffing opportunities.

• The 10-hour shift In this plan, a full-time employee is able to work a 4-day, 10-hour-a-shift week. This has advantages for personnel in providing a shortened workweek. It also gives the added bene­fit of allowing enough time to ensure that the necessary work is completed for patients. The drawback to this model, besides the longer workday, has been the added expense to the personnel budget. A reduction in personnel has not been realized here, and a probt"em of overlap exists. Staff fatigue has been cited as a problem that needs further study. This is, however, a plan that is very attractive to many professional staff.

• The 12-hour shift Some options within a 2-week pay period are: (1) seven 12-hour shifts, (2) seven shifts on and seven shifts off, and (3) three shifts per week in a 72-hour pay period. This plan pre­sents many of the advantages of the 10-hour-a-week plan. It provides an intense work period and more free time, while providing the benefits for a full-time position. The disad-vantages are also the same, particularly fatigue. 1"

• The Baylor plan A very interesting alternative staffing plan is the Baylor plan. In essence, it is a weekend alterna­tive plan. The idea, originated at Baylor University Medical Center, consists of a staff for the traditional40-hour-a-week, 8-hour-a-shift plan during the w~ek and a second staff for week­ends who work two 12-hour shifts.and are paid for a 40-hour week. Its advantages include ensuring adequate weekend coverage and working fewer hours for greater pay. A problem with this method is that there is a high turnover rate because of the undesirable hours.

• Job sharing This implies two people sharing a position, which has obvious advantages for people who desire a part-time position. This works very well at many levels of the organization and has been reported to be quite successful in the position of clinical specialist. It does require that the two individuals sharing the position be cooperative and compatible.

• Flexible hours or part-time work Part-time work falls into any category. Professional staff are able to select working hours that are compatible with their personal needs. The hours of work may be consistent with any of the preceding models or may be fewer working hours per day. This allows professionals with multiple responsibilities to still be part of the professional workforce. It has advantages for both the person and the organization. Self-scheduling provides an opportunity for the staff to work together to construct their own work schedules. Shullanberger15 reports greater worker participation in decision making with self-scheduling. Hung16 further reports an improvement in staff morale and professionalism, with a decrease in staff turnover.

• Combination plan This plan combines part-time or full-time work with a variety of staffing schedules.

While general scheduling plans provide a structured approach to providing adequate staff, shift-to-shift variations often require staffing adjustments. Problems include the unpredictable census, variations of patients seeking care, dramatic and abrupt changes in the acuity level of

280 Unit 4 • Managing Resources

critical care patients, and the competency of the staff. Flexible and innovative scheduling patterns have been proposed to induce nurses to be able to practice. The following represent some addi­

tional approaches to providing adequate staff:

• Use of a general float pool Nurses may be hired centrally and assigned to a unit on a shift-to-shift basis. Essentially, this is a unit without walls, with a traditional and an administrative structure (nurse man­ager and assistants). The float-pool staff are scheduled in 4-week blocks but are meant to address the historic census variations and staffing trends. The pool may be composed of RNs, LPNs, and paraprofessionals. The intent of this staffing model is to provide organized

supplemental staff where needed. • Use of a unit-based float pool

The same model can be used for specific, highly specialized units and serve as a unit-based float pool. Instead of providing staff for the entire organization, this pool supplies staff to

specific units. • Per diem nurses

Per diem nurses are hired on a daily basis and are not guaranteed an assignment or benefits from the organization. They may be hired from outside agencies or from within the orga­nization's staff hiring. Typically, these nurses are paid a higher hourly wage to make the

position more appealing to them. • Float-float policy17

Each institution should decide what the policy will be for asking nurses to float to other areas and what restriction will limit the practice. One such suggestion is to cluster the units that nurses may be expected to staff. Rather than expecting nurses to be available for the entire organization, clusters (a few related patient-care areas) may be formed to which the nurse may he asked to provide care.

The presence of different generations among the staff is an important consideration for staffing and work schedules. Work ethics and work values are different for different groups, and staffing assignments that are best for one generation may not fit another.

SHARED STAFFING HELP LIST A shared staffing help list (SSHL) is essentially an in-house pool of various levels of staff that serves the needs of the institution. Each unit posts its needs, and a central staffing manager fills the requests with members of the SSHL. 18

Flexibility and versatility must be characteristics of today's staffing schedules. Providing options for professional nurses is an excellent way to prevent attrition and to enhance work satis­faction. Giving autonomy and decision making about working conditions to the staff is good man­agement.

MANAGEMENT'S ROLE: PLANNING THE STAFFING PROGRAM

The role of administration is to determine the staffing program for the institution. The staffing program consists of phases for the selection of a staffing plan. These phases include:

1. Phase One. A statement of the purpose of the organization and the services offered, as well as the standard of care to be provided.

2. Phase Two. The application of a specific method to determine the number and kind of staff to deliver care.

Chapter 14 • Ma · 'nagmg Resources 281

3. Phase Three. Development of an assignment pattern using policies and gut'd 1. h

e mes to steer t e process.

4. Phase Four. This step consists of evaluation of the process through an ann lysis of pat ' ' .tent out-come data, quality indicators, and personnel issues su h as ta ff turnover, ab entccism d attrition. 19 ln addition to the overall staffing plan, the nurse mannger at the unit level wil'l ~~~­plement the organization's staffing plan and det rmine highly spe ific unit p lk ics. These policies, when developed, provide adequate coverage for hifts and patient ' need ensure stability for the nursing staff, and incorporate flexibility and fairness in work assignments.

The various questions that require policy guidance include the following:

• Who determines the staffing schedule, and what authority does this individual have over the staff?

• What is the type and length of the staffing cycle-is it fixed, weekly, biweekly, nmpthly? • Is there a rotation-of-shift policy? • Where and at what time intervals is the staffing schedule posted? • What is the duration of time for shifts? • What is the weekend-off policy? • What is the tardiness policy? • What are the low-census procedures? • Is there a policy for trading shifts or days off? • Is there a policy for rotation to other divisions? • How are vacation and holiday requests handled? • How are conflicts over requests handled? • What is the emergency-time-off policy?20

To a great extent, answers to the previous questions, when;guided by organization policy and modified at the unit level, will reduce a great deal of ambiguity ami conflict about staffing assignments. The more the staff knows and controls their assignments, the more satisfied they are likely to be.

Economic and Regulatory Issues

Economics dictates to what extent staff may be procured. Budgetary restrictions exist that allo­cate certain percentages of the operating budget to cover personnel salary and benefits. In the current environment, budgets have been drastically revised to adjust to a different system of reimbursement. Every professional and nonprofessional position has to be justified as to its ability to meet the mission of the organization. Information regarding the patients and ser­vices offered are also instrumental in developing an appropriate staffing model. Types of patients, acuity levels, and a projection of anticipated patients and services offered provide baseline data for predicting staff requirements. 21

Regulatory policies-from those of government to the variety of insurance plans-direct, in part, the limits of how much and what kind of staff is economically possible. Regulations about safety, infection control, and quality-control measures also play a part in quantifying staffing plans. A certain level of environmental quality must exist for any agency to be accredited. Thus, to some extent, regulatory bodies add a dimension to "safe" staff distributions.

Professional concerns that affect policies about working conditions may also influence staffing. These concerns include mandatory overtime (as a way of providing adequate staff) and mandatory staffing ratios. The problem of requiring nurses to work in excess of their

282 Unit 4 • Managing Resources

scheduled shifts resulted in a federal bill. The Registered Nurses and Patient Protection Act22

was introdu ed in Congress ns a way of protecting patient safety. Nursing organizations galva­nized support to prohibit the practice of insisting that nurses work beyond the usual shift time. This j a danger us practice that creates the opportunity for error. There are currently state-to-state differences in what constitutes overtime. In response, the ANA has placed work­place issues-especially mandatory overtime-high on its agenda to eliminate this practice.23

In 1999, California instituted legislation to mandate appropriate nurse-patient ratios. Currently, there are rules before the state legislature that set minimum staffing levels for nurses. The difficulty with this initiative is the lack of empirical data to describe adequate nurse-patient ratios. Research studies are being conducted to answer the question of what constitutes appropriate staffing plans, based on quality indicators and patient-outcome data. The goal of these studies is to understand the relationships between the use of resources for patient care, the characteristics and processes of these resources (direct nursing interventions), and the effects on patients (nurse-sensitive patient care outcomes). This data will be requisite for obtaining the correct number and skill level of nurses and other direct care providers nec­essary to provide safe and quality care.24

Institutional policies for recruiting, providing, sustaining, and retaining staff will involve mutual agreement between management and personnel. Involving staff in decisions concerning their working hours can create a positive work climate. Allowing autonomy in decision making facilitates staff growth and enhances morale. The most expensive personnel costs to an organiza­tion, besides providing benefits, come from staff turnover and absenteeism. These factors require that additional personnel be hired for temporary or permanent positions.

CASE STUDY An Understaffed Unit

Michael Clay, a registered nurse on the tenth-floor ICU, had just completed his fifth night of work and was looking forward to having the next two days off. The unit had been filled to ca­pacity and extremely busy. As Michael was leaving, the charge nurse approached him and asked if he would work one more night because they were really short staffed. He paused and, looking exhausted, said, "OK, but this is it." At the same time, Stephanie, another RN, walked into the report room and was greeted with "What are you doing here today? I thought you were off." Stephanie said, "I was called at five this morning to come in and help." Another nurse, Jane, joined the group and said, "I feel like quitting. I couldn't even take a break last night."

The charge nurse, who overheard the conversation, said, "You are aware of the fact that we lost three permanent staff members, and their positions have not been filled. Frankly, I'm not sure if those positions will be filled by RNs or technicians." She went on: "Several proposals are being considered, including flexible hours, innovative staffing patterns, and self-scheduling. The aim is to provide autonomy and flexibility to the current and potential staff."

• What kind of staffing patterns should be offered? • How much flexibility should be suggested? • How would you handle financial compensation for part- and full-time staff?

Chapter 14 • M · anagmg Resources 283

CASE STUDY Developing a Staffing Plan

The nurse manager of the pediatric unit (you) has experienced frequent turnover with nursing staff. Recently, you have hired several new graduate nurses to fill the staffing vacan­cies. You need to develop a staffing schedule for the upcoming holidays and ensure adequate staffing with an appropriate mix in the unit. It has always been the policy of the unit to have the holiday staffing schedule available before November first. The senior staff worked the Christmas holiday last year and are requesting it off this year and to work New Year's instead. The new staff nurses are only willing to work the New Year's holiday, or they are threatening to leave.

• Develop two staffing options for the holiday schedule.

Summary

This chapter has dealt with the most important resource to any organization: the staff. Staffing is a highly complex process that, because of the volatility in health care today, requires manage­ment know-how. Staffing is t~ process that pro­vides adequate personnel to do the work of the organization. This is based on a staffing plan that uses a particular methodology. These methodolo­gies include descriptive or consensus, industrial engineering, management engineering, and the expert panel method.

Following the development of a staffing plan-which includes an acceptable skill mix-a scheduling plan is provided that allocates person­nel to a time frame. The role of management

Learner Exercises

1. Plan a staffing pattern for a 30-bed, step-down, coronary care unit for 24 hours per day for 7 days. Which staffing methodology did you use? Why?

2. What would you do to recruit and retain staff? 3. What working conditions are the most important

to you?

include! the choice of a staffing plan and the evaluation of its effectiveness. Issues to keep in mind for the choice of a proper professional staff m9,del are environmental, organizational, and professional working conditions. Staffing is the means by which the work of the organization is operationalized.

PUTTING IT ALL TOGETHER

Staffing and scheduling means providing an ade­quate staff mix to meet the needs of the patients. Patient classification is used to help formulate the necessary staffing plan. Flexible and creative scheduling is essential for retaining staff and pro­moting a positive work climate.

4. What should be the criteria for hiring a new staff nurse?

5. Self-scheduling can increase staff job satisfaction and commitment. What would be some of the disadvantages of self-scheduling?

284 Unit 4 • Managing Resources

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References

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2. American Association of Critical-Care Nurses. (2001) . Maintaining patient-focused care in an environment of nursing staff shortages & financial constraint: A statement from AACN public policy, 2. Retrieved in October, 2001, from http:// www.aacn.org

3. Strickland, B., & Neely, S. (1995, March). Using a standard staffing index to allocate staff. journal of Nursing Administration, 25( 3), 15-21 .

4. American Nurses Association. (1999). Principles for nurse staffing. Washington, DC: Author.

5. joint Commission on the Accreditation of Healthcare Organizations (JCAHO). (2002). Comprehensive accreditation manual for hospitals: The official handbook. Oakbrook Terrance, II: Author.

6. Dunne, M. A., Norby, R., & Cournoyer, P., et a!. (1995). Expert panel method for nurse staffing and resource management. journal of Nursing Administration, 25(10), 63-67.

7. Marron, S. (2001 ). Staffing summit: Addresses gap between patient needs and RN staffing. The Oregon Nurse, 65(4), 1-4.

8. Pederson, A., Hoover, C., & Kisiel, T. (1995). Redesigning a skill mix in the !CU. Nursing Management, 26(7), 32J-32P.

9. Managing teams for peak performance: Three in a series. Healthcare Continuing Education, LTU Extension, 39-41.

10. Managing teams for peak performance: Three in a series. Healthcare Continuing Education, LTU Extension, 39-41.

11. Managing teams for peak performance: Three in a series. Healthcare Continuing Education, LTU Extension, 39-41.

12. American Hospital Association. (1983). Managing under medical prospective pricing. Chicago, IL: AHA.

13. Strickland, B., & Neely, S. (1995, March). Using a standard staffing index to allocate staff. journal of Nursing Administration, 25(3 ), 15-21.

14. Dunne, M.A., Norby, R., & Cournoyer, P., eta!. (1995). Expert panel method for nurse staffing and resource management. Journal of Nursing Administration, 25(10), 63-67.

15. Shullanberger, G. (2000). Nurse staffing decisions: An integrative review of the literature. Nursing Economics$, 18(3), 124-136.

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