Resident Centered Staffingâ„¢: 12-Hour Shift Approach

Resident Centered Staffing™: 12-Hour Shift Approach Oklahoma Association of Homes and Services for the Aging (OKAHSA) 15th Annual Meeting, Educational Seminars & Exhibition March 10, 2010 Dan Gray, President

AGENDA • Staffing and Operations • Employee Buy-In • Implementation • Resolving Challenges

4 critical areas OF SCHEDULE CHANGE

BEST PRACTICE12-HOUR SHIFTS • Minimizes number of shift changes • Eliminates shift overlap for CNAs • Provides the same number of staff • Provides consistency of staff • Prefers full-time staff

BEST PRACTICE12-HOUR SHIFTS-SAMPLE SCHEDULE

STAFFING • In order to have 3-day weekend on Friday, Saturday, and Sunday, pay period cannot end on Thursday or Sunday • Weekend differential can be eliminated • Shift differential is paid only on night shift (7p to 7a)

STAFFING • Use day shift staff pattern for Day 12 and night shift staff pattern for Night 12 • Team approach allows reduction of nurse management (e.g., Unit Manager or House Supervisors)

OPERATIONS OVERTIME • Must be based on over 40 hours not 8 over 80 • Overtime versus idle time • One idle hour = wages and benefits—all nonproductive • Overtime assumes productive work • Overtime can be more cost-effective • Most nursing home staff day and evening shifts the same—overstaffing between 7p and 11p

OPERATIONSFACILITY BENEFITS • Reporting to the same people at the beginning and end of shifts • Residents served by the same nursing staff increases consistency of care • CNAs and nurses are on the same team and have the same days off, which reduces call-offs due to peer pressure

OPERATIONSFACILITY BENEFITS • Improved recruitment • More staff to feed evening meals and return residents to bed • Less shift-to-shift complaints—problems are easier to resolve with only two shifts • Less wasted time for reporting with only two shifts—units are quieter at 3p

OPERATIONSFACILITY BENEFITS • Scheduling is simple—just fill in names each month and adjust for vacations and/or holidays • Less complaints • Working long stretches • Too many weekends—12-hour shifts gives off every other weekend (Fri/Sat/Sun)

EMPLOYEE BUY-INTIME-OFF • More days off in a two-week pay period (e.g., 7 days versus 4 days) • Never work more than 3 days without 2 days off—3 day stretch is only once every two weeks • Employees have a long weekend (Fri/Sat/Sun) every other week

EMPLOYEE BUY-ININCREASE CONTROL • Can plan their schedules since the days off are known in advance • Only need to use 24 hours of PTO to be off for 7 days at a time • Feels more like working part-time with full-time benefits

EMPLOYEE BUY-INLESS EXPENSE • Transportation • Laundry (Uniforms) • Child care

EMPLOYEE BUY-INIMPROVED RESIDENT CARE • Consistent full time staff • Residents receive care from the same 4 CNAs and 4 nurses • Increases productive hours of care due to elimination of shift change

IMPLEMENTATIONCHALLENGES • High absenteeism (> than 2% call offs) • Work force with second jobs • Work force relying on public transportation • Child care • Older staff • Heavy medication pass at 9p

IMPLEMENTATIONCHALLENGES-POSSIBLE SOLUTIONS • Explore together how to support the process of implementation in such a way that would benefit all • Could staff interact and plan together for implementation in their facilities? • Could staff work out the schedule themselves? • Develop or contract child care services to cover 12-hour Day shift

QUESTIONS 1501 Greer Lane Signal Mountain, TN 37377 423.517.0567 ▪ 423.517.0568 Fax dan.gray@consulting-cds.com www.consulting-cds.com

Resident Centered Staffingâ„¢: 12-Hour Shift Approach