Efficient Nursing Staffing Guidelines & Solutions

1. 16 Staffing and Scheduling

2. Learning Outcomes • Determine staffing needs. • Demonstrate how to use patient classification systems to calculate nursing care hours necessary. • Calculate FTEs.

3. Learning Outcomes • Determine the appropriate staffing mix and distribution of staff. • Describe the various ways to schedule staff. • Explain how to supplement staff when needed.

4. Staffing • Goal • To provide appropriate numbers and mix of nursing staff to match actual or projected patient care needs to provide effective and efficient nursing care • Managers • Examine workload pattern for the designated unit, department, or clinic

5. Staffing Guidelines • Joint Commission • Provide the right number of competent staff to meet patient's needs based on organization-selected criteria • American Nurses Association (ANA) • Focus on the level of nursing competency required to provide quality nursing care • Individual state boards of nursing

6. Patient Classification Systems • Also known as patient acuity systems • It used patients needs to objectively determine workload requirements and staffing needs. • Data collected at midpoint for every shift and analyzed before next shift

7. Patient Classification Systems • Problems • Nurses may call in sick • Patient's condition may change • Demand management: uses best practice staffing protocol to predict and control the demand for nurses based on patient outcomes. Based on historical data patients progress pattern typifies expected pt outcome throughout a stay • Deviations are tracked and staffing adjusted accordingly

8. Nursing Care Hours (NCH) • Patient workload trends analyzed for each day of the week and each hour in critical care • If 26 patients required 161 nursing care hours, an average of 6.19 nursing hours per patient per day (NHPPD) are required

9. Nursing Care Hours (NCH) • NHPPD • Total nursing care hours divided by total census (number of patients) • NCHs may vary on the average from five to 7hrs of care for pts on medical/surgical, 10-12 hrs of care for ICU, CCU

10. Calculating FTEs • One full-time staff works 80 hours (ten 8-hour shifts) in a 2-week period • To staff an 8-hour shift takes 1.4 FTEs, one person working ten 8-hour shifts (1.0 FTE) and another person working four 8-hour shifts (0.4 FTE) to provide for the full-time person's 2 days off every week

11. Calculating FTEs • Staff working all 8-hour shifts • (1.4 FTEs × 33 shifts = 4.2 FTEs)

12. Calculating FTEs • 2.1 FTEs are needed to staff one 12-hour shift each day, each week—two people each working three 12-hour shifts and one person working one 12-hour shift each week • (0.9 FTE + 0.9 FTE + 0.3 FTE = 2.1 FTEs) • Staff working 12-hour shifts • (2.1 FTEs × 32 shifts = 4.2 FTEs)

13. Determine Staffing Mix • Hygiene care, feeding, transferring, turning patients–LPNS or UAPs • Assessments, patient education, or discharge planning–RNs • High RN skill mix allows for greater staffing flexibility • Block staffing • Scheduling a set staff mix for every shift

14. Distribution of Staff • Staff needs vary by shift or day of the week • Surgery patient census fluctuates • Higher census Monday through Thursday

15. Distribution of Staff • Surgery patients • Shorter length of stay than medical patients • Medical patient census rarely fluctuates Monday through Friday, less on weekends (diagnostic tests not done)

16. Scheduling • Creative and flexible scheduling • Self-staffing and self-scheduling • Shared schedule • Open shift management • Baylor plan for weekend staffing • Supplemental staff

17. Supplemental Staff • PRN staff • Scheduled as needed • Part-time staff • Internal float pools provide staffing at substantially lower cost than agency nurses • External pools • Outside agency nurses; require orientation to facility and unit