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 Managers
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 American Nurses Association (ANA)
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, 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 FTE 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 Part-time 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