Use attached document to answer questions. 150-200 words.
1. If you were a supervisor or manager, would you prefer to manage in on a unit with centralized staffing or decentralized staffing. Explain your choice.
2. As a supervisor or manager you are considering implementing a scheduling system that combines 8 hour and 12 hour shifts. What considerations would you need to address with this type of scheduling?
Staffing Needs and Scheduling Policies
Ch. 17
Key Concepts
The manager has both a financial and an ethical duty to plan adequate staffing to meet patient care needs, staff and the organization.
Staff need to have creative methods of staffing and scheduling to avoid understaffing and overstaffing due to patient census and acuity fluctuate.
Staffing and scheduling policies should not violate labor laws, state or national laws, or union contracts.
Mandatory overtime should be a last resort, not standard operating procedure because an organization does not have enough staff.
Having a mix of professional nurses improves patient outcomes and decreases adverse incidents.
Individuals who have staffing responsibilities must remain aware of mandatory staffing ratios and comply with such mandates.
Managers need to attempt to have a diverse staff who will meet the cultural and language needs of the patient population.
Fair and equal staffing, scheduling policies and procedures must be written and communicated to all staff members.
Current staffing policies need to be examined periodically to determine if they still meet the needs of the staff and the organization or if change is needed.
“Key concepts that are important to take away from this chapter”
Responsibilities of the Scheduling Manager
1. Managers must be certain that adequate number of staff and an appropriate mix of staff are available to complete the unit needs and the organizational goals.
2. Staffing patterns and scheduling policies must be administered fairly as well as economically
a. Fiscal responsibility
i. Due to increased federal and state budget debt, health-care organizations are pressured to reduce costs
ii. When patient acuity rises managers must increase staffing and when acuity is low the staffing needs to be decreased but also remain within the budget
iii. Manager needs to calculate daily staffing needs using formulas and instructions
3. Constant reevaluation of the staffing philosophy, scheduling and staffing policies and procedures
4. Managers must understand the unique cultural and language needs of their patients and try to meet these needs with an appropriately diverse staff
5. The manager needs to be certain that scheduling policies are not violating state and national labor laws, organizational policies, or union contracts
Inna
Methods of Staffing
Centralized staffing: staffing decisions are made by individuals in a central office or staffing center, they may not be staffed by the registered nurses.
The nurse manager has limited input and making minor changes
The manager still has the responsibility to have adequate staffing to meet the needs of the workplace
Pros:
Frees time to allow the manager to focus on other tasks
Treatment towards employees is fair
Cost effective
Cons:
Not much flexibility for the nurses
The manger nurse is not making the scheduling and staffing decisions
Does not take patient acuity or skill mix into account
There are two different method of staffing centralized and decentralized(Inna)
Methods of Staffing
Decentralized staffing: The unit manager makes the scheduling decisions. In this type of method the manager takes on the responsibility of preparing monthly schedules, holiday and vacation schedules, and produces creative ways to reduce or increase staff in order to meet patient care, the manager has the responsibility of covering any shift if a scheduled nurse calls out of work (on top of her other duties)
Unit managers know the needs of the unit and make scheduling decisions
Staff feel more in control of their work environment
More work for the nurse manager
Pros
Allows person who knows the unit to make decisions
Allows staff to take requests directly to their own manager – increased autonomy and flexibility
Cons
Increases risk that employee requests may be treated unfairly or inconsistently
Time consuming for manager
(Inna)
The disadvantage of decentralized staffing is the possibility of employees being treated unfair and unequally such as the manager giving out special treatment or punishing the staff through scheduling.
Common ways of staffing and scheduling
12 hour shifts
Bonus pay for weekend work
For weekends and holidays managers places part-time or pool staff
Regular staffing provide long-term knowledge of future work schedules
Allowing nurses to exchange hours of work among themselves
Flextime
Use of supplemental staffing from outside registries and float pools
Staff self-scheduling
Shift bidding, which allows nurses to bid for shifts rather than requiring mandatory overtime
(Inna)
Minimum Requirements for Safe Staffing
Decisions made must meet state and federal labor laws and organizational policies.
Staff must not be demoralized or excessively fatigued by frequent or extended overtime requests.
Long-term as well as short-term solutions must be sought.
Patient care must not be jeopardized.
Jess
Pros and Cons of 12 Hour Shifts
Pros
Continuity of care. Nurses spend more time with their patients, and perhaps throughout an entire stay.
12 hour shifts usually equals more days off, so more time for responsibilities. For intensive care nurses, more days off from a high stress job is desirable.
For the hospitals, this means less overtime and use of agency nurses. It is also easier to create schedules with only two shifts to choose from.
Kemar
Pros and Cons of 12 Hour Shifts
Cons
Both 12 hour shift and overtime is associated with fatigue, lower quality of care, worst patient safety reports, and more care left undone.
Nurses who worked 12 hour shifts were more likely to describe the quality of care on the unit as “poor” or ”fair.”
Nurses who work long hours for 3 consecutive shift exhibit signs of sleep deprivation and a slower reaction time, both day and night shift.
The 12 hour shift nurse is more susceptible to burn out.
kemar
Learning Exercise
You are the manager of an intensive care unit (ICU). Many of the nurses have approached you requesting 12-hour shifts. Other nurses have approached you stating that they will transfer out of the unit if 12-hour shifts are implemented. You are exploring the feasibility and cost-effectiveness of using both 8- and 12-hour shifts so that staff could select which type of scheduling they wanted.
ASSIGNMENT:
Would this create a scheduling nightmare? Will you limit the number of 12-hour shifts that staff could work in a week? Would you pay overtime for the last 4 hours of the 12-hour shift? Would you allow staff to choose freely between 8- and 12-hour shifts? What other problems may result from mixing 8- and 12-hour shifts?
Kemar
External and internal forces that affect unit needs
INTERNAL EXTERNAL
Obsolescence of production and services – Regulators
New market opportunities – Competitors
New strategic direction – Market forces
A shift in socioeconomic values – Customers or Technology
kemar
Why Do Staffing Shortages Occur on a Day-to-Day Basis?
Increase in patient census
An unexpected increase in patient needs
An unexpected call-out
kemar
Mandatory Licensed Staffing Requirements
“Safe Staffing Law” (Assembly Bill 394/AB 394), passed in 1999 by the California Nurses Association.
The National Nurses United advocated for even lower ratios in 2016.
As of 2018, 13 more states have implemented regulations to address nurse staffing.
7 states are required to have staffing committees to form plans and policies
“Band-aid solution,” AB 394 does not accommodate for
Patient acuity and RN skill level
The unwillingness of hospitals to accommodate for patient acuity and RN skill level, leading to a decrease in staffing
Nursing shortages
Alex
California needed to comply by January 1, 2004
The reason for these staffing ratios are due to staffing abuses and decline in patient quality care. Even though these laws may not fix the overarching problem, there is still an ongoing debate on whether or not states should pass this law because it may make staffing worse and cause tension between nurses and the hospital
Alex
Perception
Nurses believe that inadequate staffing affects healthcare staff both personally and professionally, this could trigger responses that influence approaches to patient care, unit operations and relationships.
Nurses overwhelmingly indicated that current staffing guidelines are inadequate in meeting needs. The original staffing guidelines were published in 1983.
Jess
Solutions to Combat This Problem
Cross training
Cross‐training has been used by healthcare facilities to support the fluctuating needs of hospital units
Crossed trained nurses are more comfortable with a wider ranges of patients
Using agency/travel nurses
They are employed by an external nursing broker.
Offer scheduling relief when there is unanticipated increase in census
Float pools/ Per diem
Supplemental staff created by the hospital
Generally are crossed trained on multiple units
Must be able to perform the core competencies of the unit they are floating to in order to meet their legal and moral obligations as caregivers
Jess
Cross training: Increase knowledge,, Becoming an expert in one area of nursing is great. We need specialists and expert nurses. But we also need nurses who can take care of patients in any stage of illness or situation, so By cross-training them to other units, nurses are exposed to patients with different diseases, health conditions, technologies, and workflows.
Agency travel nurses: but they work for a premium pay, which is often 2-3 times more of a regularly employed staff nurse.
They offer scheduling relief when there is unanticipated increase in patients, but a downside is that their continuous use could become costly, also there would be concern about how familiar they are with the work setting
Float staff: have the flexability to choose if and when they want to work. Similar to agency/travel nurses, they may not be as familiar with some areas they float to. They may fill some scheduling holes, but once again they result in a lack of staff continuity. May not feel comfortable if they are not fully oriented to the floor.
Solutions to Combat This Problem cont…
Flextime
Allows employees to select the shifts that best meets their needs while still meeting work responsibilities
Could get a bit hard to coordinate
Self Scheduling
Allow nurses on the unit to work together in constructing their own schedule
Needs good leadership skills to be successful
Flextime: Could get hard to coordinate, resulting in over/understaffing.
Self scheduling: nurses make the schedule instead of management, but management would still have to review it to make sure it meets all the guidelines and requirements.
Effects of Short Staffing
High attrition rates are attributed to nurses feeling burned out and overworked.
13% of newly licensed RN’s change their profession within the first year of getting their licensure (AACN).
Nurse turnover is expensive
Nursing shortages can decrease the amount of students accepted into nursing programs
Alex
Why is Staffing and Scheduling Needs an Issue?
Poor staffing leads to poor health and poor patient outcomes
At some point, all nurse managers will face a short supply of staff
Nurse shortages due to a high attrition rate
A decrease in the amount of students due to not many instructors being available
Nurses will be more satisfied in the workplace if staffing is thoughtfully developed, fairly applied, and clearly communicated
Alex
Nclex Question
The number of adverse events such as falls and pressure ulcers on your unit are increasing. An ideal staffing plan to address this issue would include which of the following? Increasing the:
Total number of staff on the unit.
Staff and RN hours per patient.
Total number of staff, and implementing 12-hour shifts.
Number of RNs and number of RNs with experience on the unit.
ANS: D (inna)
A number of studies have identified that adverse events such as falls and pressure ulcers can be reduced by increasing the number of RNs on a unit (relative to other personnel) and utilizing experienced RNs. Overtime and 12-hour shifts are linked to greater incidence of errors.
Nclex Question
St. Raphael Medical Center has a decentralized staffing system. Which of the following is an advantage of this system of staffing (select all that apply)?
Done at unit level by a manager
Conserves time
Greater control of activities
Promotes better interpersonal relationship
Allows person who knows the individual unit to make staffing decisions
A, C, D, E (Inna)
Nclex Question
The nurse manager notes that there is an increasing unrest of the staff due to fatigue brought about by shortage of staff. Which action is a priority?
A. Evaluate the overall result of the unrest
B. Initiate a group interaction
C. Develop a plan and implement it
D. Identify external and internal forces.
Jess
Answer: B. Initiate a group interaction
Initiate a group interaction will be an opportunity to discuss the problem in the open.
Nclex Question
What are some issues with having float, travel, and agency nurses? Select all that apply
They may not be familiar with the type of diseases on the specific floor
They are not fully oriented to the floor and staff
Having to pay for their benefits even though they do not work for the hospital
Having these kinds of nurses causes a lack of staff continuity
Jess
a,b,d
Nclex Question
Nurses that are crossed trained could work on any floor because they are comfortable with everything.
True
False
Jess
B. False: They are crossed trained in wider ranges of patients, but they still can not do everything
Discussion Question
Being short staffed has a negative impact on the quality of service in medical facilities due to the lack of time, staff to patient ratio, and less training.
In what ways does short staffing impact the quality of service that patients’ receive?
Discussion Question
A nurse has worked 40 hours this week already, but the unit is short staffed. This nurse is being called in by the nurse manager to help out.
Should this nurse go in to work? And is it wrong for the Nurse manager to ask this nurse to come in even though they already worked 40 hours this week?
Jess
I think that nurses are responsible for providing the best care they could, if they feels like they would not be able to do their job to the fullest potential, then they should not go in because patient care is the priority. And the nurse manager should utilize float/pool nurses that is familiar with patients on the floor instead of burning out the staff.
Minimum criteria for safe staffing
Decisions made must meet state and federal labor laws and organizational policies.
Staff must not be demoralized or excessively fatigued by frequent or extended overtime requests.
Long-term as well as short-term solutions must be sought.
Patient care must not be jeopardized.
Discussion Question
There is usually an 8 or a 12 hour shift in a hospital. Given the pros and cons of working one of these shifts, what shift would you rather work?
Please provide reasons why you chose the shift you did, and If there could be a universal shift for all nurses, which would you choose?
References
Marquis, B. (1992) Leadership roles and management functions of nurses theory and application. (9), 433-460. doi: 10.5480/13- 1107.1.
Simpson, K. R., Lyndon, A., Wilson, J., & Ruhl, C. (2012). Nurses’ perceptions of critical issues requiring consideration in the development of guidelines for professional registered nurse staffing for perinatal units. Journal of obstetric, gynecologic, and neonatal nursing : JOGNN, 41(4), 474–482. https://doi.org/10.1111/j.1552-6909.2012.01383.x