Lecture 15 Staffing and scheduling

Question 1

Reasons that scheduling is challenging in nursing include _

Answer 1

1. Nursing does not fit the traditional business cycle.
2. Erratic and unpredictable demand for health care.
3. High-level expertise is required 24/7/365.
4. Stress of the job requires a balanced work-recreation schedule.
5. Staffing mix varies with acuity.

Question 2

Staffing mix

Answer 2

The mix (percentages) of RNs, licensed vocational nurses/licensed practical nurses, and unlicensed personnel working at a given time.

Question 3

Responsibility for scheduling continues to be an important function of _

Answer 3

First- and mid-level managers.

Question 4

Centralized staffing

Answer 4

Form of staffing in which staffing decisions are made by the personnel in a central office or staffing center.

Question 5

Decentralized staffing

Answer 5

Form of staffing in which the unit manager is often responsible for covering all scheduled staff absences, reducing staff during periods of decreased patient census or acuity, adding staff during periods of high patient census or acuity, preparing monthly unit schedules, and preparing holiday and vacation schedules.

Question 6

Strengths of centralized staffing

Answer 6

1. Provides an organization-wide view of staffing needs, which encourages optimal utilization of staffing resources.
2. Staffing policies tend to be employed more consistently and impartially.
3. More cost-effective than decentralized staffing.
4. Frees the middle-level manager to complete other management functions.

Question 7

Limitations of centralized staffing

Answer 7

1. Provides less flexibility for the worker and may not account for a specific worker’s desires or special needs.
2. Managers may be less responsive to personnel budget control in scheduling and staffing matters.

Question 8

Strengths of decentralized staffing

Answer 8

1. Manager retains greater control over unit staffing.
2. Staff are able to take requests directly to their manager.
3. Provides greater autonomy and flexibility for the individual staff member.

Question 9

Limitations of decentralized staffing

Answer 9

1. Can result in more special pleading and inconsistent treatment of employees.
2. May not be cost-effective for the organization, since staffing needs are not viewed holistically.
3. More time-consuming for the unit manager.

Question 10

Regarding the two major approaches to staffing, _ is fairer to all employees because policies tend to be employed more consistently and impartially.

Answer 10

Centralized staffing.

Question 11

Key areas that staffing policies must address include _

Answer 11

1. Sick leave.
2. Vacations.
3. Holidays.
4. Call-offs for low census.
5. On-call pay.
6. Tardiness and absenteeism.

Question 12

Minimum staffing ratios represent _

Answer 12

The maximum number of patients an RN can be assigned to care for under any circumstance.

Question 13

Flex time

Answer 13

System that allows employees to select the time schedules that best meet their personal needs while still meeting work responsibilities.

Question 14

Float pool

Answer 14

Group of employees who agree to cross-train on multiple units so that they can work additional hours during periods of high census or worker shortages.

Question 15

Per-diem employee

Answer 15

An employee who generally has the flexibility to choose if and when they want to work. In exchange for this flexibility, they receive a higher rate of pay, but usually no benefits.

Question 16

Agency and travel nurses

Answer 16

1. Nurses employed by an external nursing broker who work for premium pay (2-3 times more than a regularly employed staff nurse), with or without benefits.
2. These nurses provide scheduling relief on a short-term basis.
3. Expensive when used long-term, and may result in poor continuity of care.

Question 17

Nursing care hours per patient day - calculation

Answer 17

NCH/PPD = (Nursing hours worked in 24 hours) ÷ (Patient census)

Question 18

Examples of staffing productivity standards

Answer 18

Inpatient units = NCH/PPD
Surgery = minutes per case
Emergency departments = total visits
Labor and delivery units = number of births
Home health agencies = visits per month

Question 19

Staffing based on acuity is accomplished through the use of a _

Answer 19

Patient classification system (PCS) - patients are grouped according to similar characteristics, and hours of nursing care are assigned for each patient classification.

Question 20

Critical indicator PCS

Answer 20

Uses broad indicators such as bathing, diet, intravenous fluids and medications, and positioning to categorize patient care activities.

Question 21

Summative task PCS

Answer 21

Requires the nurse to note the frequency of occurrence of specific activities, treatments, and procedures per patient.

Question 22

National level PCS

Answer 22

A condition for participation in Medicare; also required by The Joint Commission for accreditation.

Question 23

Evidence has demonstrated that as RN hours decline in NCH/PPD, patient outcomes suffer, particularly regarding _

Answer 23

1. Medication errors.
2. Patient falls.
3. Patient satisfaction with pain management.

Question 24

Closed-unit staffing

Answer 24

Occurs when the staff members on a unit make a commitment to cover all absences and needed extra staffing (i.e., to cover increased patient census) in return for not being pulled from the unit in times of low census.

Question 25

Mandatory overtime

Answer 25

1. When nurses are forced to work additional shifts, often under threat of patient abandonment.
2. Should be a last resort, not standard operating procedure.

Question 26

Full-time equivalent (FTE) - calculation

Answer 26

1.0 FTE = 40 hours per week; five 8-hour days of staffing; 2,080 hours per year.
Nurse working three 12-hour shifts per week: 36 ÷ 40 = 0.9 FTE.

Question 27

Workload measurement system

Answer 27

System that evaluates work performance as well as necessary resource levels; captures census data, care hours, patient acuity, and patient activities.