Week 10; staffing - nursing care delivery Flashcards
What is the process of determining and providing the acceptable number and mix of nursing personnel to produce a desired level ofcare to meet the patients’ demands?
staffing
What are 4 ways managers determine staffing?
- Pt. census
- How many RN’s to patient ratio
- Budget
- Expertise of the unit RN’s/pcts
What are factors to consider with staffing needs?
Self scheduling/overtime
Shift options that are feasible
Appropriate staff to patient ratio
Staffing labor laws of state or national laws/unions
Patient needs/Acuity-based staffing tools
Plans in place for nurses that call in or acuity increases on unit
Resources with in the facility for nurses
Admissions/Transfers/Discharges
Professional Nurse skill level & expertise
What is the history of staffing?
- nursing shortage
2. quality
Why is scheduling so difficult in nursing?
It does not fit traditional business cycle
There is an erratic and unpredictable health-care demand
High-level expertise is required 24/7
Stress of job requires balanced work–recreation schedule
Staffing mix varies with acuity
What are the strengths to decentralized staffing?
- manager retains greater control over unit staffing
- staff are able to take requests directly to their manager
- Provides greater autonomy and flexibility for individual staff member
What are strengths to centralized staffing?
- provides organization-wide view of staffing needs, which encourages optimal utilization of staffing resources.
- staffing policies tend to be employed more consistently and impartially
- more cost-effective than decentralized staffing
- frees the middle-level manager to complete other management functions
What are limitations to decentralized staffing?
- can result in more special pleading and arbitrary treatment of employees
- may not be cost-effective for organization since staffing needs are not viewed holistically
- more time consuming for the unit manager
What are limitations to centralized staffing?
- provides less flexibility for the worker and may not account for a specific worker’s desires or special needs
- managers may be less responsive to personnel budget control in scheduling and staffing matters
How many hours do nurses work typically?
10 or 12 hour
What kind of pay do nurses get with weekend work?
premium pay
What kind of pool do nurses get for weekend shifts and holidays?
Part-time staffing pool
What is job sharing in nursing?
two or more people
What is flextime in nursing?
employees to select the time schedules that fits their personal needs but able to meet employers responsibilities.
What do hospitals often use for nurses?
Use of supplemental staffing from outside registries(traveler/agency) and float pools
True or false: staff self-scheduling and on call are options in nursing
true
what is shift bidding?
allows nurses to bid for shifts rather than requiring mandatory overtime
What are the 3 types of staffing ratios?
- Staffing mix
- Staffing ratios
- Numbers of staff
As Patient Acuity increases Nurse Ratios seem to do what?
stay the same or increase!
How old is most of the workforce?
50 years old and about to retire
What do you ned to be willing to do in nurses?
serve others
What happens often in nursing that makes it difficult emotionally?
we are spread so thin and stressed out at times
What does nursing promise?
job security
true or false; nursing is not rewarding
false; it is
Are there downfalls to nursing?
yes
What do staff members on a unit make a commitment to?
to cover all absences and fill all needs with own staff
In covering all absences, what happens in return?
in return for not being pulled from the unit in times of low census
What is the workload measurement tool?
Formula in use where all nursing and ancillary staff are treated equally fordetermining hours of nursing care
How is the workload measurement tool different?
No differentiation is made for differing acuity levels of patients
What is the formula for the workload measurement tool?
NCH/PPD = Nursing Care Hours worked in 24 Hours /Per Patient Day (Census)
What does each hospital/unit have?
Patient Classification Systems
What two things are measured in patient classification systems?
acuity vs. workload
What is under patient classification systems?
Eating Grooming Elimination ( Foley, Urinal, Condom cath) Comfort (q 2 hour turning), Specialized beds General Health Treatments Medications Teaching and emotional support
How many categories are under patient classification systems?
1-4
What is category 1 of pcs?
Feed self
What is category 2 of pcs?
Needs some help in preparing food tray
What is category 3 of pcs?
Cannot feed self but is able to chew and swallow
What is category 4 of pcs?
Cannot feed self and may have difficulty swallowing
What do diverse staff meet?
Meet cultural needs of the unit
What do diverse staff has as far as linguistics?
Different languages to meet patient population on unit
What must diverse staff provide nationally?
Nationally you must provide language assistance services to all patients Standard 5
What is under the umbrella of diverse staff with language assistance?
Interpreter phones/Interpreters
Decisions made in a hospital must meet what?
must meet state and federal labor laws and organizational policies
What must staff not be?
Staff must not be demoralized or excessively fatigued by frequent or extended overtime requests
What must be sought in a hospital setting?
Long-term as well as short-term solutions
Patient care must not be what in a hospital setting?
jeapordized
What are considerations in staffing policies? part 1
Type and length of staffing cycle used ( 4 weeks, usually once a month schedules)
Time and location of schedule posting ( usually 2 weeks prior to next schedule)
When shift begins and ends; day of week schedule begins
Weekend off policy; tardiness policy
Low census procedures
Mandatory OT
What are considerations in staffing policies? part 2
Policy for trading days off; days off request procedures
Absenteeism policies
Policy regarding rotating to other units (floating)
Procedures for vacation time and holiday time requests
Emergency request policies
Transfer request policies
Hospitals need policies to address what 6 things?
- Sick leave
- Vacations
- Holidays
- Call-offs for low census
- On-call pay
- Tardiness and absenteeism
What can you not violate in staffing?
Labor laws, Union contracts, State & National laws
What 4 Roles do Leaders play related to organizing patient care?
- Evaluates care delivery model periodically
- If considering a change, reviews existence of resources and support
- Considers the staff and support during the change
- Inspires and ensures models promote professional nursing practice
Management perspective requires a focus on:
- Unit philosophy conducive to change
- Uses an EBP approach
- Match of model to pt. care needs
- Maximizes resources for optimal outcomes
- Considers organizational goals / cost effectiveness
what are key identifiers of each model are?
Total Patient Care Functional Nursing Team Nursing Modular nursing Primary Care Nursing Differentiated Practice Case Management
What kind of model is patient oriented; oldest model of organizing patient care?
total patient care
In total patient care, what is the nurse responsible for?
planning, organizing, and performing all care
What are the 3 levels of position in total patient care?
- charge nurse
- nursing staff
- patients
What are the advantages of total patient care?
- high degree of autonomy
- lines of responsibility and accountability are clear
- patient receives whole care - unfragmented
What are the 3 disadvantages of total patient care?
- each RN may have a different approach to care
- not cost effective
- lack of RN availability
What model arose during the Great Depression - when there was a lack of skilled professionals, shortage of RNs?
functional nusning
What was it more practical to do with nurses during the Great Depression?
to teach a nurse aid one skill set versus inundating with several skill sets
What is the principal idea of functional nursing?
for nurses to be assigned tasks, not patients.
what do patients receive in functional nursing?
receive complete care but from different people
What is the role of medicine nursing in functional nursing?
administers drugs
What is the role of discharge nurse in functional nursing?
focuses on discharges of the day
what is the role of treatment nurse in functional nursing?
takes care of the diagnostics
what is the role of charge nurse in functional nursing?
works with the provider in ensuring patient is receiving optimum care
What 4 people is the charge nurse responsible for in functional nursing?
- RN med nurse –> patient
- RN treatment nurse –> patient
- Nursing assistants/hygienic care –> patient
- clerical/housekeeping —> patient
What are the advantages of functional nursing care?
cost effective, hire more nurse aids and LPNs, less RNS, one skill set is refined, tasks are completed quickly
What are the disadvantages of functional nursing care?
- Fragmented care
- too many care aids for one patient
- Impersonal relationship with the patient
- RN-patient relationship does not flourish
- limits the growth of RNs because it limits the application of skills she received education and training
- less challenging
True or false: team nursing is not task oriented
false; task oriented
When did team nursing evolve?
1950’s
What does team nursing use?
uses diversity of skill, education and qualification level of each team member- pairing a novice and skilled RN
What does the team nursing model rely on?
relies on a team leader with effective communication and leadership skills.
Who collaborate with who in team nursing?
Ancillary Personnel collaborate with the RN in providing care to a patient
Where is team nursing used most?
used in most inpatient and outpatient area
What the role of the RN team leader?
Managing the care Team supervisor Coordinator of care Patient Advocate Interprofessional teammember- ST,RN,Surgeon, Patient Advocate
What are the functions of the RN team leader?
- Develops / Evaluates POC
- Assures quality outcomes
- Resolves problems encountered by team
- Conducts briefings and debriefs, huddles
What are the 4 advantages of team nursing?
- Strength of every health care professional is utilized
- Every team member contributes to decision making and comprehensive care
- Improves level of communication
- Increases job satisfaction and staff morale.
What are the 5 disadvantages of team nursing?
- Prolonged patient handoff (team hand off vs individual)
- incidental overtime
- Delegation and communication skill sets are important while working with ancillary care team
- The nurse is still responsible for overall care although she assigns tasks to ancillary team.
- If daily team assignments vary (different patient every day, continuity suffers.
What is the succession of roles in the team nursing model?
- charge nurse
- team leader
- nursing staff
- patients
How does patient care work in modular nursing?
Patient care unit is divided into modules or zones with an RN as a team leader.
What is modular nursing a modification of?
Modification of team nursing
How is the team assigned in modular nursing?
consistently assigned to the same geographic area
How do assignments happen in modular nursing?
Assignments happen based on geographic location
What is the succession of roles in the modular nursing model?
- nurse manager
- geographic patient unit
- patient care team: RNs, LPNs/LVNs, nursing aides
- meds, supplies, linens
What are the 5 advantages of the modular nursing model?
- Increase in patient safety (less falls?)
- More continuity of care
- Addresses all component of HCAHPS score-Nurse responsiveness, call bell answered, pain managed, less noise.
- Increased patient satisfaction
- Less area to travel
What are the 2 disadvantages of the modular nursing model?
- Increased cost to stock each pod/module
2. Long hallways not perfect to be a module
What nursing care model evolved in the 1970s to improve autonomy?
primary care nursing
Primary care nursing assumes what?
assumes 24 hr responsibility for the patient- for planning care, directing and evaluating .
Where is primary care nursing used?
in hospice, home health, long term care setting.
What happens to patient assignments with primary care nursing?
Specific Patients are allocated to one nurse
What does patient care nursing assume?
Assumes 24 hr. responsibility for patient/s from admission to discharge
When an RN is off duty in patient care nursing what happens?
Associate RNs when off duty
What is the succession of roles in primary care nursing?
- primary nurse
- physician and other members of the health care team - associate nurses
- patient
What are the advantages of primary care nursing?
- Decentralization of decisions, authority and responsibility
24-hr accountability - Improved continuity and coordination of care
- Increased nurse, patient and physician satisfaction.
What are the disadvantages of primary care nursing?
- RN must be able to exercise high degree of autonomy
- Not cost effective
- RN has to accept 24hour responsibility
What was adopted in the 1980s with no direct care?
case management nursing
What was case management reserved for?
reserved for inpatients-long term, expensive cases, chronically ill patients.
What kind of role does a nurse assume with case management?
assumes a planning and evaluative role
What does a nurse coordinate in case management?
from a payor or facility perspective
What may a nurse use in case management?
clinical pathways - a predetermined written plan of care for a particular health problem.
What are the advantages of case management?
- There is a time frame within which clinical outcome should be achieved.
- Streamlines cost! e.g. 4 days stay after C-section; 3 days for detox
What are the disadvantages of case management?
- Large case load for a nurse
2. More focus on health expenses than the quality of care.
What is the succession of roles in case management?
Onset of illness –>
- nurse case manager –> collaborates with nursing, physicians, physical/speech/occupational therapists, dietary and ancillary services. Coordinates serives: home care, hospice, extended/long-term care, ambulatory care services.
- -> resolution of illness
What are questions to ask when choosing a nursing delivery model?
What staff mix is required?
Who makes staff assignments
Are assignments patient oriented or task oriented
Who will make decisions? An RN?
Who will be responsible and accountable?
Does it fit with unit/facility/organization?
What type of health care setting?
What are patient’s needs? Longterm, acute and chronic?
What kind of care uses relatively unskilled workers who have been trained to complete certain tasks? A. Modular nursing B. Case management nursing C. Functional nursing D. Team nursing
C; functional nursing
What are 4 questions to ask when evaluating a nursing delivery model?
- Cost-effective outcomes achieved?
- Patient satisfaction
- Staff satisfaction
- RNs utilized appropriately?
Who are nurse navigators?
A member of healthcare team who helps patients navigate the healthcare system and get timely care.
What is the oldest model of nursing?
A. Modular nursing
B. Total patient care
C. Primary care
D. Case management
B; total patient care
