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41 Cards in this Set

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1. Staffing requires a balance between the quantity of staff available and the numbers needed to provide effective quality nursing care while keeping costs down
Handling Staffing and Scheduling
2. The goal of staffing is to provide the appropriate number and mix of nursing staff ( nursing care hours) to match actual or projected patient care needs (patient care hours) that will lead to the delivery of effective and efficient nursing care.
Handling Staffing and Scheduling
3. To determine staffing requirements (number of staff), nurse manager must examine workload patterns for a designated unit. This means determining the level of care, average daily census and hours of care provided 24/7
Handling Staffing and Scheduling
4. Patient Classification Systems ( patient acuity system) are systems developed to determine workload requirements and staffing needs OBJECTIVELY
Handling Staffing and Scheduling
5. THREE PAPER AND PENCIL METHODS used to estimate ANNUAL staffing needs and determine the ANNUAL personnel budget
1. Descriptive – is a subjective classification of patient activities by category describing varying kevels of care. NEITHER represents the patient needs or the staff time.
2. Checklist –another subjective system in which acuity level is determined by identifying the level of activity within each category for each patient. Points ascribed for each level of activity are totaled and converted to a level of acuity. Provides a more individualized representation of patient needs BUT NOT adequately reflect nursing time.
3. Time standard –work sampling techniques are used to determine time standards associated with various patient care activities. Represents both the PATIENT NEEDS AND NURSING’S TIME.
 Activities required
for patient care
are identified
 Associated time
standards are
 Patient care is
totaled and
converted to an
acuity level
Handling Staffing and Scheduling
1 Medicus – an electronic PCS that clusters patients into five categories of nursing care as predetermined by indicators that determine patient dependence on nursing. Patient is placed in one of five levels of care. A patient classified as a 5 requires the greatest intensity of nursing care. Total hours of care reflect both direct and indirect care.
Electronic PCS used to determine DAILY staffing needs and predict monthly personnel budgets
2 GRASP – the most commonly used electronic PCS in the US; a PCS that identifies 85% DIRECT CARE activities, determines total hour of cares and projects nursing intervention and required staff. An adjustment factor of 15% of the time is added for unlisted direct care activities and also indirect patient care activities are added to determine the total hours of care.
• GRASP system
operates as a
nursing management
information system
(MIS) package and
includes management
budgeting, cost
identification and
quality evaluation.
Electronic PCS used to determine DAILY staffing needs and predict monthly personnel budgets
3 ARIC( allocation, resource,identification and costing) –a PCS that incorporates patient admission, discharge and transfer information from each patient along with the classification information and recognizes the dependent activities of nurses, physicians’ orders and hospital policies and the independent activities of nurses FTE and their professional judgements
Electronic PCS used to determine DAILY staffing needs and predict monthly personnel budgets
4 Staffing reports are generated based on the patient classification information entered
Handling Staffing and Scheduling
2. ONE FTE= 40hours of work/week for 52 weeks or 2080 hours per year
Determining FTEs (full-time equivalent)
3. In a 2-week pay period, 1 FTE= 80 hours
Determining FTEs (full-time equivalent)
4. One FTE can be filled by one person or any combination of personnel
Determining FTEs (full-time equivalent)
5. TECHNIQUE 1 in determining FTE incorporates information regarding the hours of work for the staff for 2 weeks, average daily census and hours of care

Average daily census =divide total patient days (obtained from daily census counts for the year) by the # of days in the year ( which is constant, 365 days)
 FTE is X
 FTE= average nursing care hours x days in staffing period x average daily census (patient)
Hour of work per FTE in 2 weeks
TECHNIQUE 1 in determining FTE
6. TECHNIQUE 2- uses nursing care hours and annual hours of work provided by 1 FTE
DATA: # of hours worked per FTE for 1 year = 2080
Total nursing care hours (from PCS) = 161

FTE = Total nursing care hours x days in a year divided by
Total annual hours per FTE
9. Determining Staffing Mix – the same data used to determine FTEs are used to identify staffing mix.
Determining Staffing Mix
1. For example, for patient care needs involving general hygiene care, feeding, transferring or turning patients, UAPs can be used.
Determining Staffing Mix
2. For patient care needs involving frequent assessments, patient education or discharge planning, RNs will be needed because of the skills required
Determining Staffing Mix
3. A high RN-skill mix allows for greater flexibility and has been found to decrease LOS while introducing various skill levels increase the # of people to manage, educate, and evaluate and increases staffing costs.
Determining Staffing Mix
1. For many patient care units, the distribution of staff varies shift to shift and by days of the week
Determining Distribution of Staff
2. Patient census on a surgical unit will probably fluctuate throughout the week, with a higher census Monday thru Thursday and a lower census over the weekend
Determining Distribution of Staff
3. Surgical patients may have a shorter LOS than many medical patients
Determining Distribution of Staff
4. The patient census on a medical unit rarely fluctuates Monday thru Friday, but maybe less on weekends when diagnostic tests are done
Determining Distribution of Staff
5. The care demands (workload) on a surgical unit will be heaviest early in the morning hours prior to the to the start of the surgical schedule; midmorning, late in the afternoon and in the evening hours
Determining Distribution of Staff
6. Critical care units may have a greatest care needs in the morning when transferring patients to medical or surgical units and in the early afternoon when admitting new surgical cases.
Determining Distribution of Staff
7. Medical units usually have the heaviest care needs in the morning hours when patient’s daily care needs are being met and physicians are making rounds
Determining Distribution of Staff
8. Skilled nursing/rehabilitation units, care needs greatest before and immediately after mealtimes and in the evening hours
Determining Distribution of Staff
9. Care needs in labor-and-delivery and ER cannot be predicted when patient care needs will be most intense. RELIES ON BLOCK STAFFING
Determining Distribution of Staff
10. Peak workload hours within the ER may be from 6PM-10PM to accommodate patient needs after physicians offices close or from 12AM to 3AM to accommodate alcohol related injuries.
Determining Distribution of Staff
11. AVERAGE OCCUPANCY RATES ARE DETERMINED BY DIVIDING THE AVERAGE PATIENT DAYS ( obtained by dividing total annual census by number of beds on unit) BY # OF DAYS IN A YEAR.


OCCUPANCY RATES = Average patient days/ days in a year
Determining Distribution of Staff
Block staffing – scheduling a set staff mix for every shift so that adequate staff is available at all times.
Block staffing
1. Perception that nurses don’t work full time when they work several days in a row and then are off for several days in a row
Problems with combined staffing patterns
2. Disruption in a continuity of care if split shits are used
Problems with combined staffing patterns
3. Immense challenges for nurse managers to communicate with all staff in a timely manner
Problems with combined staffing patterns
1. better meets patient care needs during peak workload time
2. improves staff satisfaction
3. maximizes the availabilty of nurse
Advantages of combined staffing
1. Self-Staffing is a model where nurse managers and their staff completely manage staffing and schedules.
2. The acuity of patients in hospitals, mandates staffing units on weekends by the same principles used for weekdays
3. Weekend program- nurses agrees to work 24 hours every weekend ( usually 2 12-hour shifts) for full time benefits and full time salary or premium salary
Supplemental Staff
1. Options include PRN staff ( staff scheduled on an as-needed-basis), part-time staff or float pool staff, allowing OT for full-time staff, scheduling nurse managers for direct care assignments, using extra nurses from another unit, using outside agency nurses or asking staff for suggestions or help
2. Supplemental staff are needed when workload increases beyond that which the existing staff can manage, staff absences and resignations occur, and staff vancancies
Supplemental Staff
Internal pools – acts staffing problems can be addressed by establishing internal float pools using nursing staff and UAPs.
1. Internal float pools of nurses can provide supplemental staffing at a substantially lower cost than using agency nurses.
2. A centralized pool is the most efficient. A pool of RNs. LPs, UAPs and unit clerks are available for placement anywhere in the institution
3. In decentralized pools, a staff member usually works only for one nurse manager or on only one unit.
Internal pools
1. better accountability
2. improved staffing response
3. improved continuity of care
Critical care units, OR, maternal-child units and other highly specialized or technical area tend to use a decentralized system.
Critical care units, OR, maternal-child units
External pools –.agency nurses become part of the regular staff contracted to fill vacancies for a specified period of time (traveling nurses).
1. All agency nurses require orientation to the facility and unit, must work under the supervision of an experienced in-house nurse.
2. Nurse manager must verify valid licensure, has current malpractice insurance and develop a mechanism to evaluate the agency’s nurse performance
External pools
Use of existing staff- Nurse extenders referred to as UAPs can also be explored during staffing shortage and the nurse managers
Use of existing staff