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Define Staffing :-

 Staffing is the provision of an adequate amount of staff and the right mixture of personnel to give proper
patient care at a particular time.
 Is the process of ensuring the adequacy of skilled staff to accomplish .
 Staffing is the process of determining and assigning the right personnel to the right job
 Staffing is the number and positions of personnel assigned to work in a division in a given time

Goals of Staffing
 To provide an adequate amount of staff of the right mixture of personnel to give proper care to patients
housed in the unit at certain particular time.

Importance of Staffing :-
1) Getting the work done.
2) Achieving organization mission and objectives.
3) Improving staff satisfaction.
4) Achieving high level of quality health care.

Staffing Activities :-
1) Identify the number and types of personnel needed.
2) Determine personnel categories that have the knowledge & skills to perform needed care
measures.
3) Predict the number of personnel in each job category.
4) Obtaining budget positions for the number in each job category needed to care for the expected
type & number of patients.
5) Recruit, interview & screening, select, hiring, and assign personnel based on established job
description and performance standard.
6) Use organizational resources for induction and orientation.
7) Ascertain that each employee is adequately socialized to the organization values and norms.
8) Use creative and flexible scheduling based on patient care needs to increase productivity and
retention.
9) Develop program of staff education that will continuously assist employees with meeting the goals
of the organization.

Discuss Factors Affecting Staffing :-


1- Patient Factors .

 Variety patients conditions.


 Acuity.
 Length.
 Age groups.
 General health status and health goals.
 Functions/care in numbers, acuity, variety…etc.

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2- Staff Factors.

 Job descriptions of the division / organization.


 Educational level of staff.
 Experimental level of staff.
 Work ethics of groups of staff members.
 Expectations of staff from the organization.

3- Nursing organization factors.

 Patients' care objectives


 Determined level of patient care.
 Nursing division / departmental/unit functions.
 Assignment system.
 Services to staff; e.g., in-service hours allowed.

4- Health Care Organization Factors.

 Number of beds per unit or model.


 Financial resources available.
 Personnel policies, especially regarding work time.
 Support services within the organization.
 Number and nature of interfaces within the total institution.
 Architecture and functional space layouts.

5- Extra Organizational Factors.

 Staff mix available in the community


 Staff number available
 Coordinating patterns with community in health agencies.

Staffing Component :-
1) Staffing Pattern
2) Staffing Plan

1- Staffing Pattern :-

 Indicates the way in which number and mix of personnel that should be on duty per each unit per shift, per day.
 Characteristics
 Is a relatively permanent document based on the daily average requirements for patient care in each unit.
 It is reviewed at least yearly for modifications required by changes in patient population, care trends or
other factors.

Methods of determining Staffing needs:


Traditional System

 -Determine the no. of beds/units (one nurse 4/6 pts)

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 -Day: 45% of the staff
 -Evening: 37% of the staff
 -Night: 18% of the staff
 -Calculation of nursing hours in each category / shift

New Method

 -Patients needs during a shift and nursing tasks to be performedThroughPatient classification system .

How Determining the Staffing Pattern (new method):

1) Using PCS to determine the number and kind of care activities by each patient are identified.
2) The length of time it takes to do the activities calculated, then adding up the time required by all patients on
a unit and divided by the number of productive care hours on a shift to determine the number of personnel
needed.
3) The mix of nursing personnel can be predicted by categorizing the care needed by the qualifications needed
to give it , Adding the time in each category , Dividing by productive care hours on a shift, and Obtaining the
number of specific types of personnel required to meet the patient’s needs
4) Ratio of staff mix can be established and an index is developed.
5) Using the indices for determining staffing pattern for each unit for each shift is established.

Type of Staffing Pattern


1- Basic "permanent" Staff
 It is the minimum or lowest number of personnel needed to staff a unit.
 Which is determined based on average patient care requirements (using patent classification system) and
nursing tasks to be performed by different levels of nursing staff
 may be based :
o on examination of previous staff records.
o through expert opinion of nurse manager .

 It includes fully oriented, full and part time employee.

 It includes all categories:

o Registered nurses.

o Licensed practical nurses.

o Nursing technicians or assistants for each shift

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2- Supplementary staff
 It is the scheduled as an addition to the basic group.
 It is not assured a permanent pattern & is usually scheduled for 4-week periods.
 It is needed when demands for patient care exceed the capabilities of the basic staff.
a) Borrowing method
o Is borrowing staff from units that have the most, to help those who have too little.
o The problem with this method is that the staff often resents being transferred from unit to unit and
the head nurse never admits that she has more nurses.

b) On call staff
o On call staff are regular employees who receive extra pay for being on call whether or not they are
called.
o This method is useful in OR, ICU and other special care units.
c) Float staff
o A pool of nurses who are permanent workers but do not belong to any special unit care, are used to
fill in for increase in patient care activities of absence among the unit staff .
o This is a better method for managing the increased staffing needs.
o This method helps in day to day variations in work volume.
o Some nurses like this types of assignment and the chance to work with different types of patients.

3- Variable Staffing Pattern


 It is an alternate to permanent staffing pattern
 This method is based on the assumptions regarding the average needs of patients that is determined daily
based upon present needs of patients on each unit.
 Patient needs is calculated once or twice a day by the computer based on data collected from the patient
classification and task quantification techniques. Then, it is analyzed to give the number and mix of staff
needed on each unit and each shift.
 Thus, the pattern on each unit may change daily.
 Staff of the entire hospital is centrally distributed each shift.
 Although this is a very effective method for staffing, it creates dissatisfaction among staff due to frequent
change of unit and patients.

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2- Staffing Plan

 Determining the number of personnel that must be hired to deliver on the staffing pattern.
 Is a mathematical calculation determining how many nurses of what category (professional or non-
professional) must be hired in order to deliver the required care on a yearly basis.

Formula of computing number of staff needed in the in-patient :


1) Categorize the number of patient X percent at each levels of care needed by hospital classification.
2) Find the total number of nursing hours needed by patients per year at each categorized level
a. Number of patients each level X average nursing hours needed per day.
b. Get the sum of nursing hours in the various levels.
3) Find the actual total number of working hours needed by theses patients per year.
a. Total number of nursing hours needed per day X 365 (total number of days in a year).
4) Find the actual total number of working hours rendered by each nursing personnel each year.
a. Hours on duty per day X actual working days per year.
5) Find the total number of nursing personnel needed.
a. Divide the total number of nursing hours needed by the given number of patients per year by the
actual number of working hours rendered per year.
b. Find the relief, multiply the number of nursing personnel needed by 0.095.
c. Add the number of relievers to the number of nursing personnel.
6) Categorize into professional and non-professionals.
a. Multiply the number of nursing personnel according to the ratio of professional to non-professional
personnel.
7) Distribute by shifts.

Who is responsible :-
 It is done according to the system used for staffing
 Staffing is most often the responsibility of the nursing office; is done centrally by the director of nursing
service or her assistant with consultation of the head nurses.

Define Scheduling :-
 The distribution of hours to be worked by each person during each 24 hours, seven days a week, monthly.
 Scheduling is a monthly time planning of all nursing personnel on a specific unit with specific days and hours.
 It is concerned with planning days and hours of work.

Scheduling Objectives :-
 To ensure patient care without over staffing.
 To know well in advance what individual schedules are.
 To achieve distribution of days off.
 To treat fairly individual members.
 To maximize the use of nursing staff power and to optimize the use of professional expertise.
 To satisfy personnel both as to work ours and as to perceive sense of equity.

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List Principles of Scheduling :-
1) Schedules should be planned to meet needs of each rotation (by knowing the busiest days and hours).
2) The schedule must balance the needs of both patients and personnel.
3) There is also concern to increase staff ability to respond to fluctuation in patient care needs or staff changes.
For example the shortage of staff due to illness, holidays or vacations.
4) Days off are planned so that there is enough staff present each day and during each shift of the day to
provide essential care to patients
5) There must be equitable distribution of nurses over the three shifts of the day.
6) Scheduling should reflect fair and justice treatment of all nurses. For instance, the all should be assigned
similar duty hours and equal number of days off.
7) No accumulation of days off, to insure adequate rest and relaxation for staff members.
8) Each nurse must be assured that her assigned duty shift will not be changed, unless an extreme emergency
arise and only with permission.
9) The scheduling policies must be clarified to all nurses ( this is during orientation).
10) There should be professional nurses on duty at all time (shifts), through the twenty four hours period.
11) Apply a long term plan to maintain morale, the roster is usually done every month.
12) Special requests should be answered, if they are reasonable.
13) After making out schedules, changes should be kept at a very minimal.
14) There should be an overlapping of each shift to provide time for shifts report.
15) There should be 1 day a part between head nurse and assistance head nurse days off.
16) Head nurse is rarely off duty on Saturday.
17) A day off is given after night shift.
18) Make sure that the unit is adequately staffed when inexperienced or new personnel are working.
19) Schedules are usually posted in a place easily accessible to all team members.
20) If time for students is planned by head nurse, certain points should be considered:
a) It should be cooperatively planned with the instructor.
b) Time off is given where there is no classes.
c) Keep students well supported with a graduate staff.
d) Slight overlapping for each shift.
21) Enables the staff to meet the objectives, standards, and policies of the organization.
22) Informs all staff of their work schedule for the coming consecutive 3 to 6 weeks including days off and shifts
of duty.
23) It should be developed in accordance with the current labor acts and policies regarding maximum number of
hours of work a week and the number of days within a single shift and the number of days worked without a
day off.

Systems of Staffing/Scheduling :-
1) Centralized
o One individual or a computer to do the staffing and scheduling duties for all the units
o It is usually used in small hospitals.
o Advantages:
 Balance distribution among the hospital units.
 Fairer to all employees.
 Cost effective.

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 First level manager becomes free to complete other management functions.
 Adjustment could be done more easy in case of emergency or understaffing or overstaffing.
o Disadvantages:
 Doesn’t provide as much flexibility for the worker.
 Doesn’t account for a worker's desires or special needs.
 Managers may be less responsive to personnel budget.

2) Decentralized
o Unit managers do the staffing and scheduling duties.
o This type of staffing is used in large hospitals.
o Advantages:
 unit manager understand the needs of the unit.
 Staff feel more in control of their work environment.
 Increased staff autonomy and flexibility, and decrease staff attrite on.
o Disadvantages:
 The risk that employees will be treated unequally or inconsistently.
 Time consuming for the manager.
 The difficulty in adjustment in case of emergency.
 May lead to overstaffing in some hospitals units.

3) Cyclical :-
o A mixture of both the centralized and decentralized patterns.
o Staffing consists of two stages:
 The first includes development of staffing plan by the responsibility of the nursing office
representative.
 The second is the implementation of the staffing plan at unit level by the responsibility of the head
nurse.
o Advantages:
 Leads to more objectively staffing.
 The staffing pattern is more stable.
 Each nurse know in advance her pattern and plan her time accordingly.
 There is always an accompanied policy converting requests for special duty shifts.
 Provide for coverage in case of emergencies due to absence of nurses or changes in patients needs.

Leader definition

Anyone who uses interpersonal skills to influence others to accomplish a specific outcome

To achieve consensus within a group about its goals, and facilitate accomplishment of goals

not always in a management position; may be an informal power of leadership

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cannot be a leader without followers

Manager definition

An employee who is responsible and accountable for efficiently accomplishing the goals of the organization

Directly responsible for maintaining standards of care, managing fiscal resources, and developing staff.

effective managers usually posses good leadership skills but they are a formal position of leadership

Autocratic Leadership

Concerned with task accomplishment

Makes decisions for the group/ alone

Exercises power with coercion

communication occurs down the chain of command

work output is usually high

ex. emergencies

Democratic Leadership

Primary concern with human relations & teamwork

Fosters communication & collaboration

includes the group when decisions are made

motivates by supporting staff achievements

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communication both up and down chain of command

work output is usually of good quality when cooperation and collaboration are necessary

ex. unit project

Staffing

Activities required to ensure an adequate number and mix of health care team members to meet patient needs and
provide safe, quality care

Primary considerations for staffing a nurfunctions

Number of patients

Intensity of care required

Staff experience and preparation

Geography of the environment

Available technology

Total Patient Care Delivery Model Advantages

RN maintains a high degree of practice autonomy

Lines of responsibility and accountability are clear

Patient receives holistic, unfragmented care

Communication at shift change is simple and direct

Total Patient Care Delivery Model Disadvantages

Number of RNs required is very costly

Some tasks could be accomplished by a caregiver with less training and at a lower cost

Nursing shortage will affect RN availability

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Total Patient Care Delivery Model

Functional Nursing Care Delivery Model

Functional Nursing Care Delivery Model Advantages

Provided economically and efficiently

Minimum number of RNs required for patient care

Tasks completed quickly; little confusion about responsibilities

Functional Nursing Care Delivery Model Disadvantages

May be fragmented; possibility of overlooking priority patient needs

Patient may feel confused because of many different care providers

Caregivers may feel unchallenged when performing repetitive functions

Team Nursing Care Delivery Model Advantages

High-quality, comprehensive care can be provided with a relatively high proportion of ancillary staff

Each member participates in decision making, problem solving

Each member contributes his/her own special expertise or skills

Team Nursing Care Delivery Model Disadvantages

Continuity of care may suffer with daily team assignments

Team leader may not have the leadership skills required to effectively direct the team

Insufficient time for care planning and communication leads to unclear goals and fragmented care

Primary Nursing Care Delivery Model

Primary Nursing Care Delivery Model Advantages

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Direct patient care provided by a small number of nurses allows for high-quality, holistic patient care

Patient able to establish a rapport with the primary nurse, and patient satisfaction is enhanced

Job satisfaction high because nurses are able to practice with a high degree of autonomy and feel challenged and
rewarded

Primary Nursing Care Delivery Model Disadvantages

Implementation may be difficult because primary nurse is required to practice with a high degree of responsibility
and autonomy

Inadequately prepared primary nurse may not be able to make the necessary clinical decisions or to communicate
effectively with the health care team

RN may not be willing to accept 24-hour responsibility as required

Number of RNs required for this method of care may not be cost-effective and may be difficult to recruit and train

Staffing

Ensuring that an adequate number and mix of

health care team members (e.g., RNs, LPNs or LVNs, UAP, clerical support) are available to provide safe, quality
patient care; usually a primary responsibility of the nurse manager.

Patient Acuity

Indication of the amount and complexity

of care required for any particular patient; high acuity indicates a need for more intense, complex nursing care as
compared with lower acuity, which indicates a need for moderate, less complex nursing care.

When considering staffing needs, the registered nurse (RN) is primarily concerned with:

1 the number of available licensed staff.

2 the history of staff absenteeism.

3 the availability of support staff.

4 client acuity.

4 client acuity

The nurse responsible for unit staffing recognize that client care is most affected positively by:

1 a mix of high- and low-acuity client needs.

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2 units that implement the job-sharing model.

3 nurses who report high levels of job satisfaction.

4 nursing staff that hold advanced nursing degrees.

3n

The implementation of a "Medication Nurse" is an example of what nursing care delivery model?

1 Total Patient Care

2 Functional

3 Primary

4 Team

2 Functional

n emergency department nurse will likely provide care according to which care delivery model?

1 Team

2 Primary

3 Functional

4 Total care

3 Functional

A _______________ is a measurable condition that results from interventions that can be either positive or negative
in nature.

patient outcome

differences between management and leadership

a leader selects and assumes a role; a manager is assigned or appointed to a role

management

a problem-oriented process with similarities to the nursing process

leadership

a way of behaving; it is the ability to cause others to respond, nit because they have to, but because they want to

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