Chapter 17 - Assignment Instructions: 1. Review Learning Exercise 17.4 - Calculating Staffing Needs (located in Chapter 17 of the textbook) 2. Calculate the staffing needs for the day shift and answer the following questions: a. You have on duty one RN and one LPN working 8 hour shifts and a ward clerk for 4 hours. Are you understaffed or overstaffed? b. If you had the same number of patients but the acuity levels were the following, would your staffing needs be the same? • Two patients in category I acuity level • Three patients in category II acuity level • Two patients in category III acuity level • Zero patients in category IV acuity level 3. Your paper should be: o o Typed according to APA style for margins, formatting and spacing standards. Typed into a Microsoft Word document, save the file, and then upload the file Chapter 17 Staffing Needs and Scheduling Policies Copyright © 2018 Wolters Kluwer · All Rights Reserved 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. Copyright © 2018 Wolters Kluwer · All Rights Reserved Staffing Clerks Although many organizations now use staffing clerks and computers to assist with staffing, the overall responsibility for scheduling continues to be an important function of first- and middle-level managers. Copyright © 2018 Wolters Kluwer · All Rights Reserved Strengths and Limitations of Decentralized and Centralized Staffing Copyright © 2018 Wolters Kluwer · All Rights Reserved Question Tell whether the statement is true or false: Staffing in a busy physicians office is performed by the unit manager. This is an example of an office managed using the decentralized model. A. True B. False Copyright © 2018 Wolters Kluwer · All Rights Reserved Answer A. True Rationale: In the decentralized model, staffing is often done by the unit manager, whereas under the centralized model, it is done at a central office, often by computer. Copyright © 2018 Wolters Kluwer · All Rights Reserved Staffing and Decision Making • It is important to remember that centralized and decentralized staffing is not synonymous with centralized and decentralized decision making. • Fair and uniform staffing and scheduling policies must be written and communicated to all staff. • Decentralized scheduling and staffing lead to increased autonomy and flexibility, but centralized staffing is fairer to all employees because policies tend to be employed more consistently and impartially. Copyright © 2018 Wolters Kluwer · All Rights Reserved Complying With Staffing Mandates • Many states have imposed mandatory licensed staffing requirements. • 12 states have addressed nurse staffing in hospital. • California has imposed legislation to comply with minimum staffing ratios. • Imposed staffing due to patient care being affected Copyright © 2018 Wolters Kluwer · All Rights Reserved Common Staffing and Scheduling Options in Health-Care Organizations • 10- or 12-hour shifts • Premium pay for weekend work • Part-time staffing pool for weekend shifts and holidays • Cyclical staffing, which allows long-term knowledge of future work schedules because a set staffing pattern is repeated every few weeks. Figure 17.1 shows a master staffing pattern that repeats every 4 weeks. • Job sharing • Allowing nurses to exchange hours of work among themselves • Flextime Copyright © 2018 Wolters Kluwer · All Rights Reserved Common Staffing and Scheduling Options in Health-Care Organizations—(cont.) • 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 Copyright © 2018 Wolters Kluwer · All Rights Reserved Scheduling Alternatives • Agency nurses • Travel nurses • Flextime • Self-scheduling • Float pools – Float staff must be able to perform the core competencies of the unit they are floating to meet their legal and moral obligations as caregivers. Copyright © 2018 Wolters Kluwer · All Rights Reserved • Please show Leadership Video Case: Staffing Shortage: Who Can Handle CRRT? Available as part of Lippincott CoursePoint for Marquis and Huston: Leadership Roles and Management Functions in Nursing, 9th edition. • For more info, visit thePoint.lww.com/CPMarquis9e. Copyright © 2018 Wolters Kluwer · All Rights Reserved Question What are some advantages to an organization of using travel nurses? A. B. C. D. They command premium pay. They provide scheduling relief. They offer good continuity of care. All of the above Copyright © 2018 Wolters Kluwer · All Rights Reserved Answer B. They provide scheduling relief. Rationale: Although travel or agency nurses can fill in during a scheduling emergency, their pay can be hard on the budget, and their continued use can compromise care continuity. Copyright © 2018 Wolters Kluwer · All Rights Reserved Formula for Calculating Nursing Care Hours Per Patient Day Copyright © 2018 Wolters Kluwer · All Rights Reserved Staffing by Acuity—Using a Patient Classification System • Groupings of patients according to specific characteristics • Hours of nursing care assigned for each patient classification • Unique to a specific institution • Ongoing review critical • Internal or external forces affecting unit influence classification system Copyright © 2018 Wolters Kluwer · All Rights Reserved Patient Classification System (PCS) • The critical indicator PCS uses broad indicators, such as bathing, diet, intravenous fluids, and medications, and positioning to categorize patient care activities. • The summative task PCS requires the nurse to note the frequency of occurrence of specific activities, treatments, and procedures for each patient. • At the national level, the use of a PCS is a condition for participation in Medicare and is required by The Joint Commission for certification. Copyright © 2018 Wolters Kluwer · All Rights Reserved Question A nurse-manager notes how often a patient takes his medication to determine scheduling. This is an example of using which of the following systems? A. Critical indicator PCS B. Summative task PCS C. Staffing by acuity Copyright © 2018 Wolters Kluwer · All Rights Reserved Answer B. Summative task PCS Rationale: Summative task patient classification looks at the frequency of specific activities, whereas critical indicator PCS uses broader, more general measures. Staffing by acuity groups patients according to specific characteristics. Copyright © 2018 Wolters Kluwer · All Rights Reserved The Relationship Between Staffing and Quality of Care • Staffing mix • Staffing ratios • Numbers of staff Copyright © 2018 Wolters Kluwer · All Rights Reserved Effect of Decreased Hours A review of the literature consistently and overwhelmingly demonstrates that as RN hours decrease in NCH/PPD, adverse patient outcomes increase. This includes: • Increased medication errors • Patient falls • Decreased patient satisfaction with pain management Copyright © 2018 Wolters Kluwer · All Rights Reserved Generational Diversity in Nursing Generation Year of Birth • Silent generation 1925 to 1942 • Baby boomer 1943 to early 1960s • Generation X Early 1960s to 1980 • Generation Y 1980 to present Source: Adapted from Hill (2004), McNeese and Crook (2003), and Martin (2003) Copyright © 2018 Wolters Kluwer · All Rights Reserved Question The silent generation comprises people born from: A. 1943 to early 1960s B. 1965 to 1975 C. Early 1960s to 1980 D. 1917 to 1925 E. None of the above Copyright © 2018 Wolters Kluwer · All Rights Reserved Answer E. None of the above Rationale: The silent generation refers to people born between 1925 and 1942. Copyright © 2018 Wolters Kluwer · All Rights Reserved Closed-Unit Staffing Closed-unit staffing occurs when the staff members on a unit make a commitment to cover all absences and needed extra help themselves in return for not being pulled from the unit in times of low census. Copyright © 2018 Wolters Kluwer · All Rights Reserved Criteria to Meet When Handling Understaffing Issues • 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. • Patient care must not be jeopardized. Copyright © 2018 Wolters Kluwer · All Rights Reserved Mandatory Overtime • Employees are forced to work additional shifts, often under threat of patient abandonment. • Although mandatory overtime is neither efficient nor effective in the long term, it has an even more devastating short-term impact in terms of staff perceptions of a lack of control and its subsequent impact on mood, motivation, and productivity. Copyright © 2018 Wolters Kluwer · All Rights Reserved Question The effects of mandatory overtime are most detrimental in the: A. Short-term B. Long-term Copyright © 2018 Wolters Kluwer · All Rights Reserved Answer A. Short-term Rationale: Although mandatory overtime has negative long-term consequences, the immediate effects on the staff’s mood, motivation, and productivity are even more worrisome. Copyright © 2018 Wolters Kluwer · All Rights Reserved Organizational Staffing Policies Need Policies That Address 1. Sick leave 2. Vacations 3. Holidays 4. Call-offs for low census 5. On-call pay 6. Tardiness and absenteeism Copyright © 2018 Wolters Kluwer · All Rights Reserved Fiscal Accountability Fiscal accountability to the organization for staffing is not incompatible with ethical accountability to patients and staff. It should be possible to stay within a staffing budget and meet the needs of patients and staff. Copyright © 2018 Wolters Kluwer · All Rights Reserved LEARNING EXERCISE 17.4 Calculating Staffing Needs You use a PCS to assist you with your daily staffing needs. The following are the hours of nursing care needed for each acuity level patient per shift: Category 1 Category II Category III Category IV Acuity Level Acuity Level Acuity Level Acuity Level NCH/PPD needed for 2.3 2.9 4.6 day shift NCH/PPD needed for PM shift NCH/PPD needed for night shift 3.4 2.0 2.3 2.8 3.4 0.5 1.0 2.0 2.8 When you came on duty this morning, you had the following patients: One patient in category I acuity level Two patients in category Il acuity level · Three patients in category III acuity level One patient in category IV acuity level Note that you must be overstaffed or understaffed by more than half of the hours a person is working to reduce or add staff. For example, for nurses working 8-hour shifts, the staffing must be over or under more than 4 hours to delete or add staff. ASSIGNMENT: Calculate your staffing needs for the day shift. You have on duty one RN and one li- censed vocational nurse (LVN)/licensed professional nurse (LPN) working 8-hour shifts and a ward clerk for 4 hours. Are you understaffed or overstaffed? If you had the same number of patients but the acuity levels were the following, would your staffing needs be the same? Two patients in category I acuity level • Three patients in category Il acuity level • Two patients in category III acuity level • Zero patients in category IV acuity level
Purchase answer to see full attachment