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Centralized vs Decentralized Staffing |
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Centralized staffing made by central officeDecentralized staffing done at unit level |
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Advantages and Disadvantages of Centralized Staffing |
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Adv: Tends to be fairer to employeesFrees manager for other functionsCost effectiveDis: No flexibility Doesn't account for individual desiresManagers less aware of personnel budget |
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Advantages and Disadvantages of Decentralized Staffing |
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Adv: person in charge of schedule knows the unitStaff takes requests directly to own manager fostering autonomy and flexibility Dis: Increased risk of inequality and inconsistencyTime-consuming for unit manager |
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Agency or Travel Nurses |
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**Employed by external agency-work for minimum pay (usually 2x)-no benefits-provides immediate scheduling relief -expensive to the hospital-can result in poor continuity of care |
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Per diem/ Registry Employees and Float Pools |
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**Internal supplemental staff-paid higher wage without benefits-less expensive than agency nurse-usually must commit to specified amt of work-lack of staff continuity |
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Self Scheduling |
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-employees make own schedule, manager reviews it-support of the manager is critical-tends to have a pattern-increased accountability -not having enough staff will cause a big problem |
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Flextime |
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-allows employee to select time schedules that fit personal needs while meeting work responsibilities-variable shift times-difficult to coordinate-can result in over or understaffing-if normal staff person has a meeting, maybe flextime staff could fill in from 11-4 |
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Shift Bidding |
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-to address overtime shifts-nurses bid for overtime shifts-reduces the amount paid for each overtime |
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Staffing Policies need to address: |
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sick leavevacationsholidayslow censuson call paytardiness or absenteeism |
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Nursing Care Hours Per Patient- Day |
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NCH/PPD = nursing hours worked in 24 hours ----------------------------------------------------- patient census
This determines the average numbers of hours that each patient will receive in 24 hour periodDoesn't account for acuity, nurses level of proficiency |
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Staffing by AcuityPatient Classification System (PCS) |
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Groups the patients according to specific characteristics that measure acuity of illness (how much care required)THe patient can be ranked 1-4Hours of nursing care assigned for each patient classificationUnique to each institutionInternal and external forces affect system (internal: new nurses, students, external: physician expectations, etc) Does NOT account for staffing mix! |
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PCS Types |
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Critical Indicator: broad indicator to categorize patient care activities (bathing, diet, positioning, meds)Summative Task: frequency of specific activities, treatments, and procedures for each patient (teaching, hygiene, elimination) Each type is completed before each shiftThen, hours of nursing care are assigned to each classification |
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Mandatory and Minimum Staffing Ratios |
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Mandatory staffing requirements give a maximum number of patients an RN may care for in any circumstance
Criticisms: Nursing shortage makes it harder to fill positionsServes as a Band-aid to problems of quality careUsed as a ceiling Numbers alone do not ensure improved care |
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Cross training |
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giving personnel with varying educational backgrounds and expertise the skills necessary to take on tasks normally outside their scope of work and to move between units and function knowledgeably |
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Generational Diversity4 generations |
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1. Silent/ Veteran: respect authority, structure2. Baby Boomer: traditional work ethics, individual thinker, materialistic3. Generation X: like flexibility and time with family4. Generation Y: think outside own community, want roles taht push limits |
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Closed Unit Staffing |
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Nurses make a commitment to cover all of the units needs- no floating in or out |
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Mandatory Overtime |
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Nurses forced to work additional shifts- it causes errors Some nurses charged with abandonment if they leave |
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Manager Responsibilities |
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Fiscal accountability- staying within budget and meeting needs of staff and patientsPolicies must be clear to employeesPolicies should be reviewed/ updatedDon't demoralize staffDon't jeopardize pt care |
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