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Centralized vs Decentralized Staffing
Centralized staffing made by central officeDecentralized staffing done at unit level
Advantages and Disadvantages of Centralized Staffing
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
Advantages and Disadvantages of Decentralized Staffing
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
Agency or Travel Nurses
**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
Per diem/ Registry Employees and Float Pools
**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 
Self Scheduling
-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
-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
Shift Bidding
-to address overtime shifts-nurses bid for overtime shifts-reduces the amount paid for each overtime
Staffing Policies need to address:
sick leavevacationsholidayslow censuson call paytardiness or absenteeism 
Nursing Care Hours Per Patient- Day
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 
Staffing by AcuityPatient Classification System (PCS)
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!
PCS Types 
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
Mandatory and Minimum Staffing Ratios
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
Cross training
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 
Generational Diversity4 generations
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
Closed Unit Staffing
Nurses make a commitment to cover all of the units needs- no floating in or out
Mandatory Overtime
Nurses forced to work additional shifts- it causes errors Some nurses charged with abandonment if they leave
Manager Responsibilities 
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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