Staffing and Scheduling in Nursing Management

External Variables that Affect Staffing Plans

• Accreditation agencies standards (e.g. JCAHO, JCIA) require institutions to provide an adequate number of staff members with the experience and training needed to support a unit's unique patient care needs.
• Nursing association standards (e.g. ANA) establish principles for professional nursing practice, including safe staffing.
• Consumer expectations require high-quality nursing care, delivered promptly and efficiently by satisfied nurses.

Internal Organization Variables that Affect Staffing Plans

• Organizational staffing policies and support systems impact staffing plans.
• Scheduling principles aim to distribute the budget personnel appropriately, satisfy individual staff member needs, and meet the care needs of the unit.
• The goal of personnel scheduling is to minimize variability in the ratio of staff size to workload for each shift category.
• The number of permanently assigned nursing personnel for each unit should be calculated based on the expected occupancy rate (often 80%).
• Employees are not freely interchangeable, and non-professional employees should not be expected to perform at the same level as professional employees.
• Work schedules should be posted in advance to permit employees to plan their social and recreational activities around duty hours.

Scheduling Principles

• Distribute the budget personnel appropriately across the day of the week and time of day.
• Satisfy each individual staff member needs (although not always possible).
• Be fair and balanced from the employee perspective.
• Meet the care needs of the unit.

Structure and Philosophy of the Nursing Department

• Staffing plans should allow consistency between the philosophy statement and the observable practice of nursing on units.
• The philosophy statement guides the establishment of the overall structure of the nursing service department and the staffing model.

Staffing Mix

• Staffing mix depends on the intensity of nursing care required by patients, which depends on:
• Severity of patient illness.
• Complexity of nursing care and procedures.
• Degree of patient dependency on the nursing staff.
• Amount of time required to provide patient care.
• Level of technology in the nursing unit.

Changes in Service and Projected Units of Service

• Changes in service that will be offered, such as plans to expand existing clinical services or develop new services or programs.
• Projected units of service.

Strategies for Adding Supplemental Staff to the Unit

• Increasing staff FTEs (e.g. 40 hours per week x 52 weeks per year = 2,080 hours).
• Floating staff (also known as flex staff) from clinical unit to another to fill staffing vacancies.
• Using agency staff.
• Mandatory overtime.

Floating Staff

• Floating nurses from clinical unit to another to fill staffing vacancies.
• Requires experienced nurses with competencies to work on the unit to which they are assigned.
• Potential drawbacks: floating nurses may not have the required competencies, and anxiety levels may increase, leading to errors.

Agency Staff

• Nurses who are hired as independent contractors for shifts, weeks, or longer periods through agencies.
• Advantages: high payment rates, diversity in work environment, exposure to a variety of work teams, and ability to travel.
• Disadvantages: patients may be unable to distinguish agency staff from unit staff, and potential regulatory issues.