• Staffing is the 3rd phase of the management process.
• It involves recruiting, selecting, placing, and indoctrinating personnel.
• It also promotes personnel development.
• Staffing is determining and providing the acceptable number and mix of nursing personnel to meet patient demands.
• Staffing considers physical, financial, and human resources.

Steps of Staffing Responsibilities

• Determine the number and types of personnel needed.
• Recruit, interview, select, and assign personnel based on job descriptions.
• Use organizational resources for induction and orientation.
• Socialize employees to organizational values.
• Develop a program of staff education.
• Use creative and flexible scheduling.

Nursing Shortage Implications

• Diminishes a hospital’s capacity to treat patients.
• Contributes to emergency department overcrowding.
• Results in a reduced number of staffed beds.
• Can lead to cancellation of elective surgeries.
• Can result in the discontinuation of services.

Manager Response to Shortages

• Consider budget constraints.
• Consider the type of patient care management used, whether primary, secondary, or tertiary.
• Consider the education and knowledge level of staff to be recruited.

Recruitment

• Recruitment is the active seeking or attracting applicants for existing positions.
• The goal of recruitment is to find quality employees.

Recruitment Methods

• Employee recommendations
• Word of mouth
• Advertisements
• Flyers
• Placement services

The Recruiter

• Should know the needs of the organization.
• Can represent the institution.
• Relates well to people.

The Nurse Recruiter

• A separate entity, assigned to Nurse Managers.
• Decentralization is important.
• Comes with great responsibility.

Retention

• Begins with how much the organization values staff.
• Happens when the organization creates a work environment that makes staff want to stay.

Nurse Turnover

• It is costly, with HR expenses.
• Training is expensive.
• The overtime of existing staff.
• Results in lost revenues.
• Causes an increased nurse-patient ratio.

Creating Cultures of Retention

• Provide leadership and management training.
• Delegate authority to nurse managers and staff nurses.
• Promote nurse autonomy.
• Give nurses greater control over practice.
• Encourage nurse participation in organizational policy decisions.
• Foster good nurse-physician relationships (address issues, improve communication).
• Establish appropriate staffing levels based on patient acuity.
• Adopt zero-tolerance policies for abusive behaviors.
• Minimize paperwork.
• Limit the use of mandatory overtime.
• Nursing managers play a pivotal role in nurse retention.

Interview Styles

• Structured: Requires greater planning, with questions prepared in advance addressing specific job requirements, skills, qualities, experience, and motivation; Utilized for critical positions.
• Unstructured: Requires little planning, with questions not prepared in advance; Used for less critical job positions.

Selection

• The process of choosing the best-qualified individuals for a job.
• Involves verifying qualifications and checking work history.

The Final Selection

• Notification about the applicants’ decision.
• A timely written notice to those applications that are eliminated.
• Informing of the benefits, compensation, and placement.
• Informing of the pre-employment procedures.
• Confirm in writing the intention to accept the position.

Placement

• Assigning an employee to a position and unit within the manager’s authority, considering their interests and specialization.

Indoctrination

• Adjusting an employee to the organization to establish favorable attitudes.
• Continues until the employee is socialized to the norms and values of the work group.

Induction

• The first phase of indoctrination, provides general information about the organization.
• Developed by the personnel department.
• Signed by new employees and serves as a reference.

Orientation

• The second phase of indoctrination, more specific to the position.
• Typically involves the personnel dept (1st day), staff development dept (2nd day), and specific dept (3rd day).

Socialization

• The third phase of indoctrination.
• Requires acquiring technical skills.
• Requires knowledge of behaviors.
• Requires attitudes and values that make conformity.
• Supported by role models, preceptors, and mentors.

Role Model

• Someone worthy of imitation.

Preceptor

• Provides knowledge, emotional support, and clarifies role expectations.

Mentor

• Assists the protégé in attaining expert status.

Staff Development

• Includes training, education, coaching, and team building.

Training

• An organized method of ensuring people have knowledge and skills, using methods like simulation, OJT (on-the-job training), and lectures.

Education

• More formal and broader in scope than training.

Reasons for Neglecting Training & Education

• Institutional barriers
• Workload
• Readiness of staff to learn
• Motivation
• Time
• Manager’s initiative.

Assessing Staff Development Needs

• Performance review
• Peer evaluation
• Self-administered checklists

Staffing Needs & Scheduling Policies

• Ascertain adequate numbers of nurses and an appropriate mix of personnel.
• First- and middle-level managers are responsible for meeting staffing needs.

Scheduling Types

• Centralized: Made by personnel in a central office; fairer and frees middle managers of the burden.
• Decentralized: Unit manager is responsible; intimately understands the unit and staff, can accommodate personal requests, and decrease nurse attrition.
• Cyclical: Allows long-term knowledge of future work schedules.

Nursing Care Delivery Systems

• Case Method: One nurse provides total patient care on each shift.
• Functional Nursing: Personnel of different skill levels are used according to patient care needs; task-oriented; team members supervised by an RN.
• Team Nursing: Care provided through team effort and group action.
• Primary Nursing: RNs give total patient care to 4-6 patients with 24-hour responsibility; improves accountability, continuity of care, reduces errors, and shortens hospital stays.
• Case Management: Nurses work across agencies using an interdisciplinary approach focused on the entire episode of illness.

Patient Classification System

• Groups patients by characteristics that measure acuity of illness.
• Category I: Self-care, requiring 1-2 hours of nursing care/day
• Category II: Minimal care, requiring 3-4 hours of nursing care/day
• Category III: Intermediate care, requiring 5-6 hours of nursing care/day
• Category IV: Modified intensive care, requiring 7-8 hours of nursing care/day
• Category V: Intensive care, requiring 10-14 hours of nursing care/day

Making Patient Assignments

• Patient needs
• Available staff
• Job descriptions
• Scope of practice for licensed nurses and scope of functions

National League for Nurses Formula for Staffing

ABO X NCH / # of working hrs = Total # of Nursing Service Personnel for 24 hours

Where:

• ABO = Average Bed Occupancy
• NCH = Nursing Care Hours

• of working hours = 8 (based on RA 5901, The 40 Working Hours per Week Law)

Standard values for NCH

• Medical = 3.4
• Surgical = 3.4
• Mixed MS = 3.5
• OB = 3.0
• Pedia = 4.6
• Nursery = 2.8

National League for Nurses Formula for Staffing

• Distribution per shift: Morning = 45%, Afternoon = 37%, Night = 18%
• Calculate staffing based on a % of professionals to non-professionals.