nursing administration

1. Staffing and
scheduling
By /MahmoudShaqria
‫شقريه‬ ‫محمد‬‫محمود‬

2. Out lines

 Definition of staffing
 Philosophy of staffing in nursing -
 Objectives of staffing
 Staff classification
 Components of Staffing –
 Factors affecting staffing
 Types of staffing
 Staffing process

3.  Role and function of administrator manager in staffing schedules
 Definition of Scheduling
 Objectives of scheduling
 Issues to consider in scheduling staff
 Principles of time scheduling
 Types of scheduling
 Systems of developing time planning schedule

4. Definition of Staffing (allocation) :-
• It is the process of determining and assigning the right personnel with
the right qualifications to the job in a right time to meet patient needs,
provide save, quality care and accomplish the purposes of the
organization .

5. Philosophy of staffing in nursing
1. -Matching employees 'knowledge and skills to patient care needs in a 2-manner that optimizes job
satisfaction and care quality.
-Technical and humanistic care needs of critically ill patient are so complex that care should be
provided by professional nurses.
.-Health teaching and rehabilitation needs of chronically ill patient are so complex that care should be
provided by professional and technical nurses.
-Patient assessment, work quantification and job analysis should be used to be assigned to care for
patient of each type (such as coronary care, renal failure, chronic arthritis, cancer.)
-Staffing plan and policies in all units should be developed by the head nurse and staff of the hospital.
Staffing plan should be administrated at the unit level by the head nurse so that shift start time,
number of staff assigned on holidays, and number of employees assigned to each shift can be
modified to accommodate the unit workload and workflow.

6. Objective of staffing in nursing :-
1-Appropriate numbers and mix of nursing staff.
2-Provide an all professional nurse staff in
critical care units ,operating rooms, labor and
delivery units, and emergency room

7. 3-Design a staffing plan that specifies how many nursing personnel in each classification will be
assigned to each nursing unit for each shift and how vacation and holiday time will be
requested and scheduled.
4-Empower the head nurse to adjust work schedules for unit nursing personnel to remedy any
staff excess or deficiency caused by employee absence.
5-Inform each nursing employee that requests for specific vacation or holiday time will be
honored within the limits imposed by patients care and labor contract requirements.
6-Delivery of effective and efficient nursing care.
7-Increase productivity.
8-Avoid role confusion, communication problems and time waste .
9-Maintain stability in team work.
10-Reward employees for long- term service.

8. Staff classification :-
1-Professional degree nurse: Baccalaureate.
2-Technical nurse: Secondary Technical Nursing School. (Diploma degree).
3-Auxiliary: messenger and transport personnel.

9. Components of Staffing
-Staffing pattern
-Staffing plan
Staffing pattern :
 It is the number and mix of personnel that should be on duty
per each unit per shift, per day.

10. Factors affecting staffing pattern determination:
A-Nursing organization factors:
1-Patient care objectives.
2-Determined level of patient care.
3-Assignment system.

11. B- Patient factors:
1-Acuity and general health status
2-Length of stay
3-Patient number.
Age group (pediatrics or adult.
5-Complexity of patients
Patient type (age, sex, diagnosis.

12. C- Staff factors:
1-Educational level of the nurses.
2-Experience level of the nurses
3-Staff number.
4-Job description of each category of nurses.
5- Personnel policies (job, overtime, part time, work

13. D-Health care organization factors
 Financial resources available.
 Personnel policies regarding work time.
 Support services with the organization.
 Number of beds per unit
 Architecture design of the units.
 Availability of supplies and equipment

14. Methods of determining the staffing pattern:-
- The traditional system
- The advanced system
The traditional system:
• The number of beds per unit ( one nurse per 4-6 beds)
• The average census of patients per unit (one nurse per 4 patients)
• The distribution of nurses is based on the nurse manager' opinion of the proportion of care
that is needed on each shift and the adequate staff number to provide that care.
• Example: Days: 45% of the staff
Evenings 35% of the staff
Nights 20% of the staff

15. The advanced system:
• Focuses on patient needs during a shift and nursing tasks to be performed through:
a -patient classification system
b- Task quantification
a. Patient classification system
- Also known as patient acuity systems
- A patient classification system (PCS) is a measurement tool used to determine the
nursing workload for a specific patient or group of patients over a specific period of
time.

16. :The patients grouped according to their nursing needs into 3 or more categories.
Level 1 (Minimal Care)
• Patient can take a bath on his own, feed himself, feed perform his activities of daily
living, and requires
little treatment, observation
• Average amount of nursing care hours per patient per day is 1.5 .
Level 2 (Moderate Care)
• Patients under this level need some assistance in assistance in bathing, feeding, or
ambulating for short periods of time. Vital signs ordered up to three times per shift
Average nursing care hours per patient per day is 3 hour

17. Level 3 (Maximum Care)
• Requires frequent, close nursing observation and intervention .
• Requires moderate medical intervention .
• The nursing care hours per patient per day are 4.5 hours.
Level 4 (Critical Care
• Requires continuous treatment and observation .
• The nursing care hours per patient per day may range from 6 or more.

18.  Level of care Needed hour per patient
 Minimal Care.1.5
 Moderate Care.3
 Maximum Care 4.5
 Critical Care 6

19. Task quantification system
- Focuses on nursing tasks. To be performed. Common nursing tasks are
either direct nursing care (in the presence of the patient as in giving
medication, measuring vital signs ….
- indirect nursing care (away from the patients as in preparing medication,
documentation in patients' files, giving instructions or educative
sessions.
Staffing plan :
• It determines the number of nursing personnel that must be hired to
deliver nursing care on the nursing units.

20. Types of staffing

 Basic permanent staffing:
 Supplementary staff
 In call staff.
 Float staff.

21. Basic permanent staffing
 • Which is determined based on average Patient care
requirements using (Patient classification system) and
nursing tasks (task quantification) to be performed by
different levels of nursing staff.

22. Supplementary staff:
 This is needed when demands for patient care exceed the capabilities of the basic
staff
 a) Borrowing method:
 It is borrowing staff from units that have the most to help those who have too little
 The problem here that the staff often resists being transferred from unit to unit and
head nurse never permits that she has more nurses

23. Float staff:
 - A pool of nurses who are permanent workers but do not belong to
any special unit care .
 .- This methods help to manage the day to day variations in work
volume , but some nurses like this method since it gives a chance
to work with different types of patients

24. On call staff:
 On call staff is regular employees who receive extra pay
for being on call whether or not they are called.
 - This is useful in OR, ICU, and other special care units

25. Staffing process:
 Identify the type and amount of nursing care to be given.
 Determining categories of nursing personnel should be used to deliver needed care.
 .Predicting the number of each category of personnel that will be needed to deliver care.
 .Selecting and appointing personnel from available applicants .
 .Recruit personnel to fill available positions.
 Arranging available nursing personnel into desired configurations by shift and unit

26.  .Assigning responsibilities for patient care.
 .Performance appraisal for various staff categories .
 .Continues staff development .

27. Role and function of administrator
manager in staffing schedules:-
 .Identifies creative and flexible staffing methods to meet the needs of patients, staff and
the organization.
 . regarding contemporary methods of scheduling and staffing.
 .Assumes a responsibility toward staffing that builds trust and encourage team approach.
 .Periodically examines the unit standard of productivity to determine if change needed.
 .Is alert to extraneous factors that impact on staffing.
 .Is ethically accountable to patients and employees for adequate safe staffing

28. Function;
 .Provide adequate staffing to meet patient care needs according to the philosophy of
the organization.
 .Use organization goals and patient classification tools to minimize under staffing and
over staffing.
 .Schedules staff in a fiscal responsible manner.
 .Develops fair and uniform scheduling policies and communicates clearly to all staff.
 .Assumes accountability for quality and fiscal control of staffing.
 .Evaluates scheduling and staffing procedures and policies on a regular basis..

29. Definition of Scheduling
 • Scheduling means planning patterns of on duty hours for
employees in a particular unit for a given period of time.
 It is a timetable showing planned work days and shift for nursing
personnel.
 l• Scheduling is to assign working days and days off to the nursing
personnel so that adequate patient care is assured.

30. Objectives of scheduling
 To provide adequate staffing to meet patient care needs during 24 hours For a certain time
 .To maintain staff morale , through:
 a-To treat fairly individual members in their distribution
 b- To satisfy personnel both as to work hours and as to perceive sense of
equity.
 To maximize the use of nursing of nursing staff power and optimize the use of
professional expertise.
 .To organize work in the unit and prevent confusion by avoiding periods of
understaffing or over staffing.
 .To define responsibilities of personnel.

31. Issues to consider in scheduling staff
 Patient type and acuity
 Number of patients
 Experience of Staff
 Support available to the staff

32. Principles of time scheduling:
 Enables the staff to meet the objectives, standards, and policies of the
organization.
 .Informs all staff of their work schedule for the coming consecutive 3 to 6 weeks
including days off and shifts of duty.
 .It should be planned to meet needs of each time period (by knowing the busiest
days and hours) it must balance the needs of patients and personnel.

33.  There must be an equitable distribution of the desirable as well as the undesirable hours of
duty.
 An employee must be assured that his assigned time on duty will not fluctuate unless an
extreme emergency arises, and only with his permission
 . All staff members should be assigned similar duty hours as much as possible, and days
off should be equitable for all personnel.
 . Scheduling policies must be identified at the time of employment.
 There should be no accumulation of day off.
 . There should be a professional nurse on duty at all times during the 24 hours.
 . Draw up a long term plan to maintain morale (e.g. made out for a monthly period.
 . Special requests should be granted if reasonable

34.  There should be an over lapping of each shift to provide time for shift reports.
 Posted in a clear pace and oriented for all nursing personnel.
 There should be a day apart between head nurse and assistant head nurse day off
 The head nurse is rarely off duty on Saturday, which is the beginning of the week.
 .The day off is given after a night shift.
 The head nurse has to be sure that the unit is adequately staffed when
inexperienced staff is working.

35. Types of scheduling
 Block scheduling
 Cyclical scheduling
 Self-scheduling:
 Computerized scheduling
.

36. Block scheduling
 Means that the work schedule for a unit is planned in a “block” of
week, i.e. days to be worked by staff are blocked together.
 Block scheduling is done for 4-8 weeks at a time.
 • It can be calculated easily and has flexibility.
 • This type of scheduling does not provide for maximum level of
care seven days a week.

37. )Cyclical scheduling:
 Schedule patterns are set for a certain number of weeks and are
repeated (every two, four, six, or more weeks as desired) within the
given cyclical period.
 • Taking in consideration the need of proper number and mixes of
personnel, continuity of care.
 • Is an improvement on block scheduling in that it has repetitive
work patterns.


38. **Advantages of cyclic time scheduling:-
 Personnel know their schedules in advance and consequently can plan their
personal lives and social activities.
 There is a decrease in preoccupation with staffing, time for scheduling, time
for maintenance of schedule, and conflict over preferred days off.
-Staff is treated more fairly by equitable distribution of popular and unpopular
days on duty.
-The scheduling of appropriate number and category mix of personnel is
simplified.
 -It helps establish stable work groups and decreases floating thus promoting
team spirit and continuity of care.

39. Self-scheduling
 Self-scheduling is a system that is coordinated by staff nurses.
 • Is the process by which staff nurses on a unit collectively
decide and implement the monthly work schedule, each staff
nurse chooses which day and shift he or she will work


40. **Advantages of Self-scheduling
 Help create a climate where Professional nursing can be practiced.
 Saves the manager considerable scheduling time and changes the role of the manager
from supervisor to coach.
 It increases the amount of time staff spends on scheduling, increases their ability to
negotiate with each other, and helps develop a more accountable and professional
staff.
 Increased perception of autonomy, increased job satisfaction, increased cooperative
atmosphere, improved team spirit, improved morale, decreased absenteeism, reduced
turnover.
 Increased perception of autonomy and increased job satisfaction.

41. Computerized scheduling
 • This type enables the user to devise a plan, which considers more
variables than schedules done by individuals .
 • Computerized scheduling allows for maintaining the patterns to be
used and the choice of employee and the planning of holidays, days off
and vacations. All data necessary for time planning are fed to the
computer and a program for scheduling is designed based on the fed
data .
 • The computerized scheduling is more effective than the other
types.

42. **Advantages of computerized scheduling:
 It saves the nurse’s time spent working out schedules.
 .It reduces interpersonal conflicts between staff and supervisor
created by changes made in scheduling.
 Consistent scheduling and equitable application of agency policy.
 Unbiased.
 .Cost effectiveness through reduction of clerical staff and better
utilization of professional nurses by decreasing the time spent in
non-patient care activities

43. Systems of developing time planning
schedule:
 Centralized scheduling
 Decentralized scheduling:

44. Advantages:
1. This type of staffing is fairer to all employees.
2. There is balance distribution among the hospital unite.
3. The first level manager is freed to complete other management
functions
4. Adjustment could be done more easily in case of emergency or
understaffing functions .
5. This method is more cost effective
6. Eliminates the personal contact that develops between a head nurse
and her personnel as it relates to employee work schedules

45. 1.Centralized scheduling:
 The schedule done by the upper manager for all
nurses in all departments manually or by
computer.
 • It is usually used in small hospitals

46. Disadvantage:
1. Centralized Staffing does not provide as much flexibility for the
worker.
2. It does not account for a worker’s desires or special needs.
3. Manager may be less responsive to personnel budget.

47. 2.Decentralized scheduling:
1. This type of staffing is used in large hospitals, which could be
achieved by having unit mangers make scheduling decisions
2.
3. Allows the head nurse to base her scheduling plan on her
knowledge of the personnel assigned to her unit.
4. Personnel feel that they get more personalized attention.
5. It is easier and less complicated when done for a small area
instead of the whole agency.
6. The unit manager understands the need of the unit.
7. Staff feels more in control of their work environment.

48. **Disadvantages:
 • Each head nurse under decentralized staffing tends to develop
and utilize her own staffing pattern, and so workers on various units
compare schedules and dissatisfaction may arise.
 • Sometimes makes staff members feel that the head nurse is not
objective.
 • It carries the risk that employees will be treated unequally or
inconsistently.
 • It is time consuming for the manager .
 • There is difficulty in Adjustment in case of emergency.
 • It may be lead to over staffing in some hospital unit.