shows how one hospital used open scheduling to decrease its use of agency staff and improve staff morale.
Weekend Staffing Plan Hospitals can no longer arbitrarily staff patient care units on weekends or at nights with mar- ginal numbers or levels of qualified staff. The acuity of patients in hospitals, including medical and surgical patients, mandates staffing units on the weekends by the same principles used for weekdays. Thorough trend analysis of patient data can provide the justification necessary to appropriately decrease the number of RNs, at least for some levels, because of differences in patient care needs throughout the day.
A creative method for weekend staffing is the Baylor plan. Developed at Baylor University Medical Center, nurses agree to work only 12-hour shifts on the weekend and are paid for a standard work week. Numerous hospitals have adopted this model for weekend staffing (Cedar Community Hospital, 2011; St. Vincent’s Hospital, 2011).
Automated Scheduling Technology today makes automated scheduling feasible (Douglas, 2010). Matching patient demand to nurse staffing is better done by automated systems than by individuals. To aid in scheduling decisions, data should include patient information, nurse characteristics, and hospital
CHAPTER 16 • STAFFING AND SCHEDULING 223
data (Frith, Anderson, & Sewell, 2010). Automated systems improve patient care outcomes because nurses spend more time with the patients who need the most nursing care. In addition, using nurses’ time appropriately improves financial outcomes as well (Barton, 2011).
Data are often displayed on a dashboard. A dashboard is a computer display of real-time data collected from various sources and categorized for use in decision making.
Supplementing Staff When there is a need for additional staff because of scheduled or unscheduled absences, increased workload demands, or existing staff vacancies, the nurse manager or staffing person must find additional staff. Options include using PRN staff (staff scheduled on an as-needed basis), part-time staff, internal float pools, or outside agency nurses.
Supplemental staff are needed when workload increases beyond that which the existing staff can manage, staff absences and resignations occur, and staff vacancies exist. Chronic staffing problems need to be addressed in a proactive manner involving the nurse manager, the chief nurse executive, and the nursing personnel on the unit with the problem. Strategies for dealing with turnover and for managing absenteeism are discussed in Chapter 20.
Internal Pools Acute staffing problems can be addressed by establishing internal float pools using nurs- ing staff and unlicensed assistive personnel (UAPs). Internal float pools of nurses can provide
SCHEDULING Tori Abraham and Jillian Moore are both nurse manag- ers of general med/surg units at separate hospitals that are part of a large metropolitan health care system. Staffing among the med/surg units has been problem- atic due to increased patient volume and cost control measures enacted by the health care corporation. Staff members have complained numerous times that extra shifts are only offered to part-time employees and that premium pay shifts are given to those with more senior- ity. As the holidays approach, staff tension increases as a lottery system has traditionally been used to assign shifts for major holidays. Additionally, since employees are free to transfer within any of the eight metropoli- tan hospitals, there has been significant turnover on the med/surg units as employees decide to transfer to ambu- latory care and same day surgery facilities.
Tori and Jillian have volunteered to be part of a new scheduling system for their health care system. Nurses and nursing assistants will be able to view open shifts on each unit and e-mail Tori or Jillian with requests to staff shifts for which they are qualified. By allowing staff to have greater control over which additional shifts and at which facility they prefer to work, the nurse managers hope to decrease agency staffing and increase employee satisfaction. Additional units are expected to come on- line, which will also allow staff to have experience on oncology, skilled nursing, and orthopedic patients. The education department will provide a database of employee certifications to managers to ensure that staff
wishing to work away from their home units are quali- fied for the job.
After 90 days of using the new open shift schedul- ing system, Tori and Jillian are pleased with the results. Agency staff use has decreased by 60 percent, and staff members report they are happier with the ability to schedule their own additional shifts as well as work at a different facility without having to transfer. Holiday staffing has been easier, as those employees who pre- fer to work premium pay for holidays are able to self- schedule. Tori and Jillian present their findings to the chief nursing officer and will be part of the team imple- menting systemwide use of open shift scheduling.
Manager’s Checklist The nurse manager is responsible for:
● Understanding the scheduling and staffing needs for his or her areas of responsibility
● Analyzing the economic impact of using agency staffing for open shifts and the financial impact on budget
● Ensuring adequate staffing for safe and appropriate patient care
● Communicating with staff members regarding con- cerns or frustrations over scheduling and staffing
● Using creative problem solving to address scheduling and staffing issues