Improving employee job satisfaction and patient care skills
CASE STUDY 16-1
224 PART 3 • MANAGING RESOURCES
supplemental staffing at a substantially lower cost than external agency nurses. In addition, in- ternal staff are familiar with the organization. All staff participating in the internal float pool must be adequately trained for the type of patient care they will be giving.
Internal float pools can be centralized or decentralized. A centralized pool is the most efficient. A pool of RNs, LPNs, UAPs, and unit clerks are available for placement anywhere in the institution. However, it may be difficult to place the person with the correct skills for a particular unit at the needed time.
In decentralized pools, a staff member usually works only for one nurse manager or on only one unit. The advantages of decentralized pools include better accountability, improved staffing response, and improved continuity of care. Critical care units, operating rooms, maternal–child units, and other highly specialized or technical areas tend to use a decentralized system.
In addition, staff can receive cross-training in preparation for assignment to another unit. A critical-care nurse might be cross-trained for the step-down unit, for example. Dual-unit positions could be established in the recruiting phase to give the organization the maximum flexibility in scheduling and the employee an opportunity to acquire additional skills.
External Pools For some institutions, agency nurses become part of the regular staff contracted to fill vacancies for a specified period of time (e.g., a nurse on maternity leave). However, most agency nurses are used as supplemental staff. All agency nurses require orientation to the facility and unit, and they must work under the supervision of an experienced in-house nurse. Management must verify valid licen- sure, ensure that either the agency or agency nurse has current malpractice insurance, and develop a mechanism to evaluate the agency nurse’s performance. Although an agency nurse may meet an urgent staffing need, continuity of care may be compromised and there may be some staff resent- ment because these nurses may earn two to three times the salary of in-house nurses.
Concern about the quality of agency nurses appears to be unfounded, according to a study analyzing adverse events in Pennsylvania hospitals (Aiken, Xue, Clarke, & Sloane, 2007). Rather, adverse outcomes resulted from deficits in the hospital environments, not from the quality of the agency nurse assigned there.
Ensuring that sufficient staff are available and that they are scheduled appropriately is a demanding task and one that is constantly in flux. Nevertheless, such activities are critical to achieving positive patient outcomes and providing safe, effective, and cost-conscious staffing.
What You Know Now • The goal of staffing and scheduling is to provide an adequate mix of nursing staff to match patient care
needs. • The Joint Commission requires that organizations determine criteria for nurse staffing and provide
adequate numbers of competent staff to meet that criteria. • Patient classification systems use patient needs to determine workload requirements and staffing needs. • Scheduling involves assigning available staff in a way that patient care needs are met. • Flexible and creative staffing and scheduling techniques are increasingly necessary. • Self-staffing and scheduling, including open shift management, is an option in which nursing staff partici-
pate in designing the schedule and accept responsibility for ensuring attendance. • Automated scheduling improves patient outcomes and uses fiscal resources appropriately.
Tools for Handling Staffing and Scheduling 1. Familiarize yourself with the current patient classification, acuity system, or automated system in