Chapter 19
Staffing and Scheduling
Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc.
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Staffing
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The Joint Commission (TJC) surveys
hospitals on the quality of care provided.
TJC does not mandate staffing levels but
does assess an organization’s ability to
provide the right number of competent staff to
meet the needs of patients served by the
hospital.
(TJC, 2007)
Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc.
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California Mandated Staffing
Guidelines
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California has mandatory staffing guidelines
California became the first state in the nation to require
mandatory safe licensed nurse/patient ratios in all acute care
hospital units.
Enacted in 1999, the legislation (AB 394) requires that additional
nurses be added to a minimum ratio in accordance with a
patient classification system based on the severity of the
patient’s condition.
Nine other states have since enacted legislation and/or
regulations: Washington DC, Florida, Illinois, Maine, New
Jersey, Oregon, Rhode Island, Texas, and Vermont.
Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc.
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Process of Staffing
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Daily staffing refers to filling in open shifts on
the current work schedule.
Scheduling refers to making work assignments
for the next work period. It is done from 4 to 8
weeks in advance depending on the institution.
The staffing process culminates with a
schedule (organized plan) of personnel to
provide patient care services.
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Scheduling Variables
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The number of patients, complexity of patients’
conditions, and nursing care required
The physical environment in which nursing care is to
be provided
The nursing staff members’ competency levels,
qualifications, skill range, knowledge or ability, and
experience level
The level of supervision required
Availability of nursing staff members for the
assignment of responsibilities
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Four Major Types of Staffing
Systems
1. Centralized scheduling—Decision making occurs in a
“centralized” location for the entire institution.
2. Decentralized scheduling—Decision making occurs
with the nurse manager on the unit.
3. Mixed scheduling—Blends aspects of items 1 and 2.
Individual units may manage staffing, but if they
cannot fill open shifts, they might forward their needs
to a centralized office.
4. Self-scheduling—Individual staff members schedule
themselves. The nurse manager then works with staff
members to fill empty slots.
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Pros and Cons of Centralized versus
Decentralized Scheduling
Scheduling Method
Pros
Cons
Centralized
Fairness
Cost Containment
Lack of
individualized
treatment
Decentralized
Managers have
authority
Staff get personalized
attention
Staffing is easier &
less complicated
Schedule used to
punish and reward
Time consuming for
managers
Cost containment is
more difficult
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Future Scheduling
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Pattern scheduling—Staff commit to work a set number of shift
types in a given time frame. At the end of the time period, the
pattern repeats (such as 3 weeks of day shift followed by 1 week
of night shift, repeated every 4 weeks). Pattern scheduling can
also include permanent shifts, block shifts, and rotating shifts.
Preference scheduling—Staff define their preference for shift type,
days of the week, and unit. Defined rules can override
preferences.
Rules scheduling—Based on an organization’s scheduling
policies. Because it does not take pattern or preference into
account, it is rarely used alone.
Self-scheduling—Scheduling needs are defined, and then staff on
a rotating, first-come, first-served basis; sign up for available
shifts.
Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc.
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Pros and Cons of Scheduling Types
Scheduling Type
Pros
Cons
Rules-based
Incorporates regulatory issues Does not take preferences &
(hours, time off, overtime,
staffing patterns into account
staffing ratios)
Scheduling can be erratic
Pattern
Predictable schedules
Little flexibility
Impairs recruitment
Preference
Considers staff needs
Preferences may not match
rules
Self
Enables more creativity
covering shifts
Increased staff satisfaction
Saves time for nurse
managers
less organization and
manager control of staffing
Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc.
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Full-Time Equivalent (FTE)
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40-hour full-time work week
52 weeks per year
Equals 2080 hours of work time per year
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Productive vs Non-Productive Time
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Productive = actually working
Non-productive = benefit time (holidays,
vacation, sick time, education time)
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Part-Time Staff
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Broaden horizons beyond home
Increase income
Provide ego satisfaction
Maintain nursing skills
Continue education
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Temporary Agency Nurses
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Usually a last resort
The staffing agency is a business that has a
registry of nurses who have highly flexible
schedules
Replacement staff from agency pools are
expensive
Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc.
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Travel Nurses
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“Travelers” are per diem nurses working for a
business that places them in contracted
hospitals
Unlike agency nurses, travelers usually sign
longer-term contracts with hospitals (3 to 6
months or longer)
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Overtime Concerns
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Length of time that the nurse will be working.
The nurse manager must be careful to evaluate the
exhaustion level of the staff.
There are documented instances of increased errors
when the staff is exhausted (Garrett, 2008).
On a budget end, overtime may increase the dollars
spent on care provided.
State labor law will need to be reviewed as well as
union guidelines. They may define the number of
hours required between shifts.
Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc.
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