Effective Leadership and
Management in Nursing
EIGHTH EDITION
CHAPTER
16
Staffing and
Scheduling
Learning Outcomes
1. Determine staffing needs.
2. Demonstrate how to use patient
classification systems to calculate
nursing care hours necessary.
3. Calculate FTEs.
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan
Learning Outcomes
4. Determine the appropriate staffing mix
and distribution of staff.
5. Describe the various ways to schedule
staff.
6. Explain how to supplement staff when
needed.
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan
Staffing
• Goal
– To provide appropriate numbers and
mix of nursing staff to match actual or
projected patient care needs to provide
effective and efficient nursing care
• Managers
– Examine workload pattern for the
designated unit, department, or clinic
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan
Staffing Guidelines
• Joint Commission
– Provide the right number of competent
staff to meet patient's needs based on
organization-selected criteria
• American Nurses Association (ANA)
– Focus on the level of nursing
competency required to provide quality
nursing care
• Individual state boards of nursing
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan
Patient Classification Systems
• Also known as patient acuity systems
• It used patients needs to objectively
determine workload requirements and
staffing needs.
• Data collected at midpoint for every
shift and analyzed before next shift
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan
Patient Classification Systems
• Problems
– Nurses may call in sick
– Patient's condition may change
• Demand management: uses best practice
staffing protocol to predict and control the
demand for nurses based on patient
outcomes. Based on historical data
patients progress pattern typifies expected
pt outcome throughout a stay
– Deviations are tracked and staffing
adjusted accordingly
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan
Nursing Care Hours (NCH)
• Patient workload trends analyzed for
each day of the week and each hour in
critical care
• If 26 patients required 161 nursing care
hours, an average of 6.19 nursing
hours per patient per day (NHPPD) are
required
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan
Nursing Care Hours (NCH)
• NHPPD
– Total nursing care hours divided by total
census (number of patients)
– NCHs may vary on the average from
five to 7hrs of care for pts on
medical/surgical, 10-12 hrs of care for
ICU, CCU
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan
Calculating FTEs
• One full-time staff works 80 hours (ten
8-hour shifts) in a 2-week period
• To staff an 8-hour shift takes 1.4 FTEs,
one person working ten 8-hour shifts
(1.0 FTE) and another person working
four 8-hour shifts (0.4 FTE) to provide
for the full-time person's 2 days off
every week
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan
Calculating FTEs
• Staff working all 8-hour shifts
– (1.4 FTEs × 33 shifts = 4.2 FTEs)
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan
Calculating FTEs
• 2.1 FTEs are needed to staff one 12-hour
shift each day, each week—two people
each working three 12-hour shifts and
one person working one 12-hour shift
each week
– (0.9 FTE + 0.9 FTE + 0.3 FTE = 2.1 FTEs)
• Staff working 12-hour shifts
– (2.1 FTEs × 32 shifts = 4.2 FTEs)
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan
Determine Staffing Mix
• Hygiene care, feeding, transferring,
turning patients–LPNS or UAPs
• Assessments, patient education, or
discharge planning–RNs
• High RN skill mix allows for greater
staffing flexibility
• Block staffing
– Scheduling a set staff mix for every shift
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan
Distribution of Staff
• Staff needs vary by shift or day of the
week
• Surgery patient census fluctuates
– Higher census Monday through
Thursday
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan
Distribution of Staff
• Surgery patients
– Shorter length of stay than medical
patients
• Medical patient census rarely fluctuates
Monday through Friday, less on
weekends (diagnostic tests not done)
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan
Scheduling
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Creative and flexible scheduling
Self-staffing and self-scheduling
Shared schedule
Open shift management
Baylor plan for weekend staffing
Supplemental staff
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan
Supplemental Staff
• PRN staff
– Scheduled as needed
• Part-time staff
• Internal float pools provide staffing at
substantially lower cost than agency
nurses
• External pools
– Outside agency nurses; require
orientation to facility and unit
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan