Kelompok 1 Leader

8/3/2019 Kelompok 1 Leader

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STAFFING AND SCHEDULING

Annisha RahmaniEksa BintariIke Imelda Sinaga

Nurliza PermatasariRika PebrianiSiti Robiah


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STAFFING PHILOSOPHY

Staffing is certainly one of the major problemsof any nursing organization, whether it behospital, nursing home, home-health-careagency, ambulatory care agency, or anothertype of facility.


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COMPONENT OF THE STAFFING

PROCESS Staffing study Master staffing plan

Scheduling plan Position control plan Budgeting plan

Nursing management Information system(NMIS)


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NURSING MANAGEMENT INFORMATION

SYSTEM (NMIS)1 . Quality of patient care to be delivered and its

measurement2. Characteristics of the patient and their care

requirements3. Prediction of the supply of nurse power required for

element 1 and 24. Logistics and staffing program pattern and its

control5. Evaluation of the quality of care desired, thereby

measuring the success of the staffing itself


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MEDICARE AND MEDICALREGULATION

a. Standard: organizationThe hospital must have a well-organized service with a plan of administrative.The director of nurse must be a licensed registered nurse.

b. The director of nursing must be licensed registered nurse.

Standard: staffing and delivery of care1 ) The hospital must have an organized nursing service that provides 24-hours nursing saving. The nursing services must be furnished orsupervised by a registered nursing

2) The nursing service must have a procedure to ensure that hospitalnursing personnel for whom licensure is required have valid and

current licensure3) A registered nurse must supervise and evaluate the nursing care for

each patient4) The hospital must ensure that the nursing staff develops, and keeps

current, a nursing care for plan for each patient


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5) A registered nurse assign the nursing care of each patient to othernursing personnel in accordance with the patient`s need and thespecialized qualification and competence of the nursing staff available

6) Non-employee licensed nurses who are working in the hospitalmust adhere to the polices and procedures of the hospital. Thedirector of nursing service must provide for adequate supervisionand evaluation of the clinical activities

c. Standard: preparation and administration of drugs1 ) Must be administered by or under supervision of nurse or other

personnel in accordance with Federal and State Laws andRegulation

2) Must be in writing and signed by the responsible practitioner3) Blood transfusion and intravenous medications must be

administered in accordance with State Law and Approved MedicalStaff Polices and Procedures

4) There must be a hospital procedures for reporting transfusionreaction, adverse drug reactions, and errors in administering of drugs


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STAFFING STUDY1 . Time study and task frequency

a. tasks and task element (procedures)b. point and time startedc. point and time ended

d. sample sizee. average timef. allowance for fatigue, personal variation, andunavoidable standby

g. standard time = step e + step f h. frequency of tasks x standard time = themeasurement of nursing activity

i. total of all tasks x standard time = volume of nursing work


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2. Work sampling (variation of task frequency and time).Procedures I as follows :

a. identify major and minor categories of nursing activitiesb. determine number of observations to be madec. observe random sample of nursing personnel performing

activities

d. analyze observations. Frequency occurring in a specificcategory = percentage of total time spent in that activity3. Continuous sampling (variation of tasks frequency and time).

Technique is the same as for work sampling except thata. observer follows one individual in the performance of task

b. observer may observe work performed for one or morepatients if they can be observed concurrently


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4. Self-reporting (variation of task frequency andtime)a. the individual records the work sampling or

continuous sampling on himself

b. tasks are logged using time intervals or timetasks start and end

c. logs are analyzed


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Basic to plan for staffing of a division of nursing is the fact that qualified nursing personnel must be provided in sufficient

number to ensure adequate, safe nursing care for all patient twenty-four hours a day,seven days a week, fifty-two weeks a year.


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Standards of The Joint Commission on Accreditationof Health Care Organization, The AmericanAssociation, and other professional and governmentalorganization have required upgrading of health care.Planning for staffing is influenced by he following:1 . Changing concepts of nursing roles for clinicalnurse practitioners an specialists

2. Patients populations that are changing asbirthrates decline and longevity increases

3. institutional missions and objectives relatedto research, training, and many specialities


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4. Personnel policies and practices5. Policies and practices related to admission and

discharge times of patients, assignment of patient to units,and intensive and progressive care practices

6. The degree to which other departments carry out theirsupporting services

7. The number and composition of the medical staff and the

medical service offered8. Arrangement of the physical plant, which has large impact

on staffing requirements9. The organization of the division of nursing 10

. Data to be analyzed that will include number admission,discharges, and transfers; the amount of supervisionneeded by assisting personnel; patient teaching; emergencyresponses; mode of care delivery; and staff mix.


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STAFFING ACTIVITIES


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ORIENTATION PLAN

A main purpose of orientation is to help thenursing worker adjust to a new work situation.

This should be planned program that includesorientation whether through a buddy system,

a special orientation unit, or other methode. Productive is increased, since fewer personnel

are needed when workers are fully oriented tothe work situation.


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STAFFING POLICIES1 . Vacation2. Holidays3. Sick leave4. Weekends off 5. Consecutive days off 6. Rotation to different shift7. Overtime8. Part-time and temporary personnel9. Use of float personnel10 . Exchangeability hours11 . Use of special abilities of individual staff members1 2. Exchanging hours1 3. Request of personal1 4. Request of management1 5. The work week


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W ORK CONTRACTS

A work contract should be set up between eachemployee and the institution.

The contract should state the date employmentis to commence, the job classification, the

hours of work, the rate of pay, whether the jobis full-time or part-time, and any other specificpoints agreed upon between employee andinstitutional representative


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STAFFING THE UNITS


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Each patient care unit should have a master staffing plan that includes the basic staff needed to cover the

unit each shift. Basic staff is the minimum or lowest number of personnel needed to staff a unit.

The number of complementary personnel isdetermined.

Complementary personal are scheduled as anaddition to the basic group.

Float personnel are employees who are notpermanently assigned to a station.

The number and kinds of float personnel can beaccurately determined from general monthly recordsthat show absence rates, personnel turnover, andfluctuations in patient care workloads.


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Part-time personnel will be better motivated if they receive some benefits, such as a numberof paid holidays and vacation daysproportionate to days worked and payincreases when they complete the aggregatedays worked by full-time personnal.


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STAFFING MODULES

CYCLIC SCHEDULINGCyclic scheduling is one of the best ways of staffing to meet the requirement of equitable distributionof hours of work and time off. A basic time patternfor a certain number of weeks is established andthen repeated in cycles. Since it is relativelyinflexible, cyclic scheduling works only with a staff that, rotates by policy and personal choice. It is notgenerally accepted by personnel who need flexiblestaffing to meet their personal needs such as

those related to family and educational pursuits.


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The number of staff are noted by thenurse manager for each four hours of

staffing. Nursing personnel insert theirinitials in each block according to thegivens of staffing policies. Additionalpages can be used for self-scheduling for four, six, or any other number of

weeks. Signature and initials indicatethat each employee has scheduledthemselves for specific dates and hoursof work.


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The following are some policies that might be

considered:1 . Personnel are scheduled to work their prefered

shift as much as possible.2. Personnel choices are balanced to meet the

needs of the unit and of other employess.3. An employee is allowed to make her or his own

arrangements for special time off or toexchange within specific personnel policies.

4. Policies have been established for making schedule changes.


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SELF- SCHEDULING

Self-scheduling is an activity that could makea staff happier, more cohesive and morecommited. It should be planned carefully on aunit (cost-center) basis. Planning may useeither a self-directed work team or a qualitycircle technique approach. Self-scheduling matches staff to individual preferences. It hasbeen found to shorten scheduling time andreduce conflicts; increase job retention and

job satisfaction; and reduce illness time,voluntary absenteeism, and turnover.


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Self-scheduling leads to more responsibleemployees. It meets such personal goals asfamily, social life, education, child care, andcommuting. It is an example of participatorymanagement with decentralized decisionmaking. The planning must include thegivens, or rules, to be followed. These rules

should be minimal to meet legal andprofessional standards.


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PATIENT CLASSIFICATION SYSTEMS

A patient classification system (PCS), whichquantifies the quality of nursing care, isessential to staffing nursing units of

hospitals. In selecting or implementing aPCS, a representative committee can includea representative of hospital administrationwhich would decrease skepticism about thePCS.


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PURPOSE...T

he committee will identify the purpose of thePCS to be purchased or developed. Among these purposes are the following:

1 . Staffing. The system will estabilsh a unit of

measure for nursing: time, which will be usedto determine both numbers and kinds of staff needed.

2. Program costing and formulation of the

nursing budget. A prescribed unit of time willbe used to determine the actual cost of nursing service.


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CONT..

3. Tracking changes in patient care needs. APCS gives nurse managers the ability tomoderate and control delivery of care

services, adjusting intensity adn cost.4. Determining values for the productivity

equation: output divided by input. Reducing input costs reduces costs of each output(time unit).


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NURSING MANAGEMENT INFORMATIONSYSTEMS FOR PCSS

Characterisitic Desired of PCSs:1 . Differentiate intensity of acre among definitive

classes.

2. Measure and quantify care develop amanagement engineering standard.3. Match nursing resources to patient care

reduirements.

4. Relate to time and effort spent on the associatedactivity.5. Etc,


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COMPONENTS OF PCSS

The first component of a PCS is a method forgrouping patients or patient categories.Using factor evaluation, each patient is rated

on independent elements of care, eachelements is srored (weighted), scores aresummarized, and the patient is placed in acategory based on the total numerical value

obtained. Using prototype evaluation, eachpatient is categorized to a broad descriptionof care requirements.


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The following are some policies that minght beconsidered:

1 . Personnel are scheduled to work theirpreferred shifts as much as possible.

2. Personnel choices are balanced to meet the

needs of the unit and of other employees.3. An employee is allowed to make her or his own

arrangements for special time off or toexchange within specific personnel policies.

4. Policies have been established for making schedule changes.

5. Each employee has a copy of his or her workshcedule.


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SELF-SCHEDULING

Self-scheduling is an activity that couldmake a staff happier, more cohesive andmore commited. It should be plannedcarefully on a unit (cost-center) basis.Planning may use either a self-directed workteam or a quality circle technique approach.Self-scheduling matches staff to individualpreferences. It has been found to shortenscheduling time and reduce conflicts;increase job retention and job satisfaction;and reduce illness time, voluntaryabsenteeism, and turnover.


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Category I self care1 . Activities of daily living

Eating feeds self or needs little assistanceGrooming almost entire self sufficientExcretion goes to bathroom alone or almost alone. Not continentComfort self sufficient

2.General health good. Admitted for a diagnostic procedure, simple

procedure or surgery that is simple or minor3. Teaching and emotional support routine teaching for simple procedures,follow up teaching or discharge teaching. Patient may require orientation totime, place, and person once a shift.4. Treatments and medications non or simple medications treatment


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Category II Minimal Care

1 . Activities of daily living Eatingneeds help in preparing food, positioning or encouragement to

eat. Can feed self Grooming can do majority of care unassisted or with minimal

assistance Excretion needs help getting to bathroom or using urinal. Not

incontinent or experience Comfortturns self or turns with minimal encouragement or assistance2. General Health mild symptoms including more than one mild illness.

Require monitoring of vital signs, diabetic urines, uncomplicateddrainage or infusion

3. Teaching and emotional support needs 5- 10 minutes per shift forteaching or emotional support

4. Treatments and medications requires 2 0 -30 minutes a shift. Needsevaluation of effectiveness of medication or treatment frequently.


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CATEGORY III MODERATE CARE

1 . Activities daily living

Eating needs to be fed but can chew and swallow Groomingunable to do much for self Excretion needs bedpan or urinal placed or removed. Can only partially

turn or lift self. Incontinent two time each shift Comfortcompletely dependent and needs turning but can be turned one

person2. General health acute symptoms may be impending or subsiding. Requires

monitoring and evaluation of physiological or emotional state q2-4h. hascontinuous drainage or infusion that requires monitoring q 1 h.

3. Teaching and emotional support require 10 -30 minute a shift. Very

apprehensive or mildly resistive to teaching. Patient may be confused,agitated, belligerent but is fairly well controlled by medications, frequentorientation or restrain

4. Treatment and medication require 3 0 -60 minute s shift. Require frequentobservation for side effects or allergic reaction. May require observationq1 h for mental status.


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Category IVextensive care1 . Activities daily living Eatingcannot feed self. Difficulty chewing and swallowing. May require

tube feeding Grooming complete bath, hair care, oral care. Patient cannot assist all Excretionincontinent more than two times a shift Comfortcannot turn self or assist with turning. May require two people to

turn.2. General healthseriously ill. Exhibits acute symptoms such as bleeding

and/or fluid loss, acute respiratory episodes, or other episodes.3. Teaching and emotional support require more than 3 0 minutes a shift.

Teaching of very resistive patients or care and support of patients withsevere emotional reactions.

4. Treatment and medication require more than 6 0 minutes a shift.Elaborate treatments done more than once per a shift or require twopersons.

Category V Requires one to one observation or continuous monitoring each shift.


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The commission for administration services in hospital system of patientclassification appears to be of the prototype evaluation type. CASH is apatient classification design that rates patient by intensity of care andestablishes a category relating to nursing required based on patients abilityto feed and bathe themselves with supervision, mobility status, specialprocedures and treatment, and observational, institutional, and emotionalneeds. This design is quantified by determining the nursing care timeassociated with the critical indicators.

The GRASP system of patient classification uses a workload measurementdesign to evaluate the categories of tasks that nurses perform in providing patient care and identifies how much nursing time is required for each task.T

he time is then totaled. GRASP is a factor evaluation design, as is Medicus.


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PROBLEM W ITH PCSS

One of the major problems of PCSs is inmaintaining reliability and validity. This can bedone through continuing education and quality

checks.A calendar can be established to have external

personal from staff development or anothernursing department or unit perform aclassification following that done by unitpersonal (interacter reliabity).


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Nursing should orient other department headsand physicians to the use of PCSs. Admissionand placement of patient of patients are

related to PCS outcomes.Practicing nurses want the PCS to provide

more staff. Managing nurses want to use it tovalidate staffing and scheduling and permitvariable staffing. These objectives must be keptin harmony.


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MODIFIED APPROACHES TO NURSESTAFFING AND SCHEDULING

Manny different approaches to nurse staffing and scheduling are being tried in an effort tosatisfy the needs of employees and meet

workload demands for patient care.Staffing and scheduling are reasons for

employee turnover and job retention.Understaffing has a negative effect on staff morale, delivery of quality care, and the nursing practice modality.


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MODIFIED W ORK W EEKS Modified workweek schedules using 10 and

1 2 hours shifts and other methods arecommonplace. A nurse administrator should

be sure the work schedules are fulfilling thestaffing philosophy and policies, particularlywith regard to efficiency.

The four day, 10 hours work schedule fornight nurses was studied in a hospital thathad difficulty recruiting qualified nurses tothe night shift.


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Cont..The twelve hour shift, a second scheduling modification is the twelve hour shift, on whichnurses work seven shifts in 2 weeks: 3 on, 4

off, 4 on, 3 off. They work a total of 8-4 hoursand are paid 4 hours overtime. 1 2-4 shifts andflexible staffing have been reported to haveimproved care and saved money becausenurses can manage their home and personallives better.


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Cont..The weekend alternative, another variation of flexible scheduling is the weekend alterative.Nurse work two 1 2 hour shifts and are paid for

forty hours plus benefits. They are use theweekdays to go to school or for other personalneeds. The weekend schedule has severalvariations. Monday through Friday nurses haveall weekends off.


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OTHER MODIFIED APPROACHES

a study by Imig, Powell, and Thorman indicated

that while flexible staffing filled vacant positions, it

did not increase payroll costs, hours per patient

day, or overtime, and it decreased absenteeism by6 0 percent.


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In this particular study, there was no change

in medication errors, patient and staff

injuries, quality of care plans, complaints,recruitment, and staff attitudes from before

to six months after flexible staffing.


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FLEXIBLE ROLE : RESOURCE ACUITYNURSE

Top nurse executives established a resource

acuity nurse position to provide greater

flexibility and assure adequate staffing

during peak workload periods.


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The nurse managers developed guidelinesfor undertaking the following resource acuitynurse responsibilities :

Assisting with such special procedures ascentral line placement and extensive dressing

changes Supporting nursing staff whenever a number of

patients were returning from the operating room Assisting in cardiac arrests or other emergencies Transferring unstable patients to the intensive

car units.


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FLEXIBLE HOURS

Other flexible hours program are used at thefollowing :

Metropolitan life- 9 0 % of 28 000 administrativeemployees can begin work between 7:3 0 a.mand 10 :00 a.m.

American expresss travel group- employeesbenefit from job sharing, shorter workweeks,

and telecommuting. Federal expresss treasury and credit

departments one third of the employees work athome.


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NEGATIVE ASPECT

The following are days :1 . Minimum weekend staffing (or excess staff on

weekends)2. Unsafe travel times3. Shift overlaps that decrease total number of

personnel on duty

4. Costs for overtime5. fatigue some of the disadvantages of ten-and twelve-hour


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6. strain on family life

7. Increased staffing from loss of shifts if schedule is not carefully planned.8. Possible requirement by state law to pay

overtime pay for hours worked in excess of

eight in a day and forty in a week9. Less continuity of care10 . Less communication among staff

11 . developing, maintaining, and explaining the master schedule.1 2. Modification of primary assesing.


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Experts suggest the following ways to better handleworking late or rotating shifts :

Use consistency in working shifts, work one shift all thetime if possible.

Rotate shift clockwise, one shift for a week, forth eighthours between changing shifts

Avoid caffeine, alcohol, nicotine, or other sleepdisturbing chemicals for several hours before bedtime.

Follow the workday routine on days off as much aspossible

Prepare for a new shift by splitting time between sleepand wakefulness

Shade eyes on long drives to and from work.


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CROSS TRAINING

Cross training of nursing personnel canimprove flexible scheduling. Nurses can beprepared through cross training to functioneffectively in more than one area of expertise.They can be kept in similar clinical specialtiesor in families of clinical specialties. During

cross training, they require completeorientation and ongoing staff development toprevents errors and increase job satisfaction.


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This can be done for both unit assignednurses and pool nurses. Nurses should beprovided with policies, job description, and

performance evaluations. Nurse pools canbe in house supplemental staffing agenciesthat use full time and part time nurses.Benefits can be prorated, or employees canchoose between increased pay and benefits.


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TEMPORARY W ORKERS

Nurses have been working as temporaryemployees for two decades or more. Theyhave gone to staffing agencies because they

want control over their lives, personal andprofessional. Temporary work was the onlyway they could get such control until nursemanagers and hospital administratorsrealized the need to apply the science of behavioral technology, including humanresource management, to nursing.

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