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					Staffing
   And
Scheduling
                Definitions
• Nurse to patient ratio: Number of patients
  cared for by one nurse typically specified by
  job category. This varies by shift and nursing
  unit; some researchers use
• Total nursing staff or hours per patient
  day: All staff or all hours of care including
  RN, LVN, aides counted per patient day.
• (Patient day ):is the number of days any one
  patient stays in the hospital.
• Nursing skill (or staff) mix:The proportion
  or percentage of hours of care provided by
  one category of caregiver divided by the
  total hours of care .
(A 60% RN skill mix indicates that RNs
  provide 60% of the total hours of care)
Determination Of Staffing Needs
DIRECT CARE: is the time spent providing
 hands on care to patients.
INDIRECT CARE: is the time spent on activities
 that are patient-related but are not done directly to
 the patients.
Nursing Hour Per Patient Per Day: is a standard
 measure that quantifies the nursing time available
 to each patient by available staff.
NHPPD reflects only productive nursing time
 available.
Models of nursing care delivery
              Case Method
• take one patient and care for all of their
  needs .
• The consequences of teaching nursing this
  way was that reality shock hit upon
  graduation when the new graduate critical
  care areas, labor and delivery, or any area
  where one nurse cares for one patient’s total
  needs.
             Case Method
• Advantages:
• RNS were self-employed
  Patient needs were quickly met
  Close relationship between the RN and the
  patient
• Disadvantages: Cost! RNs are expensive! :-)
             Primary Method
• This model is that one nurse cares for one group of
  patients with 24 hour accountability for planning
  their care.
• This is a decentralized delivery model: more
  responsibility and authority is placed with each
  staff nurse. It has been debated whether PN is a
  cost-effective model.
• Primary Nurse (PN) cares for her primary patients
  every time she works and for as long as the patient
  remains on her unit.
             Primary Method
• ADVANTAGES:
• Increased satisfaction for patients and nurses.
• More professional system: RN plans and
  communicates with all disciplines as more
  knowledgeable and responsible.
• RNs more satisfied because they continue to learn
  as a function of the in-depth care they are required
  to deliver.
• DISADVANTAGES
• Intimidating for new graduates who are less
  skilled and knowledgeable.
                Team Method
• The goal of the Team method is for a team to
  work democratically.
• In the ideal team, an RN is assigned as a Team
  Leader for a group of patients. The Team Leader
  has a cadre of staff reporting to her and together
  they work to disseminate the care activities. The
  team member possessing the skill needed by the
  individual patient is assigned to that patient, but
  the Team Leader still has accountability for all of
  the care.
• Team Leader must be both a skilled clinician and
  an effective group leader.
• Each member’s capabilities are maximized so job
  satisfaction should be high.
• Patients have one nurse (the Team Leader) with
  access to other providers
• Disadvantages
• Requires a team spirit and commitment to
  succeed.
• RN may be the Team Leader one day and a team
  member the next, thus continuity of patient care
  may suffer.
• Care is still fragmented with only 8 or 12 hour
  accountability.
           Modular nursing
• Modular nursing effectively combines many
  models of nursing care, enabling
  comprehensive care of individual clients. It
  promotes professional practice, high levels of
  autonomy and accountability.
• Combination between team and primary
  methods
• It ensures that nurses are able to work at
  their level of skill and competence in
  providing care to meet the varied needs of
  individual clients.
    Description of Modular Nursing
           Clinical Practice
• All clients are assigned within a module and
  to a particular nurse when they are admitted.
• Each module is made up of a group of nurses
  and their allocated clients.
• The number of clients per module and the
  number of modules are determined by the
  overall ward occupancy at any given time.
• Team or Functional Nursing Care: A model
 using the RN as a team leader and LVNs/UAPs to
 perform activities such as bathing, feeding.


• Magnet Hospital Environment: Shared
 governance, Characterized as "good places for
 nurses to work" and includes a high degree of RN
 autonomy, MD-RN collaboration, and RN control
 of practice; allows for shared decision making by
 RNs and managers.
          Functional Method
• the Task Method .
• nursing was essentially divided into tasks, a
  model that proved very beneficial when
  staffing was poor.
           Functional Method
• Advantages
• A very efficient way to delivery care. Could
  accomplish a lot of tasks in a small amount of time
  Staff did what only they were capable to do: no
  extraneous work was added that could be done by
  assistive personnel.
• disadvantages
• Care of persons became fragmented.
• Patients did not have one identifiable nurse and
  the nurse had no accountability.
• Very narrow scope of practice for RNS.
• Lead to patient and nurse dissatisfaction
    Nursing Case Management
• are Case Managers or are members of Care
  Management Teams – interdisciplinary groups
  that meet regularly to monitor patient’s progress
  through the health care system.
• Nursing case managers are
  empowered to identify the best
  patient outcomes and for mobilizing
  the resources to achieve those
  outcomes in a preset time frame.
 Evidence that relates patient outcomes
1)specific numbers, proportions, or ratios of
   nurses to patients (nurse staffing);
 The number of hours nurses spend with patients.
 Census of nurses to patients at a particular point
   in time.
2) specific organization of nursing care delivery,
   nursing models of care, or organizational
   culture.
 Nursing care delivery models.
 Hospital culture and governance structures.
 autonomy and communication
 Evidence that relates patient outcomes

3)specific nursing interventions.
4) education, training, or retraining of nurses,
  providing audit data to nurses, and
5) assessment of patient outcomes.
   Patient classification system
• Patient classification system :Measurement
  tool used to determine the nursing workload
  for a specific patient or group of patients
  over a specific period of time.
• Patient acuity: is the measure of nursing
  workload that is generated for each patient
APPROACHES TO NURSE
SCHEDULING SUPPORT

  THEORETICAL QUALITY
   ASPECTS OF NURSING
       SCHEDULES
•   Facilitation of high-quality nursing care.
•   Facilitation of efficient nursing care.
•   Facilitation of job satisfaction .
•   Supporting multiple views on nursing
    schedule quality .
    Nurse scheduling problem
• The Nurse scheduling problem (NSP) is
  the problem of determining a work schedule
  for nurses that is both reasonable (or fair)
  and efficient.
               Constraints

• Hard constraints: if this constraint fails then
  the entire schedule is invalid.
• Soft constraints: it is desirable that these
  constraints are met but not meeting them
  doesn't make the schedule invalid.
     What is self scheduling in
             Nursing?
• “A process in which staff on a unit
  collectively develop and implement the
  work schedule.”
      Goals of self scheduling
1)Self scheduling increases staff autonomy
through control over their own schedules.
2) Self scheduling promotes staff retention by
providing flexibility
3) Self scheduling decreases staff absenteeism.
4) Self scheduling also supports team development
through a heightened
sense of accountability to one another as
negotiations amongst staff takes place.
              Productivity
• Productivity in economics refers to
  measures of output from production
  processes, per unit of input. Labor
  productivity, for example, is typically
  measured as a ratio of output per labor-
  hour, an input.

				
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posted:9/23/2011
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