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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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