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Staffing

Staffing is the process of determining and providing the acceptable number and mix of
nursing personnel to produce a desired level of care to meet the patients demand
Purpose
The purpose of all staffing activities is to provide each nursing unit with an appropriate
and acceptable number of workers in each category to perform the nursing tasks
required. Too few or an improper mixture of nursing personnel will adversely affect the
quality and quantity of work performed. Such situation can lead to high rates of
absenteeism and staffs turn-over resulting in low morale and dissatisfaction.
Factors Affecting Staffing
1. the type, philosophy, objectives of the hospital and the nursing service.
2. the population served or kind of patients served whether pay or charity.
3. the number of patients and severity of their illness-knowledge and ability of
nursing personnel are matched with the actual care needs of patients
4. availability and characteristics of the nursing staff, including education, level of
preparation, mix of personnel, number and position.
5. administrative policies such as rotation, weekends, and holiday off-duties.
6. standards of care desired which should be available and clearly spelled out.
7. layout of various nursing units and resources available within the department such
as adequate equipment, supplies, and materials
8. budget including the amount allotted to salaries, fringe benefits, supplies,
materials and equipment
9. professional activities and priorities in nonpatient activities like involvement I
professional organizations, formal educational development, participation in research
and staff development.
10. teaching program or the extent of staff involvement in teaching activities.
11. expected hours of work per annum of each employee. This is influenced by
40 hour week law.
12. patterns of work schedule-traditional 5 days per week, 8 hours per day; 4
days a week, ten hours per day and three days off; or 3 days of 12 hours per day
and 3 days off per week.
Planning for Staffing and Acting to Resolve Current Nursing Shortage
Planning is the major leadership role in staffing and is often a neglected part of the
staffing process. Because the success of many staffing decisions greatly depends on
previous decisions made in planning and organizing phases, one must consider staffing
when making other plans. Consideration must be given to the type of patient care
management used, the education and knowledge level of the staff to be recruited,
budget constraints, the historical background of staffing needs and availability, and the
diversity of the patient population to be served.
Accurate predicting staffing needs is valuable management skill because it enables
the manager to avoid staffing crises. Managers should know the source of their nursing
pool, how many students are currently enrolled in local nursing schools, the usual length
of employment of new hires, peak staff resignation periods, and times when patient
census is highest. Analyzing historical patterns, using computers to sort personnel
statistics and keeping accurate unit records are example of proactive planning.
Federal moneys for nursing education have increased. The passage of legislation,
such as the 2002 Nurse Reinvestment Act, has encouraged more students to choose
nursing as a career and helps students financially to complete their education. It also
encourages graduate students to complete their studies and assume teaching positions
in nursing schools.
Some experts suggest however, that too much emphasis is placed on recruiting
new nurses to solve the current shortage and that supply could more easily be increased
by bringing unemployed or part-time nurses back to nursing full-time or by enticing
nurses back into nursing who are now working in non-nursing position.
Other expert suggests more attention be given to retaining older workers or
bringing retired nurses back into the workforce. Cyr (2005) agrees, suggesting that while
many nurses retire because they are financially independent, some would consider
delaying retirement if the work environment were altered to support older nurses. Others
suggest that employer must be able to accommodate aging workers with technology
aimed at reducing physical strain. Other strategies suggested retaining aging nurses
include flexible scheduling and benefits, continuing education aid and wellness program.
Another short term solution to the current shortage has been the importation of
foreign nurses, particularly by developed countries from developing countries. While
such importation can result in positive global economic, social, professional
development, many of the donor countries, who can least afford it, are experiencing a
substantial brain and skills drain.
Long-term solution to a shortage of staff is cross-training. Cross-training involves
giving personnel with varying educational backgrounds and expertise the skills
necessary to take on tasks normally outside their scope of work and to move between
units and function knowledgeable.
However, staffing shortages frequently occur on a day-to-day basis. These occur
because of an increase in patient census, an unexpected increase in client needs or an
increase in staff absenteeism or illness. Health care organizations have used many
methods to deal with an unexpected short supply of staff. Chief among the solutions are
closed-unit staffing, drawing from a central pool of nurses for additional staff, requesting
volunteers to work extra duty, and mandatory overtime.
Closed-unit staffing occurs when the staff members on a unit make a commitment
to cover all absences and needed extra help themselves in return for not being pulled
from the unit in times of low census. In mandatory overtime, employees are forced to
work additional shifts, often under threat of patient abandonment, should they refuse to
do so. Some hospitals routinely use mandatory overtime in an effort to keep fewer
people on the payroll.
A health care worker who is in an exhausted state represents a risk to public
health and patient safety. Working overtime increases the odds of nurses in making
errors. While mandatory overtime is neither efficient nor effective in a long term, it has
an even more devastating short-term impact with regard to staff perceptions of a lack of
control and its subsequent impact on mood, motivation, and productivity. Nurses who
are forced to work overtime do so under the stress of competing duties-to their job, their
family, their own health, and their patients safety.
However, Manthey suggests that nurses themselves, as well as employing
organizations, need to become smarter about workload issues. She maintains that
intermittent peak workload issues should not be solved by adding personnel but should
be solved by prioritizing what can get done in a shift that will meet patient critical needs
and learning what is not critical to be done.
Recruiting and Selecting Staff
Recruiting
Recruitment is the process of actively seeking out or attracting applicants for
existing positions. It should be an ongoing process in order to meet demand and provide
adequate supply of nurses at any given time.
The nurse manager may be greatly or minimally involved in recruiting interviewing
and selecting personnel depending on (a) the size of the institution, (b) the existence of
a separate personnel department, (c) the presence of a nurse recruiter within the
organization, and (d) the use of centralized or decentralized nursing department.
Generally speaking, the more decentralized nursing management and the less
complex personnel department, the greater the involvement of lower-level managers in
selecting personnel or individual units or departments. When deciding whether to hire a
nurse-recruiter or decentralize the responsibility for recruitment, the organization needs
to weigh benefits against costs. Costs include more than financial considerations. For
example, an additional cost to an organization employing a nurse-recruiter might be the
eventual loss of interest by managers in the recruiting process. The organization loses if
managers relegate their collective and individual responsibilities to the nurse recruiter.
Recruiting adequate number of nurses is less difficult if the organization is located
in a progressive community with several schools of nursing and if the organization has a
good reputation for quality patient care and fair employment practices.
Because most recruiting methods are expensive, health care organizations often
seek less costly means of recruitment. One of the best ways to maintain an adequate
employee pool is by word of mouth; the recommendation of the organizations own
satisfied and happy staff. Recruitment, however, is not the key to adequate staffing in
the long term. Retention is and only occurs when the organization is able to create a
work environment that makes staff want to stay.
Some turnover, however, is normal and, in fact, desirable. Turnover infuses the
organization with fresh ideas. It also reduces the probability of groupthink, in which
everyone shares similar thought processes, values, and goals. However, excessive or
unnecessary turnover reduces the ability of the organization to produce its end product
and is expensive.
Clearly, the manager must recognize the link between retention and recruitment.
Atencio and colleagues (2003) suggest that the social climate of the workplace is the
primary initiator of a nurses intent to stay or leave and that this social climate may
reflect either work frustration or work excitement. Similarly, Lynn and Redman (2005)
suggest that retention programs must focus on both organizational commitment and
work and professional satisfaction. The middle level manager has the greatest impact in
addressing these concerns and creating a positive social climate.
In addition, the closer the fit between what the nurse is seeking in employment
and what the organization can offer, the greater the chance that the nurse will be
retained.
Interviewing
An interview may be defined as a verbal interaction between individuals for a
particular purpose. Although other tools such as testing or reference checks may be
used, the interview is frequently accepted as the foundation for hiring. The purpose or
goals of te selection interview are threefold: (a) the interviewer seeks to obtain enough
information to determine the applicants suitability for the available position; (b) the
applicant obtains adequate information to make an intelligent decision about accepting
the job, should it be offered; and (c) the interviewer seeks to conduct the interview in
such a manner that regardless of the interviews result, the applicant will continue to
have respect for and goodwill toward the organization.
Types of Interview:
Unstructured interview requires little planning because the goals for hiring may be
unclear, questions are not prepared in advance, and often the interviewer does more
talking than the applicant.
Structured interview requires greater planning time because questions must be
developed in advance that address the specific job requirements, information must be
offered about the skills and qualities being sought, examples of the applicants
experience must be achieved, and the willingness or motivation of the applicant to do
the job must be determined. The interviewer who uses a structured format would ask the
same essential questions of all applicants.
Limitations of Interviews
The major defect of interview is subjectivity. Most interviewers feel confident that
they can overcome this subjectivity and view the interview as a reliable selection tool,
whereas most interviews still have an element of subjectivity. The applicant, trying to
create a favorable impression, also may be unduly influenced by the interviewers
personality.
As a predictor of job performance and overall effectiveness, the structured
interview is much more reliable that the unstructured interview.
Overcoming Interview Limitations
Prepare for the Interview
Asselin (2006) suggests that managers should have a complete and clear
understanding of the open position before the interviewing candidate. This includes
obtaining a copy of the job description and knowing the educational and experiential
requirements for the position. The manager should also create a list of competencies
that are essential for success on the job as well as the professional values,
characteristics, and behaviors that are most likely to ensure success in the position.
Use Team Approach
Having more than one person interview the job applicant reduces individual bias. Staff
involvement in hiring can be viewed on a continuum from no involvement to a team
approach, using unit staff for hiring decisions.
Develop A Structured Interview Format for Each Job Classification
Because each job has different position requirements, interviews must be structured to
fit the position. The same structured interview should be used for all employees applying
for the same job classification. The structured interview is advantageous because it
allows the interviewer to be consistent and prevents the interview from becoming side-
tracked.
Use Scenarios to Determine Decision-Making Ability
In addition to obtaining answers to a particular set of questions, the interview also should
be used to determine the applicants decision-making ability. This can be accomplished
by designing scenarios that require problem-solving and decision-making skills. The
same set of scenarios should be used with each category of employee
Conduct Multiple Interviews
Candidates should be interviewed more than once on separate days. This prevents
applicants from being accepted or rejected merely because they were having a good or
bad day. Regardless of the number of interviews held, the person should be interviewed
until all the interviewers questions have been answered, and they feel confident that
they have enough information to make the right decision.
Provide Training in Effective Interviewing Techniques
Training should focus on communication skills and advice on planning, conducting, and
controlling the interview. It is unfair to expect a manager to make appropriate hiring
decisions if he or she has never had adequate training in interview techniques. Unskilled
interviewers often allow subjective data rather than objective data affect their hiring
evaluation. In addition, unskilled interviewers may ask questions that could be viewed as
discriminatory or that are illegal.
Planning, Conducting, and Controlling the Interview
Planning the interview in advance is vital to its subsequent success as a selection tool. If
other interviewers are to be present, they should be available at the appointed time. The
plan also should include adequate time for the interview. Before the interview, all
interviewers should review application, noting questions concerning information supplied
by the applicant. Although it takes considerable practice, consistently using a planned
sequence in the interview format will eventually yield a relaxed and spontaneous
process. The following is a suggested interview format:
1. Introduce yourself, and greet the applicant.
2. Make a brief statement about the organization and the available positions.
3. Ascertain the position for which the person is applying.
4. Discuss the information on the application, and seek clarification or
amplification as necessary.
5. Discuss employee qualifications and proceed with the structured interview
format.
6. If the applicant appears qualified, discuss the organization and the position
further.
7. Explain the subsequent procedures for hiring, such as employment physicals,
and hiring date. If the applicant is not hired at this time, discuss how and when he or
she will be notified of the interview results.
8. Terminate the interview.
The interviewer should have control of the interview and set the tone. During the
meeting, the manager should pause frequently to allow the applicant to ask questions.
The format should always encourage ample time for questions from the applicant.
The following are methods that help to reach the goals of the interview:
Ask only job-related questions.
Use open-ended questions that require more than a yes or no answer.
Pause a few seconds after the applicant has seemingly finished before asking the
next question. This gives the applicant a chance to talk further.
Return to topics later in the interview on which the applicant offered little
information initially.
Ask only one question at a time.
Restate part of the applicants answer if you need elaboration.
Ask questions clearly, but do not verbally or nonverbally indicate the correct
answer. Otherwise, by watching the interviewers eyes and observing other body
language, the astute applicant may learn which answers are desired.
Always appear interested in what the applicant has to say. The applicant should
never be interrupted, nor should the interviewers words ever imply criticism of or
impatience with he applicant.
Language should be used that is appropriate for the applicant. Terminology or
language that makes applicants feel the interviewer is either talking down to them or
talking over their heads is inappropriate.
A written record of all interviews should be kept. Note taking ensures accuracy and
serves as a written record to recall the applicant. Keep note taking or use of a
checklist, however, to a minimum so that you do not create an uncomfortable climate.
Ten Tips to Boost Interview IQ
1. Practice Good Nonverbal Communication.
2. Dress for the Job or Company
3. Listen
4. Don't Talk Too Much
5. Don't Be Too Familiar
6. Use Appropriate Language
7. Don't Be Cocky
8. Take Care to Answer the Questions
9. Ask Questions
10. Don't Appear Desperate
Interviewing Tips for the Applicants
1. Prepare in advance for the interview.
2. Obtain copies of the philosophy and organization chart of the organization to which
you are applying.
3. Schedule an appointment for the interview.
4. Dress professionally and conservatively.
5. Practice responses to potential interview questions in advance.
6. Arrive early on the day of the interview.
7. Greet the interviewer formally, and do not sit down before he or she does unless
given permission to do so.
8. Shake the interviewers hand upon entering the room and smile.
9. During the interview, sit quietly, be attentive, and take notes only if absolutely
necessary.
10. Do not chew gum, fidget, slouch, or play with your hair, keys, or writing pen.
11. Ask appropriate questions about the organization or the specific job for which
you are applying.
12. Avoid a what can you do for me? approach, and focus instead on whether
your unique talents and interests are a fit with the organization.
13. Answer interview questions as honestly and confidently as possible.
14. Shake the interviewers hand at the close of the interview, and thank him or
her for his or her time.
15. Send a brief, typed thank-you note to the interviewer within 24 hours of the
interview.
Interview Evaluation
Interviewers should plan post-interview time to evaluate the applicants interview
performance . Interview note should be reviewed as soon as possible and necessary
points clarified or amplified. Using a form to record the interview evaluation is good idea.
The final question on the interview report form is a recommendation for or against hiring.
In answering this question, two aspects must carry the most weight:
The requirements for the job. Regardless of how interesting or friendly people are,
unless they have the basic skills for the job, they will not be successful at meeting the
expectations of the position. Likewise, those overqualified for a position will usually be
unhappy in the job.
Personal bias. Because completely eliminating the personal biases inherent in the
interview is impossible, it is important for the interviewer to examine any negative
feelings that occurred during the interview. Often, the interview discovers that the
negative feelings have no relation to the criteria necessary for success in the position.
Selection
Selection is the process of choosing from among the applicants the best-qualified
individual or individuals for a particular job or position. This process involves verifying
the applicants qualifications, checking his/her work history, and deciding of a good
match exists between the applicants qualifications and the organizations expectations.
Educational and Credential Requirements
Consideration should be given to educational requirements and credentials for
each job category as long as a relationship exists between theses requirements and
success on the job.
Reference Checks
All applications should be examined to see if they are complete and to ascertain
that the applicant is qualified for the position. At this point, references are requested,
and employment history is verified. According to Asselin (2006), the manager should
always be cognizant of red flags in applications such as unexplained gaps in
employment history or frequent changes of employer without acceptable explanation.
Positions should never be offered until information on the application has been verified
and references have been checked.
Pre-employment Testing
Pre-employment testing is used only when such testing is directly related to the
ability to perform a specific job. Although testing is not a stand-alone selection tool, it
can, when coupled with excellent interviewing and reference checking, provide
additional information about a candidate to make the best selection.
Physical Examination as a Selection Tool
A medical examination is often a requirement for hiring. This examination
determines if the applicant can meet the requirements for a specific job and provides a
record of the physical condition of the applicant at the time of hiring. The physical
examination also may be used to identify applicants who will potentially have
unfavorable attendance records or may file excessive future claims against the
organizations health insurance.
Finalizing the Selection
The closure of pre-employment process is as follows:
1. Follow up with applicants as soon as possible, thanking them for applying and
informing them when they will be notified about a decision.
2. Candidates not offered a position should be notified of this as soon as possible.
Reasons should be provided when appropriate, and candidate should be told whether
their application will be considered for future employment or if they should reapply.
3. Applicants offered a position should be informed in writing of the benefits, salary,
and placement. This avoids misunderstandings later regarding what employees think
they were promised by the nurse-recruiter or the interviewer.
4. Applicants who accept the job offers should be informed as to pre-employment
procedures such as physical examinations and supplied with the date to report to
work.
5. Applicants who are offered positions should be requested to confirm in writing their
intention to accept the position.
Placement
The astute leader is able to assign a new employee to a position within his or her
sphere of authority where the employee will have a reasonable chance for success.
Nursing units and departments develop subcultures that have their own norms, values,
and methods of accomplishing work. It is possible for one person to fit in well with an
established group, whereas another equally qualified person would never become part of
this group.
Conversely, proper placement fosters personal growth, provides a motivating
climate for the employee, maximizes productivity, and increases the probability that
organizational goals will be met. Managers who are able to match employee strengths to
job requirements facilitate unit functioning, accomplish organizational goals, and meet
employee needs.
Indoctrination
Indoctrination refers to the planned, guided adjustment of an employee to the
organization and the work environment. Although the words induction and
orientation are frequently used to describe this function, the indoctrination process
includes three separate phases: induction, orientation, and socialization.
Indoctrination seeks to (a) establish favorable employee attitudes toward the
organization, unit, and department; (b) provide the necessary information and education
for success in the position; and (c) instill a feeling of belonging and acceptance. The
employee indoctrination process begins as soon as person has been selected for a
position and continues until the employee has been socialized to the norms and values
of the work group.
Employee Indoctrination Content:
1. Organization history, mission, and philosophy
2. Organization service and service area
3. Organizational structure, including department heads, with an explanation of the
functions of the various departments
4. Employee responsibilities to the organization
5. Organizational responsibilities to the employee
6. Payroll information, including how increases in pay are earned and when they are
given (progressive or unionized companies publish pay scales for all employees)
7. Rules of conduct
8. Tour of the facility and of the assigned department
9. Work schedules, staffing and scheduling policies
10. When applicable, a discussion of the collective bargaining agreement
11. Benefit plans, including life insurance, health insurance, pension, and
unemployment
12. Safety and fire programs
13. Staff development programs, including in-service and continuing education
for relicensure.
14. Promotion and transfer policies
15. Employee appraisal system
16. Workload assignments
17. Introduction to paperwork/forms used in the organization
18. Review of selection in policies and procedures
19. Specific legal requirements, such as maintaining a current license, reporting
of accidents, and so forth
20. Introduction to fellow employees
21. Establishment of a feeling of belonging and acceptance, showing genuine
interest in the new employee
Induction
Induction, the first phase of indoctrination, takes place after the employee has
been selected but before performing the job role. The induction process includes all
activities that educate the new employee about the organization and employment and
personnel policies and procedures.
Employee handbooks, an important part of induction, are usually developed by the
personnel department. Managers, however, should know what information the employee
handbooks contain and should have input into their development. Most employee
handbooks contain a form that must be signed by the employee, verifying that he or she
has received and read it. The signed form is then placed in the employees personnel
file.
The handbook is important because employees cannot assimilate all the induction
information at one time, so they need a reference for later. However, providing an
employee with a personnel handbook is not sufficient for real understanding. The
information must be followed with discussion by various people during orientation. The
most important link in promoting real understanding of personnel is the first-level
manager.
Orientation
Orientation provides information about the activities more specific for the position.
The purpose of the orientation process is to make the employee feel like a part of the
team. This will reduce burnout and help new employees become independent more
quickly in their new roles.
Sample of Line-up of Activities Done in Orientation
- Welcome by personnel department; employee handbooks distributed and
discussed
- General Orientation by staff development
- Tour of the Organization
- Fire and safety films, body mechanics demonstration
- Introduction to each unit supervisor
- Report to individual units (time with unit supervisor and introduction to
assigned preceptor)
- General orientation of policies and procedures
- CPR recertification
- Work with preceptor on shift and unit assigned, gradually assuming greater
responsibilities
- Carry normal workload aster a week. Have at least a 30-minute meeting with
immediate supervisor to discuss progress.
Socialization and Resocialization
Socializing new nurses into the healthcare culture will help retain them.
- Sandy Keefee, MSN, RN
Role Theory
- The phenomenon of socialization has generally focused on this theory
- Explains that behaviors that accompany each role are learned socially and by
instruction, observation and trial and error
Socialization
- First occurs during nursing school and after graduation
- Because nurse administrators and nursing faculty have found to hold different
values and both this groups assist in socializing the new nurse, there is potential for the
new nurse to develop conflict and frustration.
Resocialization
- Occurs when individuals are forced to learn new values, skills, attitudes and social
rules as a result of changes in the type of work they do, the scope of responsibility they
hold, or in the work setting itself
- Individuals who need resocialization include new graduates leaving school and
entering the work world; experienced nurses who change work settings, either within
the same organization or in the new organization; and nurses who undertake new roles.
- Some employees adapt easily to resocialization, but most experience stress with
the role change.
Overcoming Motivational Deficiencies
- Difficulties in socialization and resocialization occurs because of motivational
deficiencies
- There are 2 ways to correct motivational deficiencies: positive and negative
sanctions
Positive Sanctions
- Can be used as an interactional or educational process
- The reference group sets of norms of behavior and then applies sanctions to
ensure that new members adopt the group norms before acceptance in the group.
- Managers should become aware of what role behavior they reward and what new
employee behavior the senior staff is rewarding.
Negative Sanctions
- They are like rewards
- Provide cues that enable the people to evaluate their performance consciously and
to modify behavior when needed
- They are often applied in very subtle and covert ways
- They should be constructive and not destructive
Employees with unique socialization needs
- Managers who provide appropriate socialization assistance for these groups
increase the chance of positive employment outcome
O The New Nurse
- Reality Shock was coined by Kramer (1974) which described fears and
difficulties in adapting to work setting that are common to new graduate nurses; it
occurs as a result of conflict between a new graduate nurses expectations of the
nursing role and the reality of actual role in the work setting
- Four phases of role transition from student nurse to staff nurse:
honeymoon phase, shock, recovery and resolution phase.
- Roles of nurse managers in combating reality shock:
Nurse Managers should not rely in anticipatory socialization prepared by nursing
schools.
They should be alert for signs and symptoms of the shock phase of role
transition.
They should also ensure that some of the new nurses values are supported and
encouraged so that work and academic values can blend.
O International Nurses
- One solution to current nursing shortage (applicable only to U.S.)
- Ryan (2003) suggests that socialization to the professional nursing role is one of
four basic needs that must be addresses if foreign nurses are to adapt successfully
to American workplaces.
- Bola, Driggers, Dunlap, and Ebersole (2003) state that international nurses also
frequently experience culture shock regarding nonverbal communication that may
interfere with their assimilation.
- Ryan (2003) suggests that using a Cultural Diversity Enhancement Group (CDEG)
and a buddy program may assist in socializing these international nurses; includes
staff nurses and management personnel from varied ethnic backgrounds who
agreed to buddy with the international nurses to make them feel welcomed in the
organizational culture.
- Dumpel (2005) says that international nurses need the same socialization as other
transition groups such as mentors and preceptors, support groups and other
orientation programs.
O New Managers
- Sullivan, Bretschneider, and McCausland (2003) found that many new managers
perceived themselves as lacking basic and introductory managerial skills related to
communication, conflict resolution, role transitioning, scheduling, budgeting and
payroll management, performance evaluation, and staff counseling which result in
management errors.
- The direction a new manager needs comes from several sources within
the organization which includes:
The new managers immediate superior
A group of the new mangers peers
A mentor
- Role ambiguity- describes the stress that occurs when job expectations are
unclear
- Role Overload- occurs when the demands of the role are excessive
O The Experienced Nurse in the New Position
Transition from expert to novice
- a very difficult role transition
- Many nurses transfer or change jobs because they can no longer find their present
job challenging
Transition from familiar to unfamiliar
- In the old surroundings, the employee knew everyone and where everything was
located. In the new position, the employee will not be only learning new job skills
but also be in an unfamiliar environment.
- Specialized orientation material should be developed and necessary staff
development orientation programs should be provided
O Assisting the Experienced Nurse in Role Transition
- Managers should not assume that the experienced nurse is aware of the new roles
expected attitudes.
- Managers need to support employees during this value resocialization.
Clarifying Role Expectations through Role Models,Preceptors and Mentors
In looking for a role model, I didnt have to go far.
- William M. Keane Jr.
Role Model
- Defined as someone worthy of imitation
- They are experienced, competent employees
- One of the exciting aspects of role models is their cumulative effect. The greater
the number of excellent role models available for new employees to emulate, the
greater the possibilities for new employees to perform well.
Preceptor
- An experienced nurse who provides knowledge and emotional support, as well as a
clarification of role expectations, on a one-on-one basis
- An effective preceptor can role model and adjust teaching to each learner as
needed.
Mentor
- Madison (2006) described mentoring as a distinctive interactive relationship
between two individuals, occurring most commonly in a professional setting.
- A mentor is able to instill the values and attitudes that accompany each role; often
a role model and visionary for the mentee.
- A preceptor is different from a mentor.
PRECEPTOR MENTOR
- Usually
assigned
- Freely choose
who they will
- Relatively
short
relationship
with the person
to whom they
were assigned
mentor
- Relationship is
longer and
more intense
Four phases in mentoring relationships:
1. Initiation occurs when the relationship is established
2. Cultivation characterized by coaching, protection and sponsorship as well as
counseling, acceptance and the creation of a sense of competence.
3. Separation ---
4. Redefinition Both are difficult, as the mentor and mentee may share different
perceptions about whether it is time to separate and what their new relationship
should be.
Validities and Legalities in Hiring
Healthcare facilities are more interested in hiring nursing students who can
think critically and organize than those who boast competencies, such as an
impressive number of injections given.
Lorraine Steefel, RN, MSN, CTN
Given the importance of a decision to hire, it is understandable that human
resources and first- level managers have sought refined methods to evaluate and screen
applicants. A wide variety of pre employment tests are used to determine which
candidate is best suited for a position.
Testing
- It has an impact on selection of employees
- If the employees to be hired fail the test in significantly greater percentages than
the overall failure rate, the employer using the test must prove that it is a valid
indicator of the abilities that are needed to perform the job
3 Forms of Validity in testing:
C Content Validity The test recreates or represents significant sample parts of the
job, such as typing tests.
C Construct Validity The test identifies a psychological or personality trait that is
important to successful performance, such as leadership or problem solving abilities.
C Criterion-related Validity The test contains elements on which anyone who would
do well on the job perform well or anyone who would do poorly on the job will perform
poorly.
Legal Aspects of Pre employment Inquiries
Subject of
Inquiry
It may not
be
discrimina
tory to
inquire
It may be
discrimina
tory to
inquire
about:
about:
1. Name Whether
applicant
has ever
worked
under a
different
name
a. Original
name of an
applicant
whose
name has
been
legally
changed
b. The
ethnic
association
of
applicants
name
2. Age a. If
applicant is
over the
age 18
b. If
applicant is
under the
age 18 or
21 if job
related
a.Date of
birth
b.Date of
high school
graduation
3.
Residence
a.
Applicants
place of
residence
where
employer is
located
a.Previous
addresses
b.Birthplac
e of
applicant
or
applicants
parents
4. Race or
color
a.Applicant
s race or
color of
applicants
skin
5.
National
origin and
ancestry
a.Applicant
s lineage,
ancestry,
national
origin,
parentage,
or
nationality
6. Sex
and
a. Sex of
applicant
Family
compositi
on
b.
Dependent
s of
applicant
c. Marital
Status
d. Child-
care
arrangeme
nts
7.Creed or
religion
a.Applicant
s religious
affiliation
b.Church,
parish, or
holidays
observed
8.
Citizenshi
p
a. Whether
the
applicant is
a citizen of
the United
States
b. Whether
the
applicant is
in the
country on
a visa that
permits
him or her
to work or
is a citizen
a.Whether
applicant is
a citizen of
the country
other than
the United
States
9.
Language
a.
Language
applicant
speaks and
or writes
fluently, if
job related
a.Applicant
s native
language;
language
commonly
used at
home
10.
Reference
s
a. Names
of people
willing to
provide
professiona
l and/or
a. Name of
applicants
pastor or
religious
leader
character
references
of the
applicant
11.
Relatives
a. Names
of relatives
already
employed
by the
employer
a.Name
and/or
address of
any relative
of applicant
b.Whom to
contact in
case of
emergency
12.
Organizati
ons
a.
Applicants
membershi
p in any
professiona
l, service or
trade
organizatio
n
a. All clubs
or social
organizatio
ns to which
applicant
belongs
13. Arrest
record
and
conviction
s
a.
Convictions
if related to
job
performanc
e
a. Number
and kinds
of arrests
b.
Convictions
unless
related to
job
performanc
e
14.
Photograp
hs
a.Photogra
phs with
application,
with
resume, or
before
hiring
15. Height
and
Weight
a.Any
inquiry into
height and
weight of
applicant
except
where a
bona fide
occupation
al
qualificatio
n
16.
Physical
limitation
s
a. Whether
applicant
has the
ability to
perform
job- related
functions
with or
without
accomodati
on
a.The
nature or
severity of
an illness
or the
individuals
physical
condition
b.Whether
applicant
has ever
filed a
workers
compensati
on claim
c.Any
recent or
past
operations
or surgery
dates
17.
Education
a. Training
applicant
has
received if
related to
job under
considerati
on
b. Highest
level of
education
attained, if
validated
that having
certain
educational
backgroun
d is
necessary
to perform
the specific
job
18.
Military
a. What
branch of
military
a. Type of
military
discharge
applicant
served in
b. Type of
education
or training
received in
the military
c. Rank at
discharge
19.
Financial
Status
a.Applicant
s debts and
assets
Hiring A Shared Responsibility
The question of who makes the final employment hiring from among screened
candidates is critical. Hiring remains an inexact science despite all the techniques that
have been developed and used. Ideally, the decision is made by the manager to whom
the new employee will report, with the advice and counsel of the human resources
department. This approach has the advantages that stipulated and necessary credential
requirements are met, organizational policies and employment laws are followed, and
individuals selected meet the quality standards and conform to its vales and culture.
Patient Care Classification System
The patient care classification system is a method of grouping patients according
to the amount and complexity of their nursing care requirements and the nursing time
and skill they require. This assessment can serve in determining the amount of nursing
care required, generally within 24 hours, as well as the category of nursing personnel
who should provide that care.
As a result, of patient classification systems (PCS), also known as workload
management, or patient acuity tools, were developed in the 1960s. Because other
variables within the system have an impact on nursing care hours, it is usually not
possible to transfer a PCS from one facility to another. Instead, each basic classification
system must be modified to specific institution.
Adomat and Hewison (2004) suggest that most PCSs can be classified as robust
measures for severity of illness. However, they maintain that although they are helpful,
they are not accurate tools for determining nurse-patient ratios, and that all PCS
measurement tools need nursing input if they are to measure nurse-patient needs
accurately.
There are several types of PCS measurement tools. The critical indicator PCS uses
broad indicators such as bathing, diet, intravenous fluids and medications, and
positioning to categorize patient care activities. The summative task type requires the
nurse to note for frequency of occurrence of specific activities, treatments, and
procedures for each patient. For example, a summative task-type PCS might ask the
nurse whether a patient required nursing time for teaching, elimination, or hygiene. Both
types of PCSs are generally filled out prior to each shift, although the summative task
type typically has more items to fill out than the critical incident or criterion type.
Once an appropriate PCS is adopted, hours of nursing care must be assigned for
each patient classification. Although an appropriate number of hours of care for each
classification is generally suggested by companies marketing PCSs, each institution is
unique and must determine to what degree that classification system must be adapted
to that institution. White (2003) suggests that average length of stay, and practitioner
specialty in defining its patient population. In addition, staff competency, core staff
versus visiting staff, and skill mix must be considered (White, 2003).
To develop a workable patient classification system, the nurse manager must
determine the following:
1. The number of categories into which the patients should be divided;
2. The characteristics of patients in each category;
3. The type and number of care procedures that will be needed by a typical patient in
each category; and
4. The time needed to perform these procedures that will be required by a typical
patient in each category.
The number of categories in a patient classification may range from three to four,
which is the most popular, to five or six. These classes relate to the acuity of illness and
care requirements, whether minimal, moderate, or intensive care. Other factors affecting
the classification system would relate to the patients capability to meet his physical
needs to ambulate, bathe, feed himself, and other instructional needs including
emotional support.
Patients care classifications have been developed primarily for medical, surgical,
pediatrics, and obstetrical patients in acute care facilities.
Classification Categories
The various units mat develop their own ways of classifying patient care according
to the acuity of their patients illness. Following is an example of a patient care
classification in the medical-surgical unit.
Level I Self Care or Minimal Care Patient can take a bath on his own, feed
himself, feed and perform his activities of daily living. Falling under this category are
patients about to be discharged, those in non-emergency, those newly admitted, do not
exhibit unusual symptoms, and requires little treatment/observation and/or instruction.
Average amount of nursing care hours per patient per day is 1.5. Ratio of professional
and non-professional nursing personnel is 55:45.
Level II Moderate Care or Intermediate Care Patients under this level need
some assistance in bathing, feeding, or ambulating for short periods of time. Extreme
symptoms of their illness must have subsided of have not yet appeared. Patients may
have slight emotional needs, with vital signs ordered up to three times per shift,
intravenous fluids or blood transfusion; are semi-conscious and exhibiting some
psychosocial or social problems; periodic and treatments, and/or observations and/or
instructions. Average nursing care hours per patient per day is 3 and the ratio of
professional to non-professional personnel is 60:40.
Level III Total, Complete or Intensive Care Patients under this category are
completely dependent upon the nursing personnel. They are provided complete bath,
are fed, may or may not be unconscious, with marked emotional needs, with vital signs
more than three times per shift, may be on continuous oxygen therapy, and with chest
or abdominal tubes. They require close observation at least every 30 minutes for
impending hemorrhage, with hypo or hypertension and/or cardiac arrhythmia. The
nursing care hours per patient per day is 6 with a professional to non-professional ratio
of 65:35.
Level IV Highly Specialized Critical Care Patients under this level need
maximum nursing care with a ratio of 80 professionals to 20 non-professionals. Patients
need continuous treatment and observation; with many medications, IV piggy backs;
vital signs every 15-30 minutes; hourly output. There are significant changes in doctors
orders and care hours per patient per day may range from 6-9 more, and the ratio of
professionals to non-professionals also ranges from 70:30 to 80:20.
Patient Care Classification Using Four Levels of
Nursing Care Intensity
Area of Care Category 1 Category 2 Category 3 Category 4
Eating Feeds self or
needs little
food
Needs some
help in
preparing
food tray;
may need
encouragem
ent
Cannot feed
self but is
able to chew
and swallow
Cannot feed
self and may
have
difficulty
swallowing
Grooming Almost
entirely self-
sufficient
Needs some
help in
bathing, oral
hygiene,
hair
combing,
and so forth
Unable to do
much for
self
Completely
dependent
Excretion Up and to
bathroom
alone or
almost alone
Needs some
help in
getting up
to bathroom
or using
urinal
In bed,
needs
bedpan or
urinal
placed; may
be able to
partially turn
or lift self
Completely
dependent
Area of Care Category 1 Category 2 Category 3 Category 4
Comfort Self-
sufficient
Needs some
help with
adjusting
position or
bed (e.g.,
tubes, IVs)
Cannot turn
without
help, get
drink, adjust
position of
extremities,
and so forth
Completely
dependent
General
Health
Good in for
diagnostic
procedure,
simple
treatment,
or surgical
procedure
(D & C,
biopsy,
minor
fracture)
Mild
symptoms
more than
one mild
illness, mild
debility,
mild
emotional
reaction,
mild
incontinence
(not more
than once
per shift)
Acute
symptoms
severe
emotional
reaction to
illness or
surgery,
more than
one acute
illness,
medical or
surgical
problem,
severe or
frequent
Critically ill
may have
severe
emotional
reaction
incontinence
Treatments Simple
supervised
ambulation,
dangle,
simple
dressing,
test
procedure
preparation
not
requiring
medication,
reinforceme
nt of
surgical
dressing, x-
pad, vital
signs once
per shift
Any
category 1
treatment
more than
once per
shift, Foley
catheter
care, I & O;
bladder
irrigations,
sitz baths,
compresses,
test
procedures
requiring
medications
or follow-
ups, simple
enema for
evacuation,
vital signs
every 4
hours
Any
treatment
more than
twice per
shift,
medicated
IVs,
complicated
dressings,
sterile
procedures,
care of
tracheostom
y, Harris
flush,
suctioning,
tube
feeding,
vital signs
more than
every 4
hours
Any
elaborate or
delicate
procedure
requiring
two nurses,
vital signs
more often
than every 2
hours
Medications Simple,
routine, not
needing pre-
evaluation
or post
evaluation;
medications
no more
than once
per shift
Diabetic,
cardiac,
hypotensive,
hypertensiv
e, diuretic,
anticoagula
nt
medications,
prn
medications,
more than
once per
shift,
medications
needing pre-
evaluation
or post
evaluation
High amount
of category
2
medications;
control of
refractory
diabetes
(need to be
monitored
more than
every 4
hours)
Extensive
category 3
medications;
IVs with
frequent,
close
observation
and
regulation
Teaching
and
emotional
support
Routine
follow-up
teaching;
patients
with no
unusual or
adverse
emotional
reactions
Initial
teaching of
care of
ostomies;
new
diabetics;
tubes that
will be in
place for
More
intensive
category 2
items;
teaching of
apprehensiv
e or mildly
resistive
patients;
Teaching of
resistive
patients;
care and
support of
patients with
severe
emotional
reaction
periods of
time;
conditions
requiring
major
change in
eating,
living, or
excretory
practices;
patients
with mild
adverse
reactions to
their illness
(e.g.,
depression,
overly
demanding)
care of
moderately
upset or
apprehensiv
e patients;
confused or
disoriented
patients
Table 2. Categories or levels of care of patients, nursing care hours needed per
patient per day and ratio of professionals to non-professionals
Levels of
Care
NCH
Needed
Per Pt. Per
Day
Ratio of
Prof. to
Non-Prof.
Level I 1.50 55:45
Self Care or
Minimal Care
Level II 3.0 60:40
Moderate or
Intermediate
Care
Level III 4.5 65:35
Total or
Intensive
Care
Level IV 6.0 70:30
Highly
Specialized or
Critical Care
7 or higher 80:20
The Hospital Nursing Service Administration Manual of the Department of Health has
recommended the following nursing care hours for patients in the various nursing units
of the hospital.
Table 1. Nursing care hours per patient per day according to classification of
patients by units.
Cases/Patients NCH/Pt/day Prof. to Non Prof.
Ratio
1. General Medicine 3.5 60:40
2. Medical 3.4 60:40
3. Surgical 3.4 60:40
4. Obstetrics 3.0 60:40
5. Pediatrics 4.6 70:30
6. Pathologic Nursery 2.8 55:45
7. ER/ICU/RR 6.0 70:30
8. CCU 6.0 80:20
Percentage of Nursing Care Hours
The percentage of nursing care hours at each level of care also depends on the
setting in which the care is being given. For primary hospitals, about 70 percent of their
patients need minimal care, 25 percent need moderate care. Patients needing intensive
care are given emergency treatment and when their condition becomes stable or when
immediate treatment is necessary and the hospital has no facilities for this, the patient is
transferred to a secondary of tertiary hospital.
In a secondary hospital, 65 percent of the patients need minimal care, 30 percent
need moderate care, and only 5 percent need intensive care. In tertiary hospitals, about
30 percent of patients need minimal care; 45 percent need moderate care, 15 percent
need intensive care, while 10 percent will need highly specialized intensive care. In
special tertiary hospitals about 10 percent will need minimal care; 25 percent need
moderate care; 45 percent need intensive care; while about 20 percent will need highly
specialized intensive care.
Table 3. Percentage of patients at various levels of care per type of hospital
Percentage of Patients in Various Levels of Care
Type of
Hospital
Minimal
Care
Moderate
Care
Intensive
Care
Highly Spl.
Care
Primary
Hospital
70 25 5 -
Secondary
Hospital
65 30 5 -
Tertiary
Hospital
30 45 15 10
Spl. Tertiary
Hospital
10 25 45 20
Computing for the Number of Nursing Personnel Needed
When computing for the number of nursing personnel in the various nursing units
of the hospitals, one should ensure that there is sufficient staff to cover all shifts, off-
duties, holidays, leaves, absences, and time for staff development programs.
The Forty-Hour Week Law (Republic Act 5901), provides that employees working in
hospitals with 100-bed capacity and up will work only 40 hours a week. This also applies
to employees working in agencies with at least one million population. Employees
working in agencies with less than one hundred-bed capacity or in agencies located in
communities with less than one million population will work forty-eight hours a week and
therefore will get only one off-duty a week.
There are also benefits that have to be enjoyed by each personnel regardless of
the working hours per week. The latest is the granting of the three-day special privilege
to government employees by the Civil Service Commission as per Memorandum Circular
No. 6, series of 1996, which may be spent for birthdays, weddings, anniversaries,
funerals (mourning), relocation, enrollment or graduation leave, hospitalization, and
accident leaves.
Table 4. Total number of working and non-working days and hours of nursing
personnel per year.
Rights and Privileges Given
Each Personnel
Working Hours Per Week
Per Year 40 Hours 48 Hours
1. 1. Vacation Leave 15 15
2. Sick Leave 15 15
3. Legal Holidays 10 10
4. Special Holidays 2 2
5. Special Privileges 3 3
6. Off-Duties as per R.A. 5901 104 52
7. Continuing Education Program 3 3
______ ______
Total Non-Working Days Per Year 152 100
Total Working Days Per Year 213 265
Total Working Hours Per Year 1,704 2,120
Relievers Needed
To compute for relievers needed, the following should be considered:
1. Average number of leaves taken each year - - - - - - 15
a. Vacation Leave - - - - - - - - - - - - - - - - - - - - - - - 10
b. Sick Leave - - - - - - - - - - - - - - - - - - - - - - - - - - - 5
2. Holidays - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 12
3. Special Privileges as per CSC MC#6 s.1996 - - - - - - -3
4. Continuing Education Program for Professionals - - 3
Total Average Leaves 33
It will be noted that although an employee is entitled to 15 days sick leave and 15
days vacation leave, 12 holidays, 3 days for continuing education, plus 3 days of special
privileges or 48 days total, he or she gets only an average of 33 days leave per year.
To determine the relievers needed, divide 33 (the average number of working days
an employee is absent per year) by the number of working days per year that each
employee serves (whether 213 or 265). This will be 0.15 per person who works 40 hours
per week and 0.12 per person for those working 48 hours per week.
Multiply the computed reliever per person by the computed number of nursing
personnel. This will give the total number of relievers needed.
Distribution by Shifts
Studies have shown that the morning or day shift needs the most number of
nursing personnel at 45 to 51 percent; for the afternoon shift 34 to 37 percent; and for
the night shift 15 to 18 percent. In the Philippines the distribution usually followed is 45
percent for the morning shift, 37 percent for the afternoon shift, and 18 shift for the
night shifts.
Staffing Formula
To compute for the staff needed in the In-Patient units of the hospital the following
steps are considered:
1. Categorize the number of patients according to the levels of care needed. Multiply
the total number of patients by the percentage of patients at each level of care
(whether minimal, intermediate, intensive or highly specialized).
2. Find the total number of nursing care hours needed by the patients at each
category level.
a. Find the number of patients at each level by the average number of nursing
care hours needed per day.
b. Get the sum of the nursing care hours needed at the various levels.
3. Find the actual number of nursing care hours needed by the given number of
patients. Multiply the total nursing care hours needed per day by the total number of
days in a year.
4. Find the actual number of working hours rendered by each nursing personnel per
year. Multiply the number of hours on duty per day by the actual working days per
year.
5. Find the total number of nursing personnel needed.
a. Divide the total number of nursing care needed per year by the actual
number of working hours rendered by an employee per year.
b. Find the number of relievers. Multiply the number of nursing personnel
needed by 0.15 (for those working 40 hours per week) or by 0.12 (for those
working 48 hours per week).
c. Add the number of relievers to the number of nursing personnel needed.
6. Categorize the nursing personnel into professionals and non-professionals. Multiply
the number of nursing personnel according to the ratio of professionals to non-
professionals.
7. Distribute by shifts.
To illustrate:
Find the number of nursing personnel needed for 500 patients in a tertiary
hospital.
1. Categorize the patients according to level of care needed.
500 (pts) x .30 = 150 patients needing minimal care
500 (pts) x .45 = 225 patients needing moderate care
500 (pts) x .15 = 75 patients need intensive care
500 (pts) x .10 = 50 patients need highly specialized nursing care
500
2. Find the number of nursing care hours (NCH) needed by patients at each level of
care per day.
150 pts x 1.5 (NCH needed at Level I) = 225 NCH/day
225.5 pts x 3 (NCH needed at Level II) = 675 NCH/day
75 pts x 4.5 (NCH needed at Level III) = 337.5 NCH/day
50 pts x 6 (NCH needed at Level IV) = 300 NCH/day
Total 1537.5 NCH/day
3. Find the total NCH needed by 500 patients per year.
1537.5 x 365 (days/year) = 561,187.50 NCH/year
4. Find the actual working hours rendered by each nursing personnel per year.
8 (hrs/day) x 213 (working days/year) = 1,704 (working hours/year)
5. Find the total number of nursing personnel needed.
a. Total NCH per year = 561,187.50 = 329
Working hrs/year 1,704
b. Relief x Total Nursing Personnel = 329 x 0.15 = 49
c. Total Nursing Personnel needed 329 + 49 = 378
6. Categorize to professional and non-professional personnel. Ratio of professionals to
non-professionals in a tertiary hospital is 65:35.
378 x .65 = 246 professional nurses
378 x .35 = 132 nursing attendants
7. Distribute by shifts.
246 nurses x .45 = 111 nurses on AM shift
246 nurses x .37 = 91 nurses on PM shift
246 nurses x .18 = _ 44 _nurses on night shift
Total 246 nurses
132 Nursing attendants x .45 = 59 Nursing attendants on AM shift
132 Nursing attendants x .37 = 49 Nursing attendants on PM shift
132 Nursing attendants x .18 = _ 24 _Nursing attendants on night shift
Total 132 Nursing Attendants
It should be noted that the above personnel are only for the in-patients. Therefore,
additional personnel should be hired for those in supervisory and administrative
positions and for those in special units such as the Operating Room, the Delivery Room,
the Emergency Room, and Out-Patient Department.
A Head Nurse is provided for every nursing unit. Likewise, a Nursing Superior is
provided 1) to cover every shift in each clinical department or area specialty unit; 2) for
each geographical area in hospitals beyond one hundred (100) beds and; 3) for each
functional area such as Training, Research, Infection Control, and Locality Management.
Managers Responsibilities in Meeting Staffing Needs
The manager must ascertain that adequate numbers and an appropriate mix of
personnel are available to meet daily unit needs and organizational goals.
It is important that staffing patterns and scheduling policies must be administered fairly
as well as economically because they both directly affect the daily lives of all personnel.
Leadership Roles and Management Functions Associated with
Staffing and Scheduling
LEADERSHIP ROLES MANAGEMENT FUNCTIONS
1. Identifies creative and flexible
staffing methods to meet the needs
of the patients, staff and the
organization.
2. Is knowledgeable regarding
contemporary methods of scheduling
and staffing.
3. Assumes a responsibility toward
staffing that builds trust and
encourages a team approach.
4. Periodically examines the unit
standard of productivity to determine
if changes are needed.
1. Provides adequate staffing to meet
patient care needs according to the
philosophy of the organization.
2. Uses organizational goals and
patient classification tools to
minimize understaffing and
overstaffing as patient census and
acuity fluctuate.
3. Schedules staff in a fiscally
responsible manner.
4. Develops fair and uniform
scheduling policies and
communicates these clearly to all
5. Is alert to extraneous factors that
have an impact on staffing.
6. Is ethically accountable to patients
and employees for adequate and safe
staffing.
7. Plans for staffing shortages so
patient care goals will be met.
8. Assesses if and how workforce
intergenerational values impact
staffing needs and responds
accordingly.
staff.
5. Ascertains that scheduling policies
are not in violation of local and
national labor laws, organizational
policies or union contracts.
6. Assumes accountability for quality
and fiscal control of staffing.
7. Evaluates scheduling and staffing
procedures and policies on a regular
basis.
Inflexible scheduling is a major contributor to job dissatisfaction and turnover on the part
of nurses. Managers should do whatever they can to see that employees feel they have
some control over scheduling, shift options and staffing policies.
The overall responsibility for scheduling continues to be an important function of first-
and middle-level managers, although staffing clerks and computers assist with staffing in
some organizations. Each organization has different expectations regarding the unit
managers responsibility in long-range human resource planning and in short-range
planning for daily staffing.
Centralized Staffing is where staffing decisions are made by personnel in a central office
or staffing center. Such centers may or may not be staffed by RNs, although someone in
authority would be a nurse when a staffing clerk carries out the day-to-day activity.
Advantages:
The managers role is limited to making minor adjustments and providing input.
The manager continues to have ultimate responsibility for seeing that adequate
personnel are available to meet the needs of the organization.
It is fairer to all employees because policies tend to be employed more consistently
and impartially.
It allows for the most efficient (cost effective) use of resources since the more units
that can be considered together, the easier it is to deal with variations in patient
census and staffing needs.
Disadvantages:
It does not provide as much flexibility for the worker, nor can it account as well for
a workers desires or special needs.
Managers may be less responsive to personnel budget control if they have limited
responsibility in scheduling and staffing matters.
Decentralized Staffing is where the unit manager is often responsible for covering all
scheduled staff absences, reducing staff during periods of decreased patients or acuity,
adding staff during periods of high patient census, preparing monthly unit schedules,
and preparing holiday and vacation schedules.
Advantages:
The unit manager understands the needs of the unit and staff intimately, which
leads to increased likelihood that sound staffing decisions will be made.
The staff feels more in control of their work environment because they are able to
take personal scheduling requests directly to their immediate supervisor.
It leads to increased autonomy and flexibility, thus, decreasing nurse attrition.
Disadvantages:
It carries the risk that employees will be treated unequally or inconsistently.
The manager may be viewed as granting rewards or punishments through the
staffing schedule.
It is time consuming for the manager and often promotes more special pleading
than centralized staffing.
The major difficulty is ensuring high-quality staffing decisions throughout the
organization.
Budreau, Balakrishnan, Titler and Hafner (1999) state that nursing management is
highly decentralized in most hospitals, with considerable variation found in staffing
among patient care units. This means that many nurse-manager have some control over
factors that affect cost on their specific units.
Managers must also be cognizant of the need to have an ethnically and culturally
diverse staff to meet the needs of an increasingly diverse patient population.
unique cultural and linguistic needs of patient population = appropriately diverse staff
Malloch, Deveonport and Hatler (2003) suggest that the importance of providing
culturally competent caregivers cannot be overstated since health care congruent with
cultural beliefs and values is essential for optimal outcomes.
Nurse-managers must be cognizant of new recommendations and legislation
affecting staffing.
For example: minimum staffing ratios
Proponents of legislated minimum staffing ratios say that ratios are needed
because many hospitals current staffing levels are so low that both RNs and
patients are negatively affected.
Poor staffing = (-) nurses health & safety + (-) patient outcomes
3 Arguments against Staffing Ratios:
1. The current nursing shortage will make it difficult to fill the slots when the ratios
appear.
2. The ratios may merely serve as a Band-aid to the greater problems of quality
care.
3. Numbers alone do not ensure improved patient care since not all RNs have
equivalent clinical experience and skill levels.
Scheduling Options
Some of the more frequently used creative staffing and scheduling options include:
10- or 12- hour shifts
The resultant nurse satisfaction must be weighed against the increased costs because
extending the workday with 10- to 12-hour shifts may require overtime pay.
Extending the length of shifts may result in increased judgment errors as nurses
become fatigued.
Organizations limit the number of consecutive 10- or 12-hour days a nurse can work or
the number of hours that can be worked in a given day.
Premium pay for weekend work
Part-time staffing pool for weekend shifts and holidays
Cyclical staffing, which allows long term knowledge of future work schedule
because a set staffing pattern is repeated every few weeks
Job sharing
Allowing nurses to exchange hours of work among themselves
Flextime
It is a system that allows employees to select the time schedules that best meet their
personal needs while still meeting work responsibilities.
Most flextime has been possible only for nurses in roles that did not require
continuous coverage. Staff nurses recently have been able to take part in a flextime
system through prescheduled start times. Variable start times may be longer or shorter
than the normal 8- hour workday.
Units have employees coming and leaving the unit at many different times when a
hospital uses flextime. Although flextime staffing creates greater employee choices, it
may be difficult for the manager to coordinate and could easily result in overstaffing or
understaffing.
Use of supplemental staffing from outside registries and float pools
Agency nurses or travel nurses are usually directly employed by an external broker
and work for premium pay (2-3 times that of regularly employed staff), without benefits.
While such staff provide scheduling relief, especially in response to unanticipated
increases in census or patient acuity, their continuous use is expensive and can result in
poor continuity of care.
Some hospitals have created their own internal supplemental staff by hiring per-diem
employees and creating float pools.
Per-diem staff generally has flexibility to choose if and when they want to work. In
exchange for this flexibility, they receive higher rate of pay, but usually no benefits.
Float pools are generally composed of employees who agree to cross train on multiple
units so that they can work additional hours during periods of high census or worker
shortages. Wing (2001) argues, however, that float pools are adequate for filling
intermittent staffing holes but, like agency or registry staff, are not an answer to the
ongoing need to alter staffing according to census. It results in lack of staff continuity.
Staff self-scheduling
It was developed in 1960s where it allowed nurses in a unit to work together to
construct their own schedules rather than have schedules created by management.
Employees are typically given four to six week schedule worksheets to fill out several
weeks in advance of when the schedule is to begin.
These employees typically have one to two weeks to fill in the blanks on the schedule,
following whatever guidelines or requirements are set by the management (i.e., number
of weekend shifts that must be worked, maximum number of consecutive shifts) (Hung,
2002).
The nurse-manager then reviews the worksheet to make sure all the guidelines or
requirements have been met.
Points to consider:
Although self-scheduling offers nurses greater control over their work environment, it
is not easy to implement. Success depends on the leadership skills of the manager to
support the staff and demonstrate patience and perseverance throughout the
implementation.
Shullanberger (2000) found that it provides greater worker participation in decision
making but requires greater worker involvement and management flexibility to be
successful.
It saves management time, improve morale and professionalism and reduces
personnel turnover (Hung, 2002).
Nurses most satisfied with self-scheduling were those who shared responsibility for
adequate staffing and those who had developed good negotiating skills.
Obviously, all scheduling and staffing patterns, from traditional to creative, have
shortcomings.
Therefore, any changes in current policies should be evaluated carefully as they are
implemented.
Because all scheduling and staffing patterns have a heavy impact on employees
personal lives, productivity and budgets, it is wise to have a six-month trial of new
staffing and scheduling changes, with an evaluation at the end of that time to determine
the impact on financial cost, retention, productivity, risk management and employee and
patient satisfaction.
Workload Measurement Tools
Requirements for staffing are based on whatever standard unit of measurement for
productivity is used in a given unit.
NCH/PPD = Nursing Hours Worked in 24 hours
Patient Census
This is the simplest formula for calculating nursing care hours per patient day in use and
continues to be widely used.
In this formula, all nursing and ancillary staff are treated equally for determining
hours of nursing care and no differentiation is made for differing acuity levels of
patients.
These two factors alone may result in an incomplete or even inaccurate picture of
nursing care needs.
Jennings, Loan, DePaul, Brosch and Hildreth (2001) concur, suggesting that the use
of NCH/PPD as a workload measurement tool may be too restrictive, since it may
not present the reality of todays inpatient care settings, where staffing fluctuates
not only among shifts, but within shifts.
As a result, Patient Classification Systems (PCS), also known as workload
management or patient acuity tools, were developed in the 1960s.
PCSs group patients according to specific characteristics that measure acuity of
illness in an effort to determine both the number and mix of staff needed to
adequately care for those patients.
It is usually not possible to transfer a PCS from one facility to another because
other variables within the system have an impact on nursing care hours. Instead,
each basic classification system must be modified to fit a specific institution.
Seago (2002) suggest that most PCSs can be classified as:
Critical indicator or criterion type uses broad indicator such as bathing, diet,
IVF and medications and positioning to categorize patient care activities.
Summative task type requires the nurse to note the frequency of occurrence
of specific activities, treatments and procedures for each patient.
Both type of PCSs are generally filled out prior to each shift although the
summative task type typically has more items to fill out than the critical incident or
criterion type.
Once an appropriate PCS is adopted, hours of nursing care must be assigned for
each patient classification. Each institution is unique and must determine to what
degree that classification system must be adapted for them. White (2003)
suggests that each patient population is different and that each unit must examine
clinical profiles of patients, average length of stay and practitioner specialty in
defining their patient population. In addition, core staff versus visiting staff and
skill mix must be considered.
Any classification system has many variables and all systems have their faults. It is
a mistake for managers to think that the PCS will solve all staffing problems.
Although such systems provide a better definition of problems, it is up to the
people in the organization to make judgments and use the information obtained by
the system appropriately to solve staffing problems.
The middle-level manager must be alert to internal or external forces affecting unit
need that may not be reflected in the organizations PCS. Ex. Sudden increase in
nursing or medical students using the unit, a lower skill level of new graduates, or
cultural and language difficulties of recently hired foreign nurses. The
organizations classification system may prove to be inaccurate or the hours
allotted for each category or classification of patient may be inadequate. This does
not imply that unit managers should not be held accountable for the standard unit
of measurement, but rather they must be cognizant of justifiable reasons for
variations.
Some futurists have suggested that eventually workload measurement systems may
replace acuity-based staffing systems. Workload measurement is a relatively new
technique that evaluates work performance as well as necessary resource levels (Walsh,
2003). Thus, it goes beyond patient diagnosis or acuity level, and examines the specific
number of care hours needed to meet a given populations care needs. Thus, workload
measurement systems capture census data, care hours, patient acuity and patient
activities. This tool, while more complicated, holds great promise for better predicting
the nursing resources needed to staff hospitals effectively.
Regardless of the workload measurement tool used (NCH/PPD, PCS, workload
measurement system, etc), the units of workload measurement that are used need to be
reviewed periodically and adjusted as necessary. This is both a leadership role and
management responsibility.
Nursing Care Hours, Staffing Mix and Quality Care
The relationship between nursing care hours, staffing mix and quality of care has
occurred in response to the restructuring and reengineering boom that occurred in
many acute care hospitals in 1990s.
Restructuring and reengineering was done to reduce costs, increase efficiency,
decrease waste and duplication and reshape the way care was delivered.
Given that health care is labor intensive, cost cutting under restructuring and
reengineering often included staffing models that reduced RN representation in the
staffing mix and increased the use of unlicensed assistive personnel (UAP).
This fairly rapid and dramatic shift in both RN care hours and staffing mix provide
fertile ground for comparative studies that examined the relationship between:
Nursing Care Hours + Staffing Mix = Patient Outcomes
As RN hours decrease in NCH/PPD, adverse patient outcomes increase, including
increased medication errors and patient falls and decreased patient satisfaction with
pain management.
Unit managers must understand the effect that major restructuring and redesign have
on their staffing and scheduling policies as well. As new practice models are introduced,
there must be a simultaneous examination of the existing staff mix and patient care
assessments to ensure that appropriate changes are made in staffing and scheduling
policies.
Decreased licensed staff, increasing numbers of unlicensed staff and developing new
practice models have a tremendous impact on patient care assignment methods.
Past practices of relying on part-time staff, responding to staff preferences for work and
providing a variety of shift lengths and shift rotations may no longer be enough.
Administrative practices also have saved money in the past by sending people home
when there was low census; they have also floated them to other areas to cover unit
needs, not scheduled staff for consecutive shifts because of staff preferences and had
scheduling policies that were unreasonably accommodating.
Patient assignments in the past were often made without attention to patient continuity
and assigned by numbers rather than workload.
Some of these past practices have benefited the staff, and some have been for the
benefit of the organization, but few of them have benefited the patient.
Indeed, assigning a different nurse to care for a patient each day of an already reduced
length of stay may contribute to negative patient outcomes.
Therefore, there must be an honest appraisal of current staffing, scheduling and
assignment policies simultaneously as organizations are restructured and new practice
models are engineered.
Having an adequate number of knowledgeable trained nurses is imperative to attaining
desired patient outcomes.
Ascertaining an appropriate skill mix depends on the patient care setting, acuity of
patients and other factors.
There is no national standard to determine whether staffing decisions are suitable for a
given setting.
Manthey (2001) describes several factors that will drive additional new staffing plans in
the coming decade, Work Force 2000:
oIncreased importation of foreign nurses who must be safely incorporated into the care
delivery system
oOngoing fiscal restraints that result in the need for lean staffing
oAnd plentiful, attractive career options for nurses outside the hospital.
Ethical Accountability for Staffing
The manager has ethical accountability both to patients and staff. Their needs
should be met.
Regardless of the difficulties inherent in PCSs and the assignment of nursing care
hours, they remain a method for controlling the staffing function of management.
As long as managers realize that all systems have weaknesses and as long as they
periodically evaluate the system, managers will be able to initiate the needed change.
It is critical, however, for managers to make every effort to base unit staffing on
their organizations patient classification system.
It is important for managers to use staff to provide safe and effective care
economically.
Managers must increase staffing when patient acuity rises as well as decrease
staffing when acuity is low; to do otherwise is demoralizing to the staff.
Shift staffing based on patient acuity system does, however, allow for more
consistent staffing and is better able to identify overstaffing and understaffing on a
more timely basis.
oThis is a fairer method of allocating staff.
oThe disadvantage of shift-based staffing is that it is time-consuming and somewhat
subjective, because acuity or classification systems leave much to be determined by
the person assigning the acuity levels.
oThe greater the degree of objectivity and accuracy in any system, the longer time
required to make staffing computations. Perhaps the greatest danger in staffing by
acuity is that many organizations are unable to supply the extra staff when the
system shows unit understaffing. However, the same organization may use the
acuity-based staffing system to justify reducing staff on an overstaffed unit.
Therefore, a staffing classification system can be demotivating if used inconsistently
or incorrectly.
Employees have the right to expect a reasonable workload. Managers must ensure
that adequate staffing exists to meet the needs of staff and patients.
Managers who constantly expect employees to work extra shifts, stay overtime
and carry unreasonable patient assignments are not being ethically accountable.
Effective managers, however, do not focus totally on numbers of personnel, but
look at all components of productivity; they examine nursing duties, job descriptions,
patient care organization, staffing mix, and staff competencies.
Management must work just as hard as the staff in meeting patient needs; and
that the organizations overriding philosophy is based on patient interest and not on
financial gain.
A leadership challenge for the manager is to develop policies that focus on outcomes
rather than constraints or rules that limit responsiveness to individual employee needs.
STAFF DEVELOPMENT
The staffs knowledge level and capabilities are a major factor in determining the
number of staff required to carry out unit goals.
2 components of staff development:
- Education
- Training
Early staff development emphasized on:
- Orientation
- In-service training
Training vs Education
Training
- An organized method of ensuring that people have knowledge and skills for a
specific purpose and that they have acquired the necessary knowledge to perform the
duties of the job.
Education
- More formal and broader in scope than training.
- Designed to develop the person in a broader sense
Responsibilities of the Education Department
Most education departments on the organization chart are depicted as having staff or
advisory authority rather than line authority. Likewise, unit manager has no authority
over personnel in the education department.
Because of the ambiguity of overlapping roles and difficulties inherent in line and staff
positions, educating and training employees may be neglected.
It is necessary to delineate and communicate the authority and responsibility for all
components of education and training.
Other difficulties are frequent lack of cost-effectiveness evaluation and little
accountability for the quality and outcomes of the educational activities.
The following suggestions can help overcome the difficulties inherent in a staff
development system in which there is shared authority:
The nursing department must ensure that all parties involve should understand
and carry out their responsibilities in that process.
If the nursing department is not directly responsible for the staff development
department, there must be input from the nursing department in formulating staff
development policies and delineating duties.
An advisory committee should be formed with representatives from all
departments and all classification of employees receiving training and education.
Accountability for various parts of the staff development program must be clearly
communicated.
Some method of determining the cost and benefits of various programs should be
used.
Theories of Learning
Understanding teaching-learning theories allows managers to structure training and use
teaching techniques to change employee behavior and improve competence-goal for all
staff development.
Adult learning theory
- Pedagogical-Usually ineffective for mature learners because adults have special
needs.
- Adult learners are mature, self-directed people who have learned a great deal from
life experiences and are focused toward solving problems that exist in their immediate
environment.
PEDAGOGY ANDRAGOGY
Characteristics:
- Learner is dependent - learner is self-directed
- Learner needs external rewards and punishment - learner is internally motivated
- Learners experience is unimportant or limited - learners experiences are
valued
- Self-centered - task- or problem-centered
- Teacher-directed - self-directed
Learning Environment:
- Climate is authoritative - climate is relaxed and informal
- Competition is encouraged - collaboration
- Teacher sets goals - teacher & class sets goals
- Decisions are made by teacher - decisions are made by teacher & class
- Teacher lectures - students process activities and inquire about
projects
- Teacher evaluates - teacher, self, peers evaluate
Obstacles and assets to adult learning
OBSTACLES ASSETS
- Institutional barriers - high self-motivation
- Time - self-directed
- Self-confidence - a proven learner
- Situational obstacles - knowledge experience reservoir
- Special individual obstacles - special individual assets
Social Learning Theory
- Builds on reinforcement theory as part of the motivation to learn and have
many of the same components as the theory of socialization.
- Bandura (1977) suggests that people learn most behavior by direct experience
and observation, and behaviors are retained or not retained based on positive
Involves four processes:
people learn as a result of the direct experience of the effects of their actions
knowledge is obtained through various experiences
people learn by judgments voiced by others
people evaluate the soundness of the new information by reasoning through
deductive and inductive reasoning
- Soundness of this theory is determined by the effectiveness of role models,
preceptors and mentors.
Anticipated reinforcement
Select and observe a model
Retention process Cognitive process
Behavior is reproduced
Reinforcement of behavior continues
New behavior
Behavior is internalized and attitude change occurs
Social learning theory process
Other learning theories:
- readiness to learn
- motivation to learn
- reinforcement
- task learning
- transfer of learning
- span of memory
- chunking
- knowledge of results
Assessing staff development needs
Staff development activities are carried out to:
- establish competence
- meet new learning needs
- satisfy interests the staff may have in learning specific areas
Competence
-having the abilities to meet the requirements for a particular role.
-state board licensure, national certification and performance review are some methods
used to satisfy competency requirements
The following plan outlines the sequence that should be used in developing an
educational program:
1. identify the desired knowledge or skills the staff should have
2. identify the present level of knowledge or skill
3. determine the deficit of desired knowledge and skills
4. identify the resources available to meet the needs
5. make maximum use of available resources
6. evaluate and test outcomes after use of resources
Evaluation of Staff Development Activities
Evaluation of staff development consists of more than merely having class participants
fill out an evaluation form at the end of every class session, or assigning a preceptor for
each new employee.
Control- the evaluation phase of the management process, becomes extremely difficult
when accountability is shared.
Evaluation of the three components of staff development (indoctrination, training and
education) should include the following four criteria:
1. learners reaction
2. behavior change
3. organizational impact
4. cost-effectiveness
Coaching as a strategy
Coaching
- as a means to develop and train employees is a teaching strategy rather
than a learning theory.
- Is one person helping the other to reach an optimum level of performance
- The emphasis is always on assisting the employee to recognize greater
options, to clarify statements and to grow.
*short-term coaching
- effective as a teaching tool for assisting with socialization and for dealing with short-
term problems
- frequently involves spontaneous teaching opportunities
*long-term coaching
- as a tool for career management and in dealing with disciplinary problems is different.
Meeting the Educational Needs of a Culturally Diverse Staff
(Seago,2000)
- require well-planned learning activities. There should be sufficient
opportunity for small group so that personnel can begin recognizing their own biases
and prejudices.
- This type of learning activity is especially important as more unlicensed
assistive personnel(UAP) are added to the staff.
- Education to support cultural diversity should be part of staff development of
RNs and UAP to facilitate their learning to work together in teams.
LaDuke(2001)
- pairing an older nurse with a much younger one could result in conflict and
mutual disrespect and result in less effective learning during a critical time in the older
nurses socialization to the facility.
Building Team Unity Through Staff Development
-the new momentum in organizations is toward encouraging a team effort through team
building and providing a continual supportive learning environment.
-Fitzpatrick(2001) thinks that a leader who is a good coach, and who can inspire others
to join and remain with the team, ignites the team spirit.
The Leader is a Role Model of the life-long learner.
Staffing Patterns and Scheduling Options
Schedule it is a timetable showing planned work days and shifts for Nursing
personnel. The objective in scheduling is to assign working days and days-off to the
nursing personnel so that adequate patient care is assured. A desirable distribution of
off-duties can be achieved and the individual members of the nursing team will feel that
they are treated fairly. They will also know their schedule ahead of time.
Factors to be considered in Making Schedules
different levels of nursing staff
adequate coverage for 24 hours
seven days of the week
staggered vacations and holidays
weekends
long stretches of consecutive work days
evening and afternoon shifts
relieving
Scheduling may vary from each agency, but the scheduling system must function
smoothly in terms of:
1. ability to cover the needs of the unit the minimum required number of staff
must meet the nursing needs of the clients in all the units and in all the shifts;
2. quality to enhance the nursing personnels knowledge, training, and experience
while a permanent assignment to one unit enhances skills in caring for a particular
kind of patient, many nurses who have future plans to go to teaching, or specialization
or even taking a job abroad, would prefer to experience being assigned to various units
before settling down to a particular unit of their choice.
3. fairness to the staff all nursing personnel should get their fair share of
weekends, holiday offs, rotation patterns for the whole year including assignment to
difficult or light or undesirable units or shifts;
4. stability the nursing personnel would like to know in advance their schedule of
assignment so that their personal schedules are in harmony with one another;.
5. flexibility flexibility means the ability to handle changes brought about by
emergency leaves, scheduled or unscheduled leaves of absence.
Types of Scheduling (Table on the Last Page):
1. Centralized Schedule one person, usually the chief nurse or her designate,
assigns the nursing personnel to the various units of the hospital. This includes the
on-duty and off-duty shifts.
2. Decentralized Schedule the shift and off-duties are arranged by the
Supervising Nurse or Head or Senior Nurse of the particular unit
3. Cyclical Schedule the cyclical schedule covers a designated number of weeks
called the cycle length and is repeated thereon. It assigns the required number of
nursing personnel to each nursing unit consistent with the units patient care
requirements, the staffs preference, and their educational training and experience.
The following scheduling variables should be considered:
a. length of scheduling period whether 2 or 4 weeks
b. shift rotation
c. week-ends off
d. holiday offs
e. vacation leaves
f. special days ( birthdays, weddings etc.)
g. scheduled events in the hospital, training programs, or meetings
h. job categories
i. continuing professional education programs

Four Week Cyclical Schedule
In the table above, it shows a typical 4 week cyclical schedule that gives each
personnel a fair share of week ends off. Since Mondays are usually busy days, minimal
offs on these days are observed.
The table also shows the typical ward staffing where the morning shift has a Head
or Senior Nurse and a staff nurse with two nursing attendants. The afternoon and
evening shifts are provided with relievers. This ensures coverage when either the nurse
or nursing attendants are off duty. Note that the relievers are given off duties after a
night shift such that it avoids an afternoon shift the following day. Thus ensures
adequate rest and sleep between tours of duty.
For those actually involved in patient care, it is advisable that their work days be
not on a 5 consecutive work days or else they will get easily tired. Rotation from night to
afternoon shift must be avoided because the staff nurse or nursing attendant may not
have sufficient time to rest between shifts. Insufficient rest and sleep greatly affects
nursing care performance and its quality so ample rests should be provided.
Advantages of a Cyclical Schedule
1. It is fair to all
2. it saves time
3. it enables the employees to plan ahead for their personal needs preventing
frequent changes in schedule
4. scheduled leave coverage such as vacation, holidays and sick leaves are more
stable
5. productivity is improved
Developing Job Descriptions
Job Description it is a statement that sets the duties and responsibilities of a specific
job. It includes the needed characteristics and qualifications of the individual to perform
such duties successfully. It is an important management tool to make certain that
responsibilities are wisely delegated, that work is efficiently distributed, that talents are
fully used, and morale is maintained.
Contents of a Job Description
1. Identifying Data
a. Position Title
b. Department
c. Supervisors Title
2. Job Summary includes the essential features of the job that distinguishes it from
the others
3. Qualification Requirements Educational Preparation, training and experience
necessary to fill the position
4. Job Relationships
5. Specific and Actual Functions and Activities
Uses of a Job Description
1. for recruitment and selection of qualified personnel
2. to orient new employees to their jobs
3. for job placement, transfer or dismissal
4. as an aid in evaluating the performance of an employee
5. for budgetary purposes
6. for determining departmental functions and relationships to help define the
organizational structure
7. for classifying levels of nursing functions according to skills level required
8. to identify training needs
9. as basis for staffing
10. to serve as a channel for communication
Sample Job Description of a Staff Nurse
Position Title: Staff Nurse/Nurse I
Definition:
The staff nurse is a professional nurse responsible for rendering holistic nursing care to
patients in assigned areas, the specific functions and responsibilities of which depend
upon the organizational structure of the Nursing Service/Department/Division.
Qualification Requirements:
Education: Bachelor of Science in Nursing
License: Registered Nurse
Job Summary:
The Staff Nurse provides nursing care to patients towards the promotion of health,
prevention of diseases, restoration of health, alleviation of suffering, and assisting the
dying to face death with dignity and in peace.
Employment Variables:
Professional affiliation with professional nursing associations
Job Relationships:
Source of Workers: Registered
Promoted to: Senior Nurse/ Nurse II
Responsible to: Senior Nurse/ Nurse II
Functions:
A. Patient Care Management
The Staff Nurse shall initiate and perform nursing care services to meet the needs
of patients in assigned areas/units utilizing the nursing process
1. Assesses the individuals needs for nursing care based on the patients history,
results of physical, diagnostic, and laboratory examinations
2. Infers correct nursing diagnosis
3. Plans/Prioritizes nursing care activities considering overall health needs of the
patient, the extent of his coping abilities including that of his family and significant
others and his readiness, acceptance, and abilities of self-care
4. Institutes nursing interventions consistent with the overall plan of care with
special considerations for the patients safety and comfort
5. Executes written legal prescriptions for treatment, therapies, medication
including hypodermic, intramuscular and intravenous injections; provided that in
intravenous injections, special training be required and according to protocol
established
6. Provides health teaching to patients, their family and significant others so that
they may understand this illness and participate actively in his care
7. Coordinates patients care services with members of the health care team
8. Evaluates/modifies nursing care provided in terms of:
a. Effectiveness and efficiency of nursing measures rendered
b. Feedback from patient/family/significant others
9. Conducts discharge planning with patient, family and significant others with the
health team. Refers to community health agencies as needed
10. Documents accurately the observations and services rendered to the patients
B. Hospital and Nursing Service Policies and Regulations
1. Observes hospital and nursing service rules, regulations and policies
2. Interprets to patients, family and visitors the rules, regulations, and policies that
affect them
C. Learning Experiences of Nursing and Midwifery Students
1. Coordinates with Clinical Instructors the activities of the affiliating students such
as helping select patient assignments to enhance learning experiences particularly on
patient care
2. Demonstrates good nursing in the way he or she cares for patients. He or she
also serves as role-model to the students
D. Orientation of Non-Professional Workers in the Unit
Participates in the orientation of new, non-professional nursing personnel
E. Research and Studies
Participates in/initiates nursing research and studies. Utilizes results for improvement of
Nursing Practice
F. Professional Responsibilities
1. Takes initiative and responsibility in membership in professional organizations
and participates actively in their programs and activities
2. Keeps self professionally updated through continuous education
3. Update professional license
Sample Job Description of the Head Nurse/Senior Nurse/Nurse II
Position Title: Head Nurse/Senior Nurse/Nurse II
Definition:
A Head Nurse/Senior Nurse/Nurse II is a professional nurse who assumes responsibility
for managing the human and material resources of a nursing unit to provide quality
patient care and an environment conducive to staff growth and satisfaction
Qualification Requirements:
Bachelor of Science in Nursing; Registered Nurse; at least one year of clinical nursing
experience; with supervisory development training or training in the specialty of the
clinical nursing unit to which he/she is prepared for promotion; or 9 units of Nursing
Management and Supervision in the Graduate School by RA 9173
Employment Variable:
Membership in the agencys nursing association and other professional associations such
as the Integrated Nurses of the Philippines and the Philippine Nurses Association.
Job Relationships:
Source of Workers Nurse I/Staff Nurse
Promotion to: Nurse III/Supervising Nurse
Responsible to: Nurse III/Supervising Nurse
Responsible for: Nurse I/Staff Nurse; Nursing Attendant
Functions:
A. Patient Care Management assumes responsibility for the delivery of
quality patient care for the nursing unit
1. Participates in the development of nursing standards, policies,
procedures, regarding patient care and updates these as necessary
2. Promotes/utilizes quality assurance standards and programs in
the unit
3. Supervises and evaluates the quality of patient care through
frequent rounds
4. Acts as liaison with the medical staff to coordinate medical and
nursing management of patient care
5. Serves as resource person to nursing personnel under him/her in
assessing, planning, implementing, and evaluating nursing care provided
6. assumes the role of patient advocate
7. coordinates patient care with other members of the health team,
other hospital units, services, and/or divisions
8. Serves as Committee member within the department, hospital or
professional organization
9. keeps superiors informed regarding problems/issues in patient
care within the nursing unit
B. Management of Nursing Personnel provides leadership and direction
to nursing personnel in accordance with organizational and departmental goals and
objectives
1. Participates in the selection of nursing staff of the unit
2. schedules staff assignments considering experiences, interests
and training
3. adjusts staffing levels/ratio according to the severity of the
patients illness, the number of patients and number of nurses
4. advises and/or informs staff about new or revised policies and
procedures
5. keeps the supervising nurse informed of personnel actrivities and
problems
6. present changes or innovations to staff in a positive manner
7. produce a conducive climate in which the staff will feel free to
consult him/her for problems or assistance
C. Management of Patient Care Units maintains an environment that
encourages quality patient care and staff satisfaction
1. provides safe, clean, secure environment for patients, visitors
and personnel
2. requisitions adequate supplies and equipment needed for patient
care
3. monitors utilization of supplies and equipment through monthly
audits and inventories
4. cooperates/coordinates with other hospital service/ departments
for appropriate support services
5. prepares monthly, semi-annual, annual reports of
achievements/prblems
6. Maintains effectiveness of communication within
unit/departments and other services through conference meetings
D. Educational Responsibilites
1. assists in staff development activities in the unit:
a. coordinates with training staff in planning, implementing
and evaluating orientation of new personnel
b. Informs Training Staff of the training needs of the nursing
personnel under him/her
2. assists clinical instructors of affiliating colleges of nursing or
school of midwifery in planning, implementing, and evaluating the learning
experience of the students
3. assumes responsibility for won learning and development needs
e. Acts as supervising nurse in the absence of one and when so delegated.

Dealings with Conflicts
Conflict defined as internal or external discord that results from the differences in
ideas, values, or feelings between two or more people. Conflict is created when there is a
mesh of different values, beliefs, backgrounds and goals in which an individual possesses
uniquely and is in not in harmony with another. Conflict is also created when there are
differences in economic and professional values and when there is competition among
professionals. Scarce resources, restructuring, and poorly defined role expectations also
are frequent causes of conflict.
The current sociological view of conflict is that conflict is neither good nor bad,
encouraged or avoided, but instead be managed accordingly. The managers role is to
create a work environment where conflict may be used as a conduit for growth,
innovation, and productivity.
Categories of Conflict:
Intergroup Conflict occurs between two or more groups of people, departments or
organizations
Intrapersonal Conflict occurs within the person.
Interpersonal Conflict - also known as horizontal violence or bullying happens
between two or more people
The Conflict Process
I. Latent Conflict- implies the existence of antecedent conditions such as
short staffing and rapid change. Much unnecessary could be prevented or reduced if
managers examined the organization much more closely for antecedent situations
II. Perceived Conflict- or substantive conflict; intellectualized and often
involves issues and roles
III. Felt Conflict occurs when conflict is emotionalized with such emotions
as fear, hostility, mistrust, anger etc.
IV. Manifest conflict or overt conflict; action like withdrawal, compete,
debate or resolution is taken
V. Conflict Resolution or Conflict Management addressing of conflict
VI. Conflict Aftermath positive or negative effects of conflict
Conflict Management
The optimal goal for conflict management is to create a win-win solution for all involved.
Strategies for Conflict Management
1. Compromising- each party gives up something it wants
2. Competing used when one party pursues what it wants at the expense of the
others. Usually results in a win-lose situation where the loser commits negative
emotions. Is used when a quick or unpopular decision needs are to be made. It is also
appropriately used when one party has more information or knowledge about the
situation than the other
3. Cooperating the opposite of competing. One party sacrifices his or her beliefs and
allows the other party to win
4. Accommodating one party leaves a favor/IOU to be used at another time
5. Smoothing one person smoothes the persons involved in an effort to reduce
emotional component of the conflict such that it may lead to accommodation or
cooperation. Appropriate for minor disagreements but rarely resolves conflicts
6. Avoiding the parties involved are aware of a conflict but choose not to
acknowledge it or to attempt to resolve it. May be indicated in trivial disagreements,
when the cost of dealing exceeds the benefits of solving it, when the problem should be
solved by other people than you, or when the problem will solve itself.
7. Collaborating all parties set aside their original goals and work together to
establish a supraordiante goal or priority common goal. Often leads to a win-win
situation.
Ten Rules of Collaborating accdg. To Gardner
1. Know thyself
2. Learn to value and manage diversity
3. Develop constructive conflict resolution skills
4. Use your power to create win-win situations
5. Master interpersonal and process skills
6. Recognize that collaborating is a journey
7. Leverage multidisciplinary forums to increase collaboration
8. Appreciate that collaboration can occur spontaneously
9. Balance autonomy and unity in collaborative relationships
10. Remember that collaboration is not required for all decisions
Manging Unit Conflict
Common Causes of Organizational Conflict
Poor Communication
Inadequately defined organizational structure
Individual Behavior
Unclear Expectations
Individual or group conflicts of interest
Operational or staffing changes
Diversity in Gender, Culture, or Age
Strategies to effectively manage unit conflicts:
1. Confrontation
2. Third party Consultation
3. Behavior Change
4. Responsibility Charting
5. Structure Change
6. Soothing one party
7. Negotiations
8. Consensus