Académique Documents
Professionnel Documents
Culture Documents
& Management
Patricia Kelly-Heidenthal
0-7668-2508-6
Delmar Learning
Copyright 2003 Delmar Learning, a Thomson Learning company
Chapter 12
Effective Staffing
Delmar Learning
Copyright 2003 Delmar Learning, a Thomson Learning company
Objectives
Chapter 12
Chapter 12
Factor Systems
Chapter 12
Factor Systems
Advantages
Data readily available for day-to-day operations
Provide information against which one can justify changes in
staffing requirements
Disadvantages
Create an ongoing workload for the nurse in classifying
patients every day
Problems with classification creep
Do not capture patient needs for psychosocial, environmental,
and health management support
Calculate nursing time based on a typical nurse
Chapter 12
Prototype Systems
Disadvantages
No ongoing measure of the actual nursing work required by
individual patients
No ongoing data to monitor the accuracy of the preassigned
nursing care requirements
Chapter 12
Chapter 12
10
Chapter 12
11
12
13
Historical information
What has worked in the past?
Chapter 12
14
15
Inpatient Unit
Chapter 12
16
Inpatient Unit
Chapter 12
17
Chapter 12
18
Scheduling
19
Scheduling
Volume
Patient volume numbers reviewed for peaks and valleys in
the census and patient acuity
Scheduling adjusted as necessary
20
Scheduling of Staff
Chapter 12
21
Scheduling of Staff
Financial implications
Weekend programs are more expensive than traditional
staffing patterns
They are a recruitment and retention tool for nursing
leadership
Chapter 12
22
Self-scheduling
Chapter 12
23
Self-scheduling
Educate staff as to the process, their responsibilities, and the
impact of their decisions on staffing.
Ensure that staff is committed to providing safe staffing on
all shifts for their patients.
Chapter 12
24
Chapter 12
25
Chapter 12
26
Chapter 12
27
Chapter 12
28
Advantages
Consistency of one individual caring for patients for an entire
shift
Patient, nurse, and family can develop a trusting relationship
Nurse has more opportunity to observe and monitor patient
progress
Disadvantages
Nurse may look at the patient on a shift-by-shift basis rather
than on a continuum of care
Uses a high level of RN nursing hours to deliver care
Costlier than other models
Chapter 12
29
Functional Nursing
Chapter 12
30
Functional Nursing
Advantages
Care can be delivered to a large number of patients
Uses other types of health care workers when there is a
shortage of RNs
Disadvantages
Lack of continuity of care
Patient may feel that care is disjointed
Chapter 12
31
Team Nursing
Chapter 12
32
Team Nursing
Chapter 12
33
Team Nursing
Advantages
Maximizes the role of the registered nurse
Nurse is able to get work done through others
Disadvantages
Patients often receive fragmented, depersonalized care
Communication is complex
Shared responsibility and accountability can cause
confusion and lack of accountability
Chapter 12
34
Primary Nursing
35
Primary Nursing
Chapter 12
36
Primary Nursing
Advantages
Patients and families are able to develop a trusting
relationship with the nurse.
Accountability and responsibility of the nurse developing a
plan of care with the patient and family are defined.
Such a holistic approach to care, rather than a shift-to-shift
focus, facilitates continuity of care.
Authority for decision making is given to the nurse at the
bedside.
Chapter 12
37
Primary Nursing
Disadvantages
Cost is high due to the higher RN skill mix.
The person making assignments needs to be knowledgeable
about all the patients and staff to ensure appropriate
matching of nurse to patient.
Lack of geographical boundaries within the unit may
require nursing staff to travel long distances at the unit level
to care for their primary patients.
Nursing time is often used in functions that could be
completed by other staff.
Nurse-to-patient ratios must be realistic.
Chapter 12
38
39
Advantages
Most convenient for patients
Expedites services to patients
Disadvantages
Can be extremely costly to decentralize major services in an
organization
Some perceive model as a way of reducing RNs and cutting
costs in hospitals
Chapter 12
40
Differentiated Practice
41
Differentiated Practice
Advantage
Nurses are allowed to work in specialized roles for which
they were educated, leading to greater career satisfaction.
Disadvantages
Nurses who have experience, knowledge, and capability to
function beyond their original education may not be
recognized.
Organizations that have determined minimal educational
requirements for RN positions may have difficulty in
recruiting staff with the requisite credentials.
Chapter 12
42
Chapter 12
43
Chapter 12
44
Chapter 12
45
Clinical Pathways
46
Clinical Pathways
Advantages
Very instructive to new staff
Save a significant amount of time in the process of care
In most cases, improve care and shorten length of stay for
the population on the pathway
Allow for data collection of variances to the pathway
Chapter 12
47
Clinical Pathways
Disadvantages
Some physicians perceive pathways to be cookbook
medicine and are reluctant to participate in their
development.
Development requires a significant amount of work to gain
consensus from the various disciplines on the expected plan
of care.
Pathways are less effective for patient populations that are
nonstandard, since they are constantly being modified to
reflect individual patient needs.
Chapter 12
48
Case Management
49
Case Management
50