Again this week you will continue to work with your groups on staffing and scheduling your ideal nursing units. Staffing a unit in a hospital or ambulatory care clinic is a challenging process. Different health care organizations handle staffing and scheduling in a variety of ways. One method is self-scheduling, in which parameters or principles are given for signing up for specific shifts. When conflicts or shortages occur, managers negotiate with staff members or have staff members negotiate with one another. In other health care organizations, the managers, with input from the staff, create a schedule. The staffing and scheduling exercise that you are about to complete gives you an understanding of the complexity of scheduling staff and covering all shifts and times.
A manager must assess employees’ requests for time off, which includes vacation, scheduled days off, and personal time. A manager also must handle the call-ins for sick time. To staff a unit effectively, the manager must establish a skill mix level and project a unit service figure.
Staffing and Scheduling Scenario
25 med/surg/OB swing beds (Only staffing for this unit; do not include the 6 beds for Rehab originally introduced in week 3)
Average daily census: 17 patients/day
Skill mix: 75% registered nurses (RNs) and 25% unlicensed assistive personnel (UAP)
| RNs | UAP |
| Susie is full-time (7-3) | Jill is full-time (7-3) |
| Jen is full-time (7-3) | Joan is 24 hours per week (7-3) |
| Jon is full-time (7-3) | Jeremy is as needed (3-11) |
| Sylvia is full-time (7-3) | Jerry is part-time 24 hours per week (3-11) |
| Ben is full-time (7-3 and 3-11) | Janet is as needed (3-11) |
| Kim is full-time (3-11) | Jessie is 32 hours per week (11-7) |
| Jack is full-time (3-11) | |
| Cindy is 24 hours/week (3-11) | |
| Jack works on an as-needed basis (3-11 and 11-7) | |
| Tom is full-time (11-7) | |
| Jan is full-time (11-7) |
The nurse manager has determined that a max of 12 staff members (nurses and nurse aids) are required for a 24-hour period based on the average daily acuity level. The nurse manager must cover 24 hours/week for 7 days a week. The breakdown for percentage of nurses (not UAP) needed is as follows: days, 45%; evenings, 36%; and nights, 19%.
Hiring of some as-needed or pool nurses who are flexible to help meet vacation coverage is important. You can get UAP’s from a float pool as well if you need. Just put float nurse or float UAP in the name slot and schedule them as necessary.
RN requests: Susie cannot work Mondays because of school. Jen is getting married and needs September 1 to 17 off for her honeymoon. Jon is going away for a fishing trip and needs the first weekend of September off. Jack (part-time Jack) does not want to work Tuesdays and Thursdays because of babysitting difficulties and does not want every weekend.
UAP requests: Jessie will be on vacation September 1 to 10. Janet will not be able to work Fridays because of a continuing education course.
**Note when someone is requesting a day off you can assume for this assignment they are using Paid Time Off so you can count those hours as part of their 40 hours for that week.
Questions to Consider
- How many employees will be scheduled for each shift?
- What type of employees will be scheduled for each shift? How many of each skill level?
- Are there any vacation or personal requests?
- Who works full-time and who works part-time? What are the part-time employees’ hours?
Summary
Working with staffing and scheduling is complex. When individuals call in because of illness or personal crisis, finding an individual to fill the opening may be harrowing. Meeting individual requests in a tight schedule can be problematic. Many units have resorted to self-scheduling to give staff more flexibility to plan their work and personal lives and to encourage them to cover each other’s shifts.
Directions
- Create a schedule with the following requests using the census of 17, and calculate the number of staff needed per shift.
- First, determine how many employees are on each shift for day, evening, and night shifts.
- Then, calculate the number of RNs and UAPs needed per day, evening, and night shift.
- Next, put all the requests on your calendar.
- Finally, create a schedule, using this empty schedule grid (remember, employees do not like to work every weekend). You may adjust the table as needed.
