25102504 Staffing in Nursing Management

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 ob!ectives of the hospital and the nursing service.
". the population served or kind of patients served whether pay or charity.
#. the number of patients and severity of their illness-knowledge and ability of nursing personnel are matched with the
actual care needs of patients
$. availability and characteristics of the nursing staff including education level of preparation mix of personnel
number and position.
%. administrative policies such as rotation weekends and holiday off-duties.
&. standards of care desired which should be available and clearly spelled out.
'. layout of various nursing units and resources available within the department such as adequate equipment
supplies and materials
(. budget including the amount allotted to salaries fringe benefits supplies materials and equipment
). professional activities and priorities in nonpatient activities like involvement * professional organi+ations formal
educational development participation in research and staff development.
1,. 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 $, hour week law.
1". patterns of work schedule-traditional % days per week ( hours per day- $ days a week ten hours per day and three
days off- or # . days of 1" hours per day and # . days off per week.
Planning for Staffing and Acting to Resolve Current Nursing Shortage
/lanning is the ma!or leadership role in staffing and is often a neglected part of the staffing process. 0ecause the
success of many staffing decisions greatly depends on previous decisions made in planning and organi+ing phases one
must consider staffing when making other plans. 1onsideration 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.
2ccurate predicting staffing needs is valuable management skill because it enables the manager to avoid staffing
crises. 3anagers 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. 2naly+ing historical patterns using computers to sort personnel statistics and keeping accurate unit records are
example of proactive planning.
4ederal moneys for nursing education have increased. The passage of legislation such as the ",," 5urse
6einvestment 2ct has encouraged more students to choose nursing as a career and helps students financially to complete
their education. *t 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.
7ther expert suggests more attention be given to retaining older workers or bringing retired nurses back into the
workforce. 1yr 8",,%9 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. 7thers suggest that
employer must be able to accommodate aging workers with technology aimed at reducing physical strain. 7ther strategies
suggested retaining aging nurses include flexible scheduling and benefits continuing education aid and wellness program.
2nother short term solution to the current shortage has been the importation of foreign nurses particularly by
developed countries from developing countries. :hile 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.
;ong-term solution to a shortage of staff is cross-training. 1ross-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.
<owever 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. <ealth care organi+ations
have used many methods to deal with an unexpected short supply of staff. 1hief 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.
1losed-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. *n 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.
2 health care worker who is in an exhausted state represents a risk to public health and patient safety. :orking
overtime increases the odds of nurses in making errors. :hile 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. 5urses who are forced to work overtime do so under the stress of
competing duties-to their !ob their family their own health and their patient’s safety.
<owever 3anthey suggests that nurses themselves as well as employing organi+ations 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 prioriti+ing 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
6ecruiting
6ecruitment is the process of actively seeking out or attracting applicants for existing positions. *t 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 8a9 the si+e of the institution 8b9 the existence of a separate personnel department 8c9 the presence of a
nurse recruiter within the organi+ation and 8d9 the use of centrali+ed or decentrali+ed nursing department.
=enerally speaking the more decentrali+ed nursing management and the less complex personnel department the
greater the involvement of lower-level managers in selecting personnel or individual units or departments. :hen deciding
whether to hire a nurse-recruiter or decentrali+e the responsibility for recruitment the organi+ation needs to weigh benefits
against costs. 1osts include more than financial considerations. 4or example an additional cost to an organi+ation
employing a nurse-recruiter might be the eventual loss of interest by managers in the recruiting process. The organi+ation
loses if managers relegate their collective and individual responsibilities to the nurse recruiter.
6ecruiting adequate number of nurses is less difficult if the organi+ation is located in a progressive community with
several schools of nursing and if the organi+ation has a good reputation for quality patient care and fair employment
practices.
0ecause most recruiting methods are expensive health care organi+ations often seek less costly means of
recruitment. 7ne of the best ways to maintain an adequate employee pool is by word of mouth- the recommendation of the
organi+ation’s own satisfied and happy staff. 6ecruitment however is not the key to adequate staffing in the long term.
6etention is and only occurs when the organi+ation 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 organi+ation with fresh ideas. *t also
reduces the probability of groupthink in which everyone shares similar thought processes values and goals. <owever
excessive or unnecessary turnover reduces the ability of the organi+ation to produce its end product and is expensive.
1learly the manager must recogni+e the link between retention and recruitment. 2tencio and colleagues 8",,#9
suggest that the social climate of the workplace is the primary initiator of a nurse’s intent to stay or leave and that this social
climate may reflect either work frustration or work excitement. Similarly ;ynn and 6edman 8",,%9 suggest that retention
programs must focus on both organi+ational commitment and work and professional satisfaction. The middle level manager
has the greatest impact in addressing these concerns and creating a positive social climate.
*n addition the closer the fit between what the nurse is seeking in employment and what the organi+ation can offer
the greater the chance that the nurse will be retained.
*nterviewing
2n interview may be defined as a verbal interaction between individuals for a particular purpose. 2lthough 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> 8a9 the interviewer seeks to obtain enough information to determine
the applicant’s suitability for the available position- 8b9 the applicant obtains adequate information to make an intelligent
decision about accepting the !ob should it be offered- and 8c9 the interviewer seeks to conduct the interview in such a
manner that regardless of the interview’s result the applicant will continue to have respect for and goodwill toward the
organi+ation.
Types of *nterview>
?nstructured 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 !ob requirements information must be offered about the skills and qualities being sought examples of the
applicant’s experience must be achieved and the willingness or motivation of the applicant to do the !ob must be
determined. The interviewer who uses a structured format would ask the same essential questions of all applicants.
;imitations of *nterviews
The ma!or defect of interview is sub!ectivity. 3ost interviewers feel confident that they can overcome this sub!ectivity
and view the interview as a reliable selection tool whereas most interviews still have an element of sub!ectivity. The
applicant trying to create a favorable impression also may be unduly influenced by the interviewer’s personality.
2s a predictor of !ob performance and overall effectiveness the structured interview is much more reliable that the
unstructured interview.
7vercoming *nterview ;imitations
• Prepare for the Interview
2sselin 8",,&9 suggests that managers should Ahave a complete and clear understanding of the open positionB before the
interviewing candidate. This includes obtaining a copy of the !ob 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
!ob as well as the professional values characteristics and behaviors that are most likely to ensure success in the position.
• Use Team Approach
<aving more than one person interview the !ob 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
0ecause each !ob 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 !ob 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!a"in# Abilit$
*n addition to obtaining answers to a particular set of questions the interview also should be used to determine the
applicant’s 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 !ultiple Interviews
1andidates should be interviewed more than once on separate days. This prevents applicants from being accepted or
re!ected merely because they were having a good or bad day. 6egardless 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 Trainin# in Effective Interviewin# Techni%ues
Training should focus on communication skills and advice on planning conducting and controlling the interview. *t is unfair
to expect a manager to make appropriate hiring decisions if he or she has never had adequate training in interview
techniques. ?nskilled interviewers often allow sub!ective data rather than ob!ective data affect their hiring evaluation. *n
addition unskilled interviewers may ask questions that could be viewed as discriminatory or that are illegal.
/lanning 1onducting and 1ontrolling the *nterview
/lanning the interview in advance is vital to its subsequent success as a selection tool. *f other interviewers are to be
present they should be available at the appointed time. The plan also should include adequate time for the interview. 0efore
the interview all interviewers should review application noting questions concerning information supplied by the applicant.
2lthough 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. *ntroduce yourself and greet the applicant.
". 3ake a brief statement about the organi+ation and the available positions.
#. 2scertain the position for which the person is applying.
$. Ciscuss the information on the application and seek clarification or amplification as necessary.
%. Ciscuss employee qualifications and proceed with the structured interview format.
&. *f the applicant appears qualified discuss the organi+ation and the position further.
'. Dxplain the subsequent procedures for hiring such as employment physicals and hiring date. *f the applicant is
not hired at this time discuss how and when he or she will be notified of the interview results.
(. Terminate the interview.
The interviewer should have control of the interview and set the tone. Curing 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>
• 2sk only !ob-related questions.
• ?se open-ended questions that require more than a AyesB or AnoB answer.
• /ause a few seconds after the applicant has seemingly finished before asking the next question. This gives the
applicant a chance to talk further.
• 6eturn to topics later in the interview on which the applicant offered little information initially.
• 2sk only one question at a time.
• 6estate part of the applicant’s answer if you need elaboration.
• 2sk questions clearly but do not verbally or nonverbally indicate the correct answer. 7therwise by watching the
interviewer’s eyes and observing other body language the astute applicant may learn which answers are desired.
• 2lways appear interested in what the applicant has to say. The applicant should never be interrupted nor should
the interviewer’s words ever imply criticism of or impatience with he applicant.
• ;anguage 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.
• 2 written record of all interviews should be kept. 5ote taking ensures accuracy and serves as a written record to
recall the applicant. Eeep note taking or use of a checklist however to a minimum so that you do not create an
uncomfortable climate.
Ten Tips to 0oost *nterview *F
1. /ractice =ood 5onverbal 1ommunication.
2. Cress for the Gob or 1ompany
3. ;isten
4. ConHt Talk Too 3uch
5. ConHt 0e Too 4amiliar
. ?se 2ppropriate ;anguage
!. ConHt 0e 1ocky
". Take 1are to 2nswer the Fuestions
#. 2sk Fuestions
1$. ConHt 2ppear Cesperate
*nterviewing Tips for the 2pplicants
1. /repare in advance for the interview.
". 7btain copies of the philosophy and organi+ation chart of the organi+ation to which you are applying.
#. Schedule an appointment for the interview.
$. Cress professionally and conservatively.
%. /ractice responses to potential interview questions in advance.
&. 2rrive early on the day of the interview.
'. =reet the interviewer formally and do not sit down before he or she does unless given permission to do so.
(. Shake the interviewer’s hand upon entering the room and smile.
). Curing the interview sit quietly be attentive and take notes only if absolutely necessary.
1,. Co not chew gum fidget slouch or play with your hair keys or writing pen.
11. 2sk appropriate questions about the organi+ation or the specific !ob for which you are applying.
1". 2void a Awhat can you do for meIB approach and focus instead on whether your unique talents and interests are a
fit with the organi+ation.
1#. 2nswer interview questions as honestly and confidently as possible.
1$. Shake the interviewer’s hand at the close of the interview and thank him or her for his or her time.
1%. Send a brief typed thank-you note to the interviewer within "$ hours of the interview.
*nterview Dvaluation
*nterviewers should plan post-interview time to evaluate the applicant’s interview performance . *nterview note should be
reviewed as soon as possible and necessary points clarified or amplified. ?sing 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. *n answering this
question two aspects must carry the most weight>
• The re%uirements for the &ob' 6egardless of how interesting or friendly people are unless they have the basic skills
for the !ob they will not be successful at meeting the expectations of the position. ;ikewise those overqualified for a
position will usually be unhappy in the !ob.
• Personal bias' 0ecause 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. 7ften 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 !ob
or position. This process involves verifying the applicant’s qualifications checking hisJher work history and deciding of a
good match exists between the applicant’s qualifications and the organi+ation’s expectations.
Dducational and 1redential 6equirements
1onsideration should be given to educational requirements and credentials for each !ob category as long as a
relationship exists between theses requirements and success on the !ob.
6eference 1hecks
2ll applications should be examined to see if they are complete and to ascertain that the applicant is qualified for
the position. 2t this point references are requested and employment history is verified. 2ccording to 2sselin 8",,&9 the
manager should always be cogni+ant of red flags in applications such as Aunexplained gaps in employment history or
frequent changes of employer without acceptable explanationB. /ositions should never be offered until information on the
application has been verified and references have been checked.
/re-employment Testing
/re-employment testing is used only when such testing is directly related to the ability to perform a specific !ob.
2lthough 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.
/hysical Dxamination as a Selection Tool
2 medical examination is often a requirement for hiring. This examination determines if the applicant can meet the
requirements for a specific !ob 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 organi+ation’s health insurance.
4inali+ing the Selection
The closure of pre-employment process is as follows>
1. 4ollow up with applicants as soon as possible thanking them for applying and informing them when they will be
notified about a decision.
". 1andidates not offered a position should be notified of this as soon as possible. 6easons should be provided when
appropriate and candidate should be told whether their application will be considered for future employment or if they
should reapply.
#. 2pplicants 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.
$. 2pplicants who accept the !ob offers should be informed as to pre-employment procedures such as physical
examinations and supplied with the date to report to work.
%. 2pplicants who are offered positions should be requested to confirm in writing their intention to accept the position.
/lacement
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. 5ursing units and departments develop subcultures that have their
own norms values and methods of accomplishing work. *t 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.
1onversely proper placement fosters personal growth provides a motivating climate for the employee maximi+es
productivity and increases the probability that organi+ational goals will be met. 3anagers who are able to match employee
strengths to !ob requirements facilitate unit functioning accomplish organi+ational goals and meet employee needs.
*ndoctrination
Indoctrination refers to the planned guided ad!ustment of an employee to the organi+ation and the work
environment. 2lthough the words AinductionB and AorientationB are frequently used to describe this function the indoctrination
process includes three separate phases> induction orientation and sociali+ation.
*ndoctrination seeks to 8a9 establish favorable employee attitudes toward the organi+ation unit and department- 8b9
provide the necessary information and education for success in the position- and 8c9 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 sociali+ed to the norms and values of the work group.
Dmployee *ndoctrination 1ontent>
1. 7rgani+ation history mission and philosophy
". 7rgani+ation service and service area
#. 7rgani+ational structure including department heads with an explanation of the functions of the various
departments
$. Dmployee responsibilities to the organi+ation
%. 7rgani+ational responsibilities to the employee
&. /ayroll information including how increases in pay are earned and when they are given 8progressive or unioni+ed
companies publish pay scales for all employees9
'. 6ules of conduct
(. Tour of the facility and of the assigned department
). :ork schedules staffing and scheduling policies
1,. :hen applicable a discussion of the collective bargaining agreement
11. 0enefit plans including life insurance health insurance pension and unemployment
1". Safety and fire programs
1#. Staff development programs including in-service and continuing education for relicensure.
1$. /romotion and transfer policies
1%. Dmployee appraisal system
1&. :orkload assignments
1'. *ntroduction to paperworkJforms used in the organi+ation
1(. 6eview of selection in policies and procedures
1). Specific legal requirements such as maintaining a current license reporting of accidents and so forth
",. *ntroduction to fellow employees
"1. Dstablishment of a feeling of belonging and acceptance showing genuine interest in the new employee
*nduction
Induction( the first phase of indoctrination takes place after the employee has been selected but before performing
the !ob role. The induction process includes all activities that educate the new employee about the organi+ation and
employment and personnel policies and procedures.
Dmployee handbooks an important part of induction are usually developed by the personnel department.
3anagers however should know what information the employee handbooks contain and should have input into their
development. 3ost 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 employee’s personnel file.
The handbook is important because employees cannot assimilate all the induction information at one time so they
need a reference for later. <owever 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.
7rientation
)rientation 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 ;ine-up of 2ctivities Cone in 7rientation
- :elcome by personnel department- employee handbooks distributed and discussed
- =eneral 7rientation by staff development
- Tour of the 7rgani+ation
- 4ire and safety films body mechanics demonstration
- *ntroduction to each unit supervisor
- 6eport to individual units 8time with unit supervisor and introduction to assigned preceptor9
- =eneral orientation of policies and procedures
- 1/6 recertification
- :ork with preceptor on shift and unit assigned gradually assuming greater responsibilities
- 1arry normal workload aster a week. <ave at least a #,-minute meeting with immediate supervisor to
discuss progress.
Sociali%ation and Resociali%ation
“Socializing new nurses into the healthcare culture will help retain them.”
Sand$ *eefee( !S+( ,+
• Role &heor'
- The phenomenon of sociali+ation has generally focused on this theory
- Dxplains that behaviors that accompany each role are learned socially and by instruction observation and trial and
error
© Sociali%ation
- 4irst occurs during nursing school and after graduation
- 0ecause nurse administrators and nursing faculty have found to hold different values and both this groups assist in
sociali+ing the new nurse there is potential for the new nurse to develop conflict and frustration.
© Resociali%ation
- 7ccurs 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
- *ndividuals who need resociali+ation include new graduates leaving school and entering the work world-
experienced nurses who change work settings either within the same organi+ation or in the new organi+ation- and nurses
who undertake new roles.
- Some employees adapt easily to resociali+ation but most experience stress with the role change.
• (verco)ing *otivational +eficiencies
- Cifficulties in sociali+ation and resociali+ation occurs because of motivational deficiencies
- There are " ways to correct motivational deficiencies> positive and negative sanctions
1Positive Sanctions
- 1an 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.
- 3anagers should become aware of what role behavior they reward and what new employee behavior the senior
staff is rewarding.
1 Negative Sanctions
- They are like rewards
- /rovide 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
• ,)plo'ees -ith uni.ue sociali%ation needs
- 3anagers who provide appropriate sociali+ation assistance for these groups increase the chance of positive
employment outcome
O &he Ne- Nurse
- Reality Shock @ was coined by Eramer 81)'$9 which described fears and difficulties in adapting to work setting that
are common to new graduate nurses- it occurs as a result of conflict between a new graduate nurse’s expectations of
the nursing role and the reality of actual role in the work setting
- Four phases of role transition from student nurse to staff nurse: honeymoon phase shock recovery and
resolution phase.
- Roles of nurse managers in combating reality shock:
1 5urse 3anagers should not rely in anticipatory sociali+ation prepared by nursing schools.
1 They should be alert for signs and symptoms of the shock phase of role transition.
1 They should also ensure that some of the new nurse’s values are supported and encouraged so that work and
academic values can blend.
O /nternational Nurses
- 7ne solution to current nursing shortage 8applicable only to ?.S.9
- 6yan 8",,#9 suggests that sociali+ation to the professional nursing role is one of four basic needs that must be
addresses if foreign nurses are to adapt successfully to 2merican workplaces.
- 0ola Criggers Cunlap and Dbersole 8",,#9 state that international nurses also frequently experience culture shock
regarding nonverbal communication that may interfere with their assimilation.
- 6yan 8",,#9 suggests that using a Cultural Diversit$ Enhancement -roup .CDE-/ and a budd$ pro#ram may assist
in sociali+ing 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 organi+ational
culture.
- Cumpel 8",,%9 says that international nurses need the same sociali+ation as other transition groups such as
mentors and preceptors support groups and other orientation programs.
O Ne- *anagers
- Sullivan 0retschneider and 3c1ausland 8",,#9 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.
- &he direction a ne- )anager needs co)es fro) several sources -ithin the organi%ation -hich includes0
1 The new manager’s immediate superior
1 2 group of the new manger’s peers
1 2 mentor
- Role ambiguity- describes the stress that occurs when !ob expectations are unclear
- Role Oerload- occurs when the demands of the role are excessive
O &he ,1perienced Nurse in the Ne- Position
© &ransition fro) e1pert to novice
- a very difficult role transition
- 3any nurses transfer or change !obs because they can no longer find their present !ob challenging
© &ransition fro) fa)iliar to unfa)iliar
- *n the old surroundings the employee knew everyone and where everything was located. *n the new position the
employee will not be only learning new !ob skills but also be in an unfamiliar environment.
- Speciali+ed orientation material should be developed and necessary staff development orientation programs should
be provided
O Assisting the ,1perienced Nurse in Role &ransition
- 3anagers should not assume that the experienced nurse is aware of the new role’s expected attitudes.
- 3anagers need to support employees during this value resociali+ation.
Clarif'ing Role ,1pectations through Role *odels2Preceptors and *entors
“!n looking for a role model" ! didn#t hae to go far.”
0illiam !' *eane Jr'
• Role *odel
- Cefined as someone worthy of imitation
- They are experienced competent employees
- 7ne 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
- 2n experienced nurse who provides knowledge and emotional support as well as a clarification of role
expectations on a one-on-one basis
- 2n effective preceptor can role model and ad!ust teaching to each learner as needed.
• *entor
- 3adison 8",,&9 described mentoring as a distinctive interactive relationship between two individuals occurring
most commonly in a professional setting.
- 2 mentor is able to instill the values and attitudes that accompany each role- often a role model and visionary for the
mentee.
- 2 preceptor is different from a mentor.
PR,C,P&(R *,N&(R
- ?sually assigned
- 6elatively short
relationship with the
person to whom they
were assigned
- 4reely choose who
they will mentor
- 6elationship is
longer and more
intense
Four phases in mentoring relationships:
1. /nitiation @ occurs when the relationship is established
2. Cultivation @ characteri+ed by coaching protection and sponsorship as well as counseling acceptance and the
creation of a sense of competence.
3. Separation ---
4. Redefinition @ 0oth 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.
3alidities and 4egalities in 5iring
“$ealthcare facilities are more interested in hiring nursing students who can think critically and organize than
those who boast competencies" such as an impressie number of in%ections gien.”
1orraine Steefel( ,+( !S+( CT+
=iven 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. 2 wide variety of pre employment tests are used to
determine which candidate is best suited for a position.
• &esting
- *t has an impact on selection of employees
- *f 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 !ob
© 3 For)s of 3alidit' in testing0
C &ontent 'alidity @ The test recreates or represents significant sample parts of the !ob such as typing tests.
C &onstruct 'alidity @ The test identifies a psychological or personality trait that is important to successful performance
such as leadership or problem solving abilities.
C &riterion(related 'alidity @ The test contains elements on which anyone who would do well on the !ob perform well or
anyone who would do poorly on the !ob will perform poorly.
• 4egal Aspects of Pre e)plo')ent /n.uiries
Su67ect of
/n.uir'
/t )a' not 6e
discri)inator'
to in.uire
a6out0
/t )a' 6e
discri)inator'
to in.uire
a6out0
1. Na)e :hether
applicant has
ever worked
under a
different name
a. 7riginal
name of an
applicant whose
name has been
legally changed
b. The ethnic
association of
applicant’s
name
2. Age a. *f applicant is
over the age 1(
b. *f applicant is
under the age
1( or "1 if !ob
related
a.Cate of birth
b.Cate of high
school
graduation
3. Residence a. 2pplicant’s
place of
residence
where employer
is located
a./revious
addresses
b.0irthplace of
applicant or
applicant’s
parents
4. Race or
color
a.2pplicant’s
race or color of
applicant’s skin
5. National
origin and
ancestr'
a.2pplicant’s
lineage
ancestry
national origin
parentage or
nationality
. Se1 and
Fa)il'
co)position
a. Sex of
applicant
b. Cependents
of applicant
c. 3arital Status
d. 1hild- care
arrangements
!.Creed or
religion
a.2pplicant’s
religious
affiliation
b.1hurch
parish or
holiday’s
observed
". Citi%enship a. :hether the
applicant is a
citi+en of the
?nited States
b. :hether the
applicant is in
the country on a
visa that
permits him or
her to work or is
a citi+en
a.:hether
applicant is a
citi+en of the
country other
than the ?nited
States
#. 4anguage a. ;anguage
applicant
speaks and or
writes fluently if
!ob related
a.2pplicant’s
native
language-
language
commonly used
at home
1$. References a. 5ames of
people willing to
provide
professional
andJor
character
references of
the applicant
a. 5ame of
applicant’s
pastor or
religious leader
11. Relatives a. 5ames of
relatives
already
employed by
the employer
a.5ame andJor
address of any
relative of
applicant
b.:hom to
contact in case
of emergency
12.
(rgani%ations
a. 2pplicant’s
membership in
any
professional
a. 2ll clubs or
social
organi+ations to
which applicant
service or trade
organi+ation
belongs
13. Arrest
record and
convictions
a. 1onvictions if
related to !ob
performance
a. 5umber and
kinds of arrests
b. 1onvictions
unless related
to !ob
performance
14.
Photographs
a./hotographs
with application
with resume or
before hiring
15. 5eight and
8eight
a.2ny inquiry
into height and
weight of
applicant except
where a bona
fide
occupational
qualification
1. Ph'sical
li)itations
a. :hether
applicant has
the ability to
perform !ob-
related
functions with
or without
accomodation
a.The nature or
severity of an
illness or the
individual’s
physical
condition
b.:hether
applicant has
ever filed a
worker’s
compensation
claim
c.2ny recent or
past operations
or surgery dates
1!. ,ducation a. Training
applicant has
received if
related to !ob
under
consideration
b. <ighest level
of education
attained if
validated that
having certain
educational
background is
necessary to
perform the
specific !ob
1". *ilitar' a. :hat branch
of military
applicant
served in
b. Type of
education or
training
received in the
military
c. 6ank at
discharge
a. Type of
military
discharge
1#. Financial
Status
a.2pplicant’s
debts and
assets
• 5iring 9 A Shared Responsi6ilit'
The question of who makes the final employment hiring from among screened candidates is critical. <iring remains
an inexact science despite all the techniques that have been developed and used. *deally 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 organi+ational policies and
employment laws are followed and individuals selected meet the quality standards and conform to its vales and culture.
Patient Care Classification S'ste)
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 "$ hours as well as the category of nursing personnel who should provide
that care.
2s a result of patient classification s$stems 8/1S9 also known as workload management or patient acuit$ tools
were developed in the 1)&,s. 0ecause other variables within the system have an impact on nursing care hours it is usually
not possible to transfer a /1S from one facility to another. *nstead each basic classification system must be modified to
specific institution.
2domat and <ewison 8",,$9 suggest that most /1Ss can be classified as robust measures for severity of illness.
<owever they maintain that although they are helpful they are not accurate tools for determining nurse-patient ratios and
that all /1S measurement tools need nursing input if they are to measure nurse-patient needs accurately.
There are several types of /1S measurement tools. The critical indicator /1S uses broad indicators such as
bathing diet intravenous fluids and medications and positioning to categori+e patient care activities. The summative tas"
type requires the nurse to note for frequency of occurrence of specific activities treatments and procedures for each
patient. 4or example a summative task-type /1S might ask the nurse whether a patient required nursing time for teaching
elimination or hygiene. 0oth types of /1Ss 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.
7nce an appropriate /1S is adopted hours of nursing care must be assigned for each patient classification.
2lthough an appropriate number of hours of care for each classification is generally suggested by companies marketing
/1Ss each institution is unique and must determine to what degree that classification system must be adapted to that
institution. :hite 8",,#9 suggests that average length of stay and practitioner specialty in defining its patient population. *n
addition staff competency core staff versus visiting staff and skill mix must be considered 8:hite ",,#9.
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-
". The characteristics of patients in each category-
#. The type and number of care procedures that will be needed by a typical patient in each category- and
$. The time needed to perform these procedures that will be required by a typical patient in each category.
The number of categories in a patient classification may range from three to four which is the most popular to five
or six. These classes relate to the acuity of illness and care requirements whether minimal moderate or intensive care.
7ther factors affecting the classification system would relate to the patient’s capability to meet his physical needs to
ambulate bathe feed himself and other instructional needs including emotional support.
/atients care classifications have been developed primarily for medical surgical pediatrics and obstetrical patients
in acute care facilities.
Classification Categories
The various units mat develop their own ways of classifying patient care according to the acuity of their patient’s
illness. 4ollowing is an example of a patient care classification in the medical-surgical unit.
;evel * @ Self 1are or 3inimal 1are @ /atient can take a bath on his own feed himself feed and perform his
activities of daily living. 4alling under this category are patients about to be discharged those in non-emergency those
newly admitted do not exhibit unusual symptoms and requires little treatmentJobservation andJor instruction. 2verage
amount of nursing care hours per patient per day is 1.%. 6atio of professional and non-professional nursing personnel is
%%>$%.
;evel ** @ 3oderate 1are or *ntermediate 1are @ /atients under this level need some assistance in bathing feeding
or ambulating for short periods of time. Dxtreme symptoms of their illness must have subsided of have not yet appeared.
/atients 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 andJor
observations andJor instructions. 2verage nursing care hours per patient per day is # and the ratio of professional to non-
professional personnel is &,>$,.
;evel *** @ Total 1omplete or *ntensive 1are @ /atients 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 #, minutes for impending hemorrhage with hypo or hypertension
andJor cardiac arrhythmia. The nursing care hours per patient per day is & with a professional to non-professional ratio of
&%>#%.
;evel *K @ <ighly Speciali+ed 1ritical 1are @ /atients under this level need maximum nursing care with a ratio of (,
professionals to ", non-professionals. /atients need continuous treatment and observation- with many medications *K
piggy backs- vital signs every 1%-#, minutes- hourly output. There are significant changes in doctor’s orders and care hours
per patient per day may range from &-) more and the ratio of professionals to non-professionals also ranges from ',>#, to
(,>",.
Patient Care Classification :sing Four 4evels of
Nursing Care /ntensit'
2rea of 1are 1ategory 1 1ategory " 1ategory # 1ategory $
Dating 4eeds self or
needs little food
5eeds some help
in preparing food
tray- may need
encouragement
1annot feed self
but is able to
chew and
swallow
1annot feed self
and may have
difficulty
swallowing
=rooming 2lmost entirely
self-sufficient
5eeds some help
in bathing oral
hygiene hair
combing and so
forth
?nable to do
much for self
1ompletely
dependent
Dxcretion ?p and to 5eeds some help *n bed needs 1ompletely
bathroom alone
or almost alone
in getting up to
bathroom or
using urinal
bedpan or urinal
placed- may be
able to partially
turn or lift self
dependent
2rea of 1are 1ategory 1 1ategory " 1ategory # 1ategory $
1omfort Self-sufficient 5eeds some help
with ad!usting
position or bed
8e.g. tubes *Ks9
1annot turn
without help get
drink ad!ust
position of
extremities and
so forth
1ompletely
dependent
=eneral <ealth =ood @ in for
diagnostic
procedure
simple treatment
or surgical
procedure 8C L
1 biopsy minor
fracture9
3ild symptoms @
more than one
mild illness mild
debility mild
emotional
reaction mild
incontinence 8not
more than once
per shift9
2cute symptoms
@ severe
emotional
reaction to illness
or surgery more
than one acute
illness medical
or surgical
problem severe
or frequent
incontinence
1ritically ill @ may
have severe
emotional
reaction
Treatments Simple @
supervised
ambulation
dangle simple
dressing test
procedure
preparation not
requiring
medication
reinforcement of
surgical dressing
x-pad vital signs
once per shift
2ny category 1
treatment more
than once per
shift 4oley
catheter care * L
7- bladder
irrigations sit+
baths
compresses test
procedures
requiring
medications or
follow-ups
simple enema for
evacuation vital
signs every $
hours
2ny treatment
more than twice
per shift
medicated *Ks
complicated
dressings sterile
procedures care
of tracheostomy
<arris flush
suctioning tube
feeding vital
signs more than
every $ hours
2ny elaborate or
delicate
procedure
requiring two
nurses vital signs
more often than
every " hours
3edications Simple routine
not needing pre-
evaluation or post
evaluation-
medications no
more than once
per shift
Ciabetic cardiac
hypotensive
hypertensive
diuretic
anticoagulant
medications prn
medications
more than once
per shift
medications
needing pre-
evaluation or post
<igh amount of
category "
medications-
control of
refractory
diabetes 8need to
be monitored
more than every
$ hours9
Dxtensive
category #
medications- *Ks
with frequent
close observation
and regulation
evaluation
Teaching and
emotional
support
6outine follow-up
teaching- patients
with no unusual
or adverse
emotional
reactions
*nitial teaching of
care of ostomies-
new diabetics-
tubes that will be
in place for
periods of time-
conditions
requiring ma!or
change in eating
living or
excretory
practices-
patients with mild
adverse reactions
to their illness
8e.g. depression
overly
demanding9
3ore intensive
category " items-
teaching of
apprehensive or
mildly resistive
patients- care of
moderately upset
or apprehensive
patients-
confused or
disoriented
patients
Teaching of
resistive patients-
care and support
of patients with
severe emotional
reaction
&a6le 2. Categories or levels of care of patients2 nursing care hours needed per patient per da' and ratio of
professionals to non;professionals
4evels of Care NC5 Needed
Per Pt. Per +a'
Ratio of Prof.
to Non;Prof.
;evel * 1.%, %%>$%
Self 1are or
3inimal 1are
;evel ** #., &,>$,
3oderate or
*ntermediate 1are
;evel *** $.% &%>#%
Total or *ntensive
1are
;evel *K &., ',>#,
<ighly Speciali+ed
or 1ritical 1are
' or higher (,>",
The <ospital 5ursing Service 2dministration 3anual of the Cepartment of <ealth has recommended the following nursing
care hours for patients in the various nursing units of the hospital.
&a6le 1. Nursing care hours per patient per da' according to classification of patients 6' units.
Cases<Patients NC5<Pt<da' Prof. to Non Prof. Ratio
1. =eneral 3edicine #.% &,>$,
". 3edical #.$ &,>$,
#. Surgical #.$ &,>$,
$. 7bstetrics #., &,>$,
%. /ediatrics $.& ',>#,
&. /athologic 5ursery ".( %%>$%
'. D6J*1?J66 &., ',>#,
(. 11? &., (,>",
Percentage of Nursing Care 5ours
The percentage of nursing care hours at each level of care also depends on the setting in which the care is being
given. 4or primary hospitals about ', percent of their patients need minimal care "% percent need moderate care. /atients
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.
*n a secondary hospital &% percent of the patients need minimal care #, percent need moderate care and only %
percent need intensive care. *n tertiary hospitals about #, percent of patients need minimal care- $% percent need
moderate care 1% percent need intensive care while 1, percent will need highly speciali+ed intensive care. *n special
tertiary hospitals about 1, percent will need minimal care- "% percent need moderate care- $% percent need intensive care-
while about ", percent will need highly speciali+ed intensive care.
&a6le 3. Percentage of patients at various levels of care per t'pe of hospital
Percentage of Patients in 3arious 4evels of Care
Type of <ospital 3inimal 1are 3oderate 1are *ntensive 1are <ighly Spl. 1are
/rimary <ospital ', "% % -
Secondary <ospital &% #, % -
Tertiary <ospital #, $% 1% 1,
Spl. Tertiary <ospital 1, "% $% ",
Co)puting for the Nu)6er of Nursing Personnel Needed
:hen 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 4orty-<our :eek ;aw 86epublic 2ct %),19 provides that employees working in hospitals with 1,,-bed capacity
and up will work only $, hours a week. This also applies to employees working in agencies with at least one million
population. Dmployees working in agencies with less than one hundred-bed capacity or in agencies located in communities
with less than one million population will work forty-eight hours a week and therefore will get only one off-duty a week.
There are also benefits that have to be en!oyed by each personnel regardless of the working hours per week. The
latest is the granting of the three-day special privilege to government employees by the 1ivil Service 1ommission as per
3emorandum 1ircular 5o. & series of 1))& which may be spent for birthdays weddings anniversaries funerals
8mourning9 relocation enrollment or graduation leave hospitali+ation and accident leaves.
&a6le 4. &otal nu)6er of -or=ing and non;-or=ing da's and hours of nursing personnel per 'ear.
Rights and Privileges >iven ,ach
Personnel
8or=ing 5ours Per 8ee=
Per ?ear 4$ 5ours 4" 5ours
1. 1. Kacation ;eave 1% 1%
". Sick ;eave 1% 1%
#. ;egal <olidays 1, 1,
$. Special <olidays " "
%. Special /rivileges # #
&. 7ff-Cuties as per 6.2. %),1 1,$ %"
'. 1ontinuing Dducation /rogram # #
MMMMMM MMMMMM
Total 5on-:orking Cays /er Near 1%" 1,,
Total :orking Cays /er Near "1# "&%
Total :orking <ours /er Near 1',$ "1",
Relievers Needed
To compute for relievers needed the following should be considered>
1. 2verage number of leaves taken each year - - - - - - 1%
a. Kacation ;eave - - - - - - - - - - - - - - - - - - - - - - - 1,
b. Sick ;eave - - - - - - - - - - - - - - - - - - - - - - - - - - - %
". <olidays - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1"
#. Special /rivileges as per 1S1 31O& s.1))& - - - - - - -#
$. 1ontinuing Dducation /rogram for /rofessionals - - #
Total 2verage ;eaves ##
*t will be noted that although an employee is entitled to 1% days sick leave and 1% days vacation leave 1" holidays
# days for continuing education plus # days of special privileges or $( days total he or she gets only an average of ## days
leave per year.
To determine the relievers needed divide ## 8the average number of working days an employee is absent per year9
by the number of working days per year that each employee serves 8whether "1# or "&%9. This will be ,.1% per person who
works $, hours per week and ,.1" per person for those working $( hours per week.
3ultiply the computed reliever per person by the computed number of nursing personnel. This will give the total
number of relievers needed.
+istri6ution 6' Shifts
Studies have shown that the morning or day shift needs the most number of nursing personnel at $% to %1 percent-
for the afternoon shift #$ to #' percent- and for the night shift 1% to 1( percent. *n the /hilippines the distribution usually
followed is $% percent for the morning shift #' percent for the afternoon shift and 1( shift for the night shifts.
Staffing For)ula
To compute for the staff needed in the *n-/atient units of the hospital the following steps are considered>
1. 1ategori+e the number of patients according to the levels of care needed. 3ultiply the total number of patients by the
percentage of patients at each level of care 8whether minimal intermediate intensive or highly speciali+ed9.
". 4ind the total number of nursing care hours needed by the patients at each category level.
a. 4ind the number of patients at each level by the average number of nursing care hours needed per day.
b. =et the sum of the nursing care hours needed at the various levels.
#. 4ind the actual number of nursing care hours needed by the given number of patients. 3ultiply the total nursing care
hours needed per day by the total number of days in a year.
$. 4ind the actual number of working hours rendered by each nursing personnel per year. 3ultiply the number of hours on
duty per day by the actual working days per year.
%. 4ind the total number of nursing personnel needed.
a. Civide the total number of nursing care needed per year by the actual number of working hours rendered by an
employee per year.
b. 4ind the number of relievers. 3ultiply the number of nursing personnel needed by ,.1% 8for those working $, hours
per week9 or by ,.1" 8for those working $( hours per week9.
c. 2dd the number of relievers to the number of nursing personnel needed.
&. 1ategori+e the nursing personnel into professionals and non-professionals. 3ultiply the number of nursing personnel
according to the ratio of professionals to non-professionals.
'. Cistribute by shifts.
To illustrate2
4ind the number of nursing personnel needed for %,, patients in a tertiary hospital.
1.1ategori+e the patients according to level of care needed.
%,, 8pts9 x .#, P 1%, patients needing minimal care
%,, 8pts9 x .$% P ""% patients needing moderate care
%,, 8pts9 x .1% P '% patients need intensive care
%,, 8pts9 x .1, P %, patients need highly speciali+ed nursing care
%,,
".4ind the number of nursing care hours 851<9 needed by patients at each level of care per day.
1%, pts x 1.% 851< needed at ;evel *9 P ""% 51<Jday
""%.% pts x # 851< needed at ;evel **9 P &'% 51<Jday
'% pts x $.% 851< needed at ;evel ***9 P ##'.% 51<Jday
%, pts x & 851< needed at ;evel *K9 P #,, 51<Jday
Total 1%#'.% 51<Jday
#.4ind the total 51< needed by %,, patients per year.
1%#'.% x #&% 8daysJyear9 P %&11('.%, 51<Jyear
$. 4ind the actual working hours rendered by each nursing personnel per year.
( 8hrsJday9 x "1# 8working daysJyear9 P 1',$ 8working hoursJyear9
%.4ind the total number of nursing personnel needed.
a. Total 51< per year P %&11('.%, P #")
:orking hrsJyear 1',$
b. 6elief x Total 5ursing /ersonnel P #") x ,.1% P $)
c. Total 5ursing /ersonnel needed #") Q $) P #'(
&. 1ategori+e to professional and non-professional personnel. 6atio of professionals to non-professionals in a tertiary
hospital is &%>#%.
#'( x .&% P "$& professional nurses
#'( x .#% P 1#" nursing attendants
'. Cistribute by shifts.
"$& nurses x .$% P 111 nurses on 23 shift
"$& nurses x .#' P )1 nurses on /3 shift
"$& nurses x .1( P M $$ Mnurses on night shift
Total "$& nurses
1#" 5ursing attendants x .$% P %) 5ursing attendants on 23 shift
1#" 5ursing attendants x .#' P $) 5ursing attendants on /3 shift
1#" 5ursing attendants x .1( P M "$ M5ursing attendants on night shift
Total 1#" 5ursing 2ttendants
*t 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 7perating 6oom the
Celivery 6oom the Dmergency 6oom and 7ut-/atient Cepartment.
2 <ead 5urse is provided for every nursing unit. ;ikewise a 5ursing Superior is provided 19 to cover every shift in
each clinical department or area specialty unit- "9 for each geographical area in hospitals beyond one hundred 81,,9 beds
and- #9 for each functional area such as Training 6esearch *nfection 1ontrol and ;ocality 3anagement.
*anager@s Responsi6ilities in *eeting Staffing Needs
The manager must ascertain that adequate numbers and an appropriate mix of personnel are available to meet daily unit
needs and organi+ational goals.
*t is important that staffing patterns and scheduling policies must be administered fairl$ as well as economicall$ because
they both directly affect the daily lives of all personnel.
4eadership Roles and *anage)ent Functions Associated -ith Staffing and Scheduling
;D2CD6S<*/ 67;DS 3252=D3D5T 4?51T*75S
1. *dentifies creative and flexible staffing methods to
meet the needs of the patients staff and the
organi+ation.
". *s knowledgeable regarding contemporary
methods of scheduling and staffing.
#. 2ssumes a responsibility toward staffing that
1. /rovides adequate staffing to meet patient care
needs according to the philosophy of the
organi+ation.
". ?ses organi+ational goals and patient
classification tools to minimi+e understaffing and
overstaffing as patient census and acuity fluctuate.
builds trust and encourages a team approach.
$. /eriodically examines the unit standard of
productivity to determine if changes are needed.
%. *s alert to extraneous factors that have an impact
on staffing.
&. *s ethically accountable to patients and
employees for adequate and safe staffing.
'. /lans for staffing shortages so patient care goals
will be met.
(. 2ssesses if and how workforce intergenerational
values impact staffing needs and responds
accordingly.
#. Schedules staff in a fiscally responsible manner.
$. Cevelops fair and uniform scheduling policies and
communicates these clearly to all staff.
%. 2scertains that scheduling policies are not in
violation of local and national labor laws
organi+ational policies or union contracts.
&. 2ssumes accountability for quality and fiscal
control of staffing.
'. Dvaluates scheduling and staffing procedures and
policies on a regular basis.
Infle3ible schedulin# is a ma!or contributor to !ob dissatisfaction and turnover on the part of nurses. 3anagers 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 organi+ations. Dach organi+ation has different expectations
regarding the unit manager’s responsibility in long-range human resource planning and in short-range planning for daily
staffing.
Centrali4ed Staffin# is where staffing decisions are made by personnel in a central office or staffing center. Such centers
may or may not be staffed by 65s although someone in authority would be a nurse when a staffing clerk carries out the
day-to-day activity.
2dvantages>
The manager’s role is limited to making minor ad!ustments and providing input. The manager continues to have
ultimate responsibility for seeing that adequate personnel are available to meet the needs of the organi+ation.
*t is fairer to all employees because policies tend to be employed more consistently and impartially.
*t allows for the most efficient 8cost effective9 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.
Cisadvantages>
*t does not provide as much flexibility for the worker nor can it account as well for a worker’s desires or special
needs.
3anagers may be less responsive to personnel budget control if they have limited responsibility in scheduling and
staffing matters.
Decentrali4ed Staffin# 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.
2dvantages>
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.
*t leads to increased autonomy and flexibility thus decreasing nurse attrition.
Cisadvantages>
*t 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.
*t is time consuming for the manager and often promotes more Aspecial pleadingB than centrali+ed staffing.
The ma!or difficulty is ensuring high-quality staffing decisions throughout the organi+ation.
0udreau 0alakrishnan Titler and <afner 81)))9 state that nursing management is highly decentrali+ed 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.
3anagers must also be cogni+ant of the need to have an ethnicall$ and culturall$ diverse staff to meet the needs of
an increasingly diverse patient population.
unique cultural and linguistic needs of patient population P appropriately diverse staff
3alloch Ceveonport and <atler 8",,#9 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.
5urse-managers must be cogni+ant of new recommendations and legislation affecting staffing.
4or example> minimum staffing ratios
/roponents of legislated minimum staffing ratios say that ratios are needed because many hospitals’ current staffing
levels are so low that both 65s and patients are ne#ativel$ affected'
/oor staffing P 8-9 nurses’ health L safety Q 8-9 patient outcomes
# 2rguments against Staffing 6atios>
1. The current nursing shortage will make it difficult to fill the slots when the ratios appear.
". The ratios may merely serve as a 0and-aid to the greater problems of quality care.
#. 5umbers alone do not ensure improved patient care since not all 65s have equivalent clinical experience and
skill levels.
Scheduling (ptions
Some of the more frequently used creative staffing and scheduling options include>
1 1,- or 1"- hour shifts
The resultant nurse satisfaction must be weighed against the increased costs because extending the workday with 1,-
to 1"-hour shifts may require overtime pay.
Dxtending the length of shifts may result in increased !udgment errors as nurses become fatigued.
7rgani+ations limit the number of consecutive 1,- or 1"-hour days a nurse can work or the number of hours that can be
worked in a given day.
1 /remium pay for weekend work
1 /art-time staffing pool for weekend shifts and holidays
1 1yclical staffing which allows long term knowledge of future work schedule because a set staffing pattern is repeated
every few weeks
1 Gob sharing
1 2llowing nurses to exchange hours of work among themselves
1 4lextime
*t is a system that allows employees to select the time schedules that best meet their personal needs while still meeting
work responsibilities.
3ost 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. Kariable start times may be longer or
shorter than the normal (- hour workday.
?nits have employees coming and leaving the unit at many different times when a hospital uses flextime. 2lthough
flextime staffing creates greater employee choices it may be difficult for the manager to coordinate and could easily result in
overstaffing or understaffing.
1 ?se of supplemental staffing from outside registries and float pools
A#enc$ nurses or travel nurses are usually directly employed by an external broker and work for premium pay 8"-#
times that of regularly employed staff9 without benefits.
:hile 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 perdiem employees and creating float
pools'
/er-diem staff generally has flexibility to choose if and when they want to work. *n exchange for this flexibility they
receive higher rate of pay but usually no benefits.
4loat 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. :ing 8",,19 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. *t results in lack of staff continuity.
1 Staff self-scheduling
*t was developed in 1)&,s where it allowed nurses in a unit to work together to construct their own schedules rather
than have schedules created by management.
Dmployees 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 8i.e. number of weekend shifts that must be worked maximum number of
consecutive shifts9 8<ung ",,"9.
The nurse-manager then reviews the worksheet to make sure all the guidelines or requirements have been met.
/oints to consider>
• 2lthough 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 8",,,9 found that it provides greater worker participation in decision making but requires greater worker
involvement and management flexibility to be successful.
• *t saves management time improve morale and professionalism and reduces personnel turnover 8<ung ",,"9.
• 5urses most satisfied with self-scheduling were those who shared responsibility for adequate staffing and those who
had developed good negotiating skills.
7bviously 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.
0ecause 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.
8or=load *easure)ent &ools
6equirements for staffing are based on whatever standard unit of measurement for productivity is used in a given unit.
NC5<PP+ A Nursing 5ours 8or=ed 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.
*n 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.
Gennings ;oan Ce/aul 0rosch and <ildreth 8",,19 concur suggesting that the use of 51<J//C as a workload
measurement tool may be too restrictive since it may not present the reality of today’s inpatient care settings
where staffing fluctuates not only among shifts but within shifts.
2s a result Patient Classification S'ste)s 8/1S9 also known as wor"load mana#ement or patient acuit$ tools were
developed in the 1)&,s.
/1Ss 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.
*t is usually not possible to transfer a /1S from one facility to another because other variables within the system
have an impact on nursing care hours. *nstead each basic classification system must be modified to fit a specific
institution.
Seago 8",,"9 suggest that most /1Ss can be classified as>
• Critical indicator or criterion t$pe uses broad indicator such as bathing diet *K4 and medications and
positioning to categori+e patient care activities.
• Summative tas" t$pe requires the nurse to note the frequency of occurrence of specific activities
treatments and procedures for each patient.
0oth type of /1Ss 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.
7nce an appropriate /1S is adopted hours of nursing care must be assigned for each patient classification. Dach
institution is unique and must determine to what degree that classification system must be adapted for them. :hite
8",,#9 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. *n addition core staff
versus visiting staff and skill mix must be considered.
2ny classification system has many variables and all systems have their faults. *t is a mistake for managers to think
that the /1S will solve all staffing problems. 2lthough such systems provide a better definition of problems it is up
to the people in the organi+ation to make !udgments 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 organi+ation’s /1S. Dx. 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 organi+ation’s 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 cogni+ant of !ustifiable reasons for variations.
Some futurists have suggested that eventually wor"load measurement systems may replace acuity-based staffing systems.
:orkload measurement is a relatively new technique that evaluates work performance as well as necessary resource levels
8:alsh ",,#9. Thus it goes beyond patient diagnosis or acuity level and examines the specific number of care hours
needed to meet a given population’s 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.
6egardless of the workload measurement tool used 851<J//C /1S workload measurement system etc9 the units of
workload measurement that are used need to be reviewed periodically and ad!usted as necessary. This is both a leadership
role and management responsibility.
Nursing Care 5ours2 Staffing *i1 and Bualit' Care
The relationship between nursing care hours staffing mix and quality of care has occurred in response to the
ArestructuringB and AreengineeringB boom that occurred in many acute care hospitals in 1)),s.
6estructuring and reengineering was done to reduce costs increase efficiency decrease waste and duplication and
reshape the way care was delivered.
º =iven that health care is labor intensive cost cutting under restructuring and reengineering often included staffing models
that reduced 65 representation in the staffing mix and increased the use of unlicensed assistive personnel 8?2/9.
This fairly rapid and dramatic shift in both 65 care hours and staffing mix provide fertile ground for comparative studies
that examined the relationship between>
5ursing 1are <ours Q Staffing 3ix P /atient 7utcomes
º 2s 65 hours decrease in 51<J//C adverse patient outcomes increase including increased medication errors and
patient falls and decreased patient satisfaction with pain management.
?nit managers must understand the effect that ma!or restructuring and redesign have on their staffing and scheduling
policies as well. 2s 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.
º Cecreased licensed staff increasing numbers of unlicensed staff and developing new practice models have a tremendous
impact on patient care assignment methods.
º /ast 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.
º 2dministrative 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.
º /atient 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 organi+ation but few
of them have benefited the patient.
º *ndeed 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
organi+ations are restructured and new practice models are engineered.
º <aving an adequate number of knowledgeable trained nurses is imperative to attaining desired patient outcomes.
º 2scertaining an appropriate skill mix depends on the patient care setting acuity of patients and other factors.
º There is no national standard to determine whether staffing decisions are suitable for a given setting.
º 3anthey 8",,19 describes several factors that will drive additional new staffing plans in the coming decade :ork 4orce
",,,>
o*ncreased importation of foreign nurses who must be safely incorporated into the care delivery system
o7ngoing fiscal restraints that result in the need for lean staffing
o2nd plentiful attractive career options for nurses outside the hospital.
,thical Accounta6ilit' for Staffing
· The manager has ethical accountability both to patients and staff. Their needs should be met.
· 6egardless of the difficulties inherent in /1Ss and the assignment of nursing care hours they remain a method for
controlling the staffing function of management.
· 2s long as managers reali+e that all systems have weaknesses and as long as they periodically evaluate the
system managers will be able to initiate the needed change.
· *t is critical however for managers to make every effort to base unit staffing on their organi+ation’s patient
classification system.
· *t is important for managers to use staff to provide safe and effective care economically.
· 3anagers must increase staffing when patient acuity rises as well as decrease staffing when acuity is low- to do
otherwise is demorali+ing 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 sub!ective because acuity or
classification systems leave much to be determined by the person assigning the acuity levels.
oThe greater the degree of ob!ectivity and accuracy in any system the longer time required to make staffing
computations. /erhaps the greatest danger in staffing by acuity is that many organi+ations are unable to supply the
extra staff when the system shows unit understaffing. <owever the same organi+ation may use the acuity-based
staffing system to !ustify reducing staff on an overstaffed unit. Therefore a staffing classification system can be
demotivating if used inconsistently or incorrectly.
· Dmployees have the right to expect a reasonable workload. 3anagers must ensure that adequate staffing exists to
meet the needs of staff and patients.
· 3anagers who constantly expect employees to work extra shifts stay overtime and carry unreasonable patient
assignments are not being ethically accountable.
· Dffective managers however do not focus totally on numbers of personnel but look at all components of
productivity- they examine nursing duties !ob descriptions patient care organi+ation staffing mix and staff competencies.
· 3anagement must work !ust as hard as the staff in meeting patient needs- and that the organi+ation’s overriding
philosophy is based on patient interest and not on financial gain.
2 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.
S&AFF +,3,4(P*,N&
The staff’s knowledge level and capabilities are a ma!or factor in determining the number of staff required to carry out unit
goals.
5 components of staff development2
- Dducation
- Training
Earl$ staff development emphasi4ed on2
- 7rientation
- *n-service training
&raining vs ,ducation
Trainin#
- 2n organi+ed 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 !ob.
Education
- 3ore formal and broader in scope than training.
- Cesigned to develop the person in a broader sense
Responsi6ilities of the ,ducation +epart)ent
3ost education departments on the organi+ation chart are depicted as having staff or advisory authority rather than line
authority. ;ikewise unit manager has no authority over personnel in the education department.
0ecause of the ambiguity of overlapping roles and difficulties inherent in line and staff positions educating and training
employees may be neglected.
*t is necessary to delineate and communicate the authority and responsibility for all components of education and training.
7ther 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.
• *f 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.
• 2n advisory committee should be formed with representatives from all departments and all classification of
employees receiving training and education.
• 2ccountability 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.
&heories of 4earning
?nderstanding 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 learnin# theor$
- /edagogical-?sually ineffective for mature learners because adults have special needs.
- 2dult 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.
P,+A>(>? AN+RA>(>?
Characteristics2
- ;earner is dependent - learner is self-directed
- ;earner needs external rewards and punishment - learner is internally motivated
- ;earner’s experience is unimportant or limited - learner’s experiences are
valued
- Self-centered - task- or problem-centered
- Teacher-directed - self-directed
1earnin# Environment2
- 1limate is authoritative - climate is relaxed and informal
- 1ompetition is encouraged - collaboration
- Teacher sets goals - teacher L class sets goals
- Cecisions are made by teacher - decisions are made by teacher L class
- Teacher lectures - students process activities and inquire about pro!ects
- Teacher evaluates - teacher self peers evaluate
)bstacles and assets to adult learnin#
(CS&AC4,S ASS,&S
- *nstitutional barriers - high self-motivation
- Time - self-directed
- Self-confidence - a proven learner
- Situational obstacles - knowledge experience reservoir
- Special individual obstacles - special individual assets
Social 4earning &heor'
- 0uilds on reinforcement theory as part of the motivation to learn and have many of the same components as
the theory of sociali+ation.
- 0andura 81)''9 suggests that people learn most behavior by direct experience and observation and behaviors
are retained or not retained based on positive *nvolves 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 !udgments 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.
Social learning theory process
)ther learnin# theories2
- readiness to learn
- motivation to learn
- reinforcement
- task learning
- transfer of learning
- span of memory
- chunking
- knowledge of results
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
Assessing staff develop)ent 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
". identify the present level of knowledge or skill
#. determine the deficit of desired knowledge and skills
$. identify the resources available to meet the needs
%. make maximum use of available resources
&. evaluate and test outcomes after use of resources
,valuation of Staff +evelop)ent Activities
Dvaluation 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.
Dvaluation of the three components of staff development 8indoctrination training and education9 should include the following
four criteria>
1. learner’s reaction
". behavior change
#. organi+ational impact
$. cost-effectiveness
Coaching as a strateg'
Coachin#
- as a means to develop and train employees is a teaching strategy rather than a learning theory.
- *s one person helping the other to reach an optimum level of performance
- The emphasis is always on assisting the employee to recogni+e greater options to clarify statements and
to grow.
Rshortterm coachin#
- effective as a teaching tool for assisting with sociali+ation and for dealing with short-term problems
- frequently involves spontaneous teaching opportunities
Rlon#term coachin#
- as a tool for career management and in dealing with disciplinary problems is different.
*eeting the ,ducational Needs of a Culturall' +iverse Staff
8Seago",,,9
- require well-planned learning activities. There should be sufficient opportunity for small group so that
personnel can begin recogni+ing their own biases and pre!udices.
- This type of learning activity is especially important as more unlicensed assistive personnel8?2/9 are
added to the staff.
- Dducation to support cultural diversity should be part of staff development of 65s and ?2/ to facilitate their
learning to work together in teams.
;aCuke8",,19
- 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 nurse’s sociali+ation to the facility.
Cuilding &ea) :nit' &hrough Staff +evelop)ent
-the new momentum in organi+ations is toward encouraging a team effort through team building and providing a continual
supportive learning environment.
-4it+patrick8",,19 thinks that a leader who is a good coach and who can inspire others to !oin and remain with the team
ignites the team spirit.
“)he *eader is a Role +odel of the life(long learner.”
Staffing Patterns and Scheduling (ptions
Schedule 9 it is a timetable showing planned work days and shifts for 5ursing personnel. The ob!ective in scheduling is to
assign working days and days-off to the nursing personnel so that adequate patient care is assured. 2 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 6e considered in *a=ing Schedules
• different levels of nursing staff
• adequate coverage for "$ 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. abilit$ 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-
". %ualit$ to enhance the nursin# personnel6s "nowled#e( trainin#( and e3perience @ 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 speciali+ation or even taking a !ob abroad would prefer to experience being assigned to various units
before settling down to a particular unit of their choice.
#. 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 AdifficultB or AlightB or AundesirableB units or shifts-
$. stabilit$ @ the nursing personnel would like to know in advance their schedule of assignment so that their
personal schedules are in harmony with one another-.
%. fle3ibilit$ @ flexibility means the ability to handle changes brought about by emergency leaves scheduled or
unscheduled leaves of absence.
&'pes of Scheduling D&a6le on the 4ast PageE0
1. Centrali4ed 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.
". Decentrali4ed Schedule @ the shift and off-duties are arranged by the Supervising 5urse or <ead or Senior
5urse of the particular unit
#. C$clical Schedule @ the cyclical schedule covers a designated number of weeks called the cycle length and is
repeated thereon. *t assigns the required number of nursing personnel to each nursing unit consistent with the unit’s
patient care requirements the staff’s preference and their educational training and experience.
The following scheduling variables should be considered>
a. length of scheduling period whether " or $ weeks
b. shift rotation
c. week-ends off
d. holiday offs
e. vacation leaves
f. special days 8 birthdays weddings etc.9
g. scheduled events in the hospital training programs or meetings
h. !ob categories
i. continuing professional education programs

Four 8ee= C'clical Schedule
*n the table above it shows a typical $ week cyclical schedule that gives each personnel a fair share of week ends
off. Since 3ondays 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 <ead or Senior 5urse 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. 5ote 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.
4or those actually involved in patient care it is advisable that their work days be not on a % consecutive work days
or else they will get easily tired. 6otation from night to afternoon shift must be avoided because the staff nurse or nursing
attendant may not have sufficient time to rest between shifts. *nsufficient rest and sleep greatly affects nursing care
performance and its quality so ample rests should be provided.
Advantages of a C'clical Schedule
1. *t is fair to all
". it saves time
#. it enables the employees to plan ahead for their personal needs preventing frequent changes in schedule
$. scheduled leave coverage such as vacation holidays and sick leaves are more stable
%. productivity is improved
+eveloping Fo6 +escriptions
Fo6 +escription 9 it is a statement that sets the duties and responsibilities of a specific !ob. *t includes the needed
characteristics and qualifications of the individual to perform such duties successfully. *t 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 Fo6 +escription
1. *dentifying Cata
a. /osition Title
b. Cepartment
c. Supervisor’s Title
". Gob Summary @ includes the essential features of the !ob that distinguishes it from the others
#. Fualification 6equirements @ Dducational /reparation training and experience necessary to fill the position
$. Gob 6elationships
%. Specific and 2ctual 4unctions and 2ctivities
:ses of a Fo6 +escription
1. for recruitment and selection of qualified personnel
". to orient new employees to their !obs
#. for !ob placement transfer or dismissal
$. as an aid in evaluating the performance of an employee
%. for budgetary purposes
&. for determining departmental functions and relationships to help define the organi+ational structure
'. for classifying levels of nursing functions according to skills level required
(. to identify training needs
). as basis for staffing
1,. to serve as a channel for communication
Sa)ple Fo6 +escription of a Staff Nurse
Position &itle0 Staff Nurse<Nurse /
+efinition0
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 organi+ational structure of the 5ursing
ServiceJCepartmentJCivision.
Bualification Re.uire)ents0
Dducation> 0achelor of Science in 5ursing
;icense> 6egistered 5urse
Fo6 Su))ar'0
The Staff 5urse 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.
,)plo')ent 3aria6les0
/rofessional affiliation with professional nursing associations
Fo6 Relationships0
Source of :orkers> 6egistered
/romoted to> Senior 5urseJ 5urse **
6esponsible to> Senior 5urseJ 5urse **
Functions0
2. /atient 1are 3anagement
The Staff 5urse shall initiate and perform nursing care services to meet the needs of patients in assigned
areasJunits utili+ing the nursing process
1. 2ssesses the individual’s needs for nursing care based on the patient’s history results of physical diagnostic
and laboratory examinations
". *nfers correct nursing diagnosis
#. /lansJ/rioriti+es 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
$. *nstitutes nursing interventions consistent with the overall plan of care with special considerations for the
patient’s safety and comfort
%. Dxecutes written legal prescriptions for treatment therapies medication including hypodermic intramuscular
and intravenous in!ections- provided that in intravenous in!ections special training be required and according to protocol
established
&. /rovides health teaching to patients their family and significant others so that they may understand this illness
and participate actively in his care
'. 1oordinates patient’s care services with members of the health care team
(. DvaluatesJmodifies nursing care provided in terms of>
a. Dffectiveness and efficiency of nursing measures rendered
b. 4eedback from patientJfamilyJsignificant others
). 1onducts discharge planning with patient family and significant others with the health team. 6efers to
community health agencies as needed
1,. Cocuments accurately the observations and services rendered to the patients
0. <ospital and 5ursing Service /olicies and 6egulations
1. 7bserves hospital and nursing service rules regulations and policies
". *nterprets to patients family and visitors the rules regulations and policies that affect them
1. ;earning Dxperiences of 5ursing and 3idwifery Students
1. 1oordinates with 1linical *nstructors the activities of the affiliating students such as helping select patient
assignments to enhance learning experiences particularly on patient care
". Cemonstrates good nursing in the way he or she cares for patients. <e or she also serves as role-model to the
students
C. 7rientation of 5on-/rofessional :orkers in the ?nit
/articipates in the orientation of new non-professional nursing personnel
D. 6esearch and Studies
/articipates inJinitiates nursing research and studies. ?tili+es results for improvement of 5ursing /ractice
4. /rofessional 6esponsibilities
1. Takes initiative and responsibility in membership in professional organi+ations and participates actively in their
programs and activities
". Eeeps self professionally updated through continuous education
#. ?pdate professional license
Sa)ple Fo6 +escription of the 5ead Nurse<Senior Nurse<Nurse //
Position &itle0 5ead Nurse<Senior Nurse<Nurse //
+efinition0
2 <ead 5urseJSenior 5urseJ5urse ** 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
Bualification Re.uire)ents0
0achelor of Science in 5ursing- 6egistered 5urse- at least one year of clinical nursing experience- with supervisory
development training or training in the specialty of the clinical nursing unit to which heJshe is prepared for promotion- or )
units of 5ursing 3anagement and Supervision in the =raduate School by 62 )1'#
,)plo')ent 3aria6le0
3embership in the agency’s nursing association and other professional associations such as the *ntegrated 5urses of the
/hilippines and the /hilippine 5urses 2ssociation.
Fo6 Relationships0
Source of :orkers @ 5urse *JStaff 5urse
/romotion to> 5urse ***JSupervising 5urse
6esponsible to> 5urse ***JSupervising 5urse
6esponsible for> 5urse *JStaff 5urse- 5ursing 2ttendant
Functions0
2. /atient 1are 3anagement @ assumes responsibility for the delivery of quality patient care for the
nursing unit
1. /articipates in the development of nursing standards policies procedures regarding
patient care and updates these as necessary
". /romotesJutili+es quality assurance standards and programs in the unit
#. Supervises and evaluates the quality of patient care through frequent rounds
$. 2cts as liaison with the medical staff to coordinate medical and nursing management of
patient care
%. Serves as resource person to nursing personnel under himJher in assessing planning
implementing and evaluating nursing care provided
&. assumes the role of patient advocate
'. coordinates patient care with other members of the health team other hospital units
services andJor divisions
(. Serves as 1ommittee member within the department hospital or professional organi+ation
). keeps superiors informed regarding problemsJissues in patient care within the nursing unit
0. 3anagement of 5ursing /ersonnel @ provides leadership and direction to nursing personnel in
accordance with organi+ational and departmental goals and ob!ectives
1. /articipates in the selection of nursing staff of the unit
". schedules staff assignments considering experiences interests and training
#. ad!usts staffing levelsJratio according to the severity of the patient’s illness the number of
patients and number of nurses
$. advises andJor informs staff about new or revised policies and procedures
%. keeps the supervising nurse informed of personnel actrivities and problems
&. present changes or innovations to staff in a positive manner
'. produce a conducive climate in which the staff will feel free to consult himJher for problems
or assistance
1. 3anagement of /atient 1are ?nits @ maintains an environment that encourages quality patient
care and staff satisfaction
1. provides safe clean secure environment for patients visitors and personnel
". requisitions adequate supplies and equipment needed for patient care
#. monitors utili+ation of supplies and equipment through monthly audits and inventories
$. cooperatesJcoordinates with other hospital serviceJ departments for appropriate support
services
%. prepares monthly semi-annual annual reports of achievementsJprblems
&. 3aintains effectiveness of communication within unitJdepartments and other services
through conference meetings
C. Dducational 6esponsibilites
1. assists in staff development activities in the unit>
a. coordinates with training staff in planning implementing and evaluating orientation
of new personnel
b. *nforms Training Staff of the training needs of the nursing personnel under himJher
". assists clinical instructors of affiliating colleges of nursing or school of midwifery in
planning implementing and evaluating the learning experience of the students
#. assumes responsibility for won learning and development needs
e. 2cts as supervising nurse in the absence of one and when so delegated.

+ealings -ith Conflicts
1onflict @ defined as internal or external discord that results from the differences in ideas values or feelings between two or
more people. 1onflict 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. 1onflict 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 manager’s role is to create a work environment where conflict may be used as a conduit for
growth innovation and productivity.
Categories of Conflict0
/ntergroup Conflict 9 occurs between two or more groups of people departments or organi+ations
/ntrapersonal Conflict @ occurs within the person.
/nterpersonal Conflict ; also known as Ahori+ontal violenceB or AbullyingB happens between two or more people
&he Conflict Process
*. ;atent 1onflict- implies the existence of antecedent conditions such as short staffing and rapid
change. 3uch unnecessary could be prevented or reduced if managers examined the organi+ation much more closely
for antecedent situations
**. /erceived 1onflict- or substantive conflict- intellectuali+ed and often involves issues and roles
***. 4elt 1onflict @ occurs when conflict is emotionali+ed with such emotions as fear hostility mistrust
anger etc.
*K. 3anifest conflict @ or overt conflict- action like withdrawal compete debate or resolution is taken
K. 1onflict 6esolution or 1onflict 3anagement @ addressing of conflict
K*. 1onflict 2ftermath @ positive or negative effects of conflict
Conflict *anage)ent
The optimal goal for conflict management is to create a win-win solution for all involved.
Strategies for 1onflict 3anagement
1. 1ompromising- each party gives up something it wants
". 1ompeting @ used when one party pursues what it wants at the expense of the others. ?sually results in a win-lose
situation where the loser commits negative emotions. *s used when a quick or unpopular decision needs are to be made.
*t is also appropriately used when one party has more information or knowledge about the situation than the other
#. 1ooperating @ the opposite of competing. 7ne party sacrifices his or her beliefs and allows the other party to win
$. 2ccommodating @ one party leaves a favorJ*7? to be used at another time
%. 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. 2ppropriate for minor disagreements but rarely resolves conflicts
&. 2voiding @ the parties involved are aware of a conflict but choose not to acknowledge it or to attempt to resolve it.
3ay 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.
'. 1ollaborating @ all parties set aside their original goals and work together to establish a supraordiante goal or
priority common goal. 7ften leads to a win-win situation.
Ten 6ules of 1ollaborating accdg. To =ardner
1. Enow thyself
". ;earn to value and manage diversity
#. Cevelop constructive conflict resolution skills
$. ?se your power to create win-win situations
%. 3aster interpersonal and process skills
&. 6ecogni+e that collaborating is a !ourney
'. ;everage multidisciplinary forums to increase collaboration
(. 2ppreciate that collaboration can occur spontaneously
). 0alance autonomy and unity in collaborative relationships
1,. 6emember that collaboration is not required for all decisions
*anging :nit Conflict
1ommon 1auses of 7rgani+ational 1onflict
• /oor 1ommunication
• *nadequately defined organi+ational structure
• *ndividual 0ehavior
• ?nclear Dxpectations
• *ndividual or group conflicts of interest
• 7perational or staffing changes
• Civersity in =ender 1ulture or 2ge
Strategies to effectively manage unit conflicts>
1. 1onfrontation
". Third party 1onsultation
#. 0ehavior 1hange
$. 6esponsibility 1harting
%. Structure 1hange
&. Soothing one party
'. 5egotiations
(. 1onsensus