StaffingStaffing 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

PurposeThe 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 Staffing1. the type, philosophy, objectives of the hospital and the nursing service.2. the population served or kind of patients served whether pay or charity.3. the number of patients and severity of their illness-knowledge and ability of nursing personnel are matched with the

actual care needs of patients4. availability and characteristics of the nursing staff, including education, level of preparation, mix of personnel,

number and position.5. administrative policies such as rotation, weekends, and holiday off-duties.6. standards of care desired which should be available and clearly spelled out.7. layout of various nursing units and resources available within the department such as adequate equipment,

supplies, and materials8. budget including the amount allotted to salaries, fringe benefits, supplies, materials and equipment9. professional activities and priorities in nonpatient activities like involvement I professional organizations, formal

educational development, participation in research and staff development.10. teaching program or the extent of staff involvement in teaching activities.11. expected hours of work per annum of each employee. This is influenced by 40 hour week law.12. patterns of work schedule-traditional 5 days per week, 8 hours per day; 4 days a week, ten hours per day and three

days off; or 3 ½ days of 12 hours per day and 3 ½ days off per week.

Planning for Staffing and Acting to Resolve Current Nursing ShortagePlanning is the major leadership role in staffing and is often a neglected part of the staffing process. Because the

success of many staffing decisions greatly depends on previous decisions made in planning and organizing phases, one must consider staffing when making other plans. Consideration must be given to the type of patient care management used, the education and knowledge level of the staff to be recruited, budget constraints, the historical background of staffing needs and availability, and the diversity of the patient population to be served.

Accurate predicting staffing needs is valuable management skill because it enables the manager to avoid staffing crises. Managers should know the source of their nursing pool, how many students are currently enrolled in local nursing schools, the usual length of employment of new hires, peak staff resignation periods, and times when patient census is highest. Analyzing historical patterns, using computers to sort personnel statistics and keeping accurate unit records are example of proactive planning.

Federal moneys for nursing education have increased. The passage of legislation, such as the 2002 Nurse Reinvestment Act, has encouraged more students to choose nursing as a career and helps students financially to complete their education. It also encourages graduate students to complete their studies and assume teaching positions in nursing schools.

Some experts suggest however, that too much emphasis is placed on recruiting new nurses to solve the current shortage and that supply could more easily be increased by bringing unemployed or part-time nurses back to nursing full-time or by enticing nurses back into nursing who are now working in non-nursing position.

Other expert suggests more attention be given to retaining older workers or bringing retired nurses back into the workforce. Cyr (2005) agrees, suggesting that while many nurses retire because they are financially independent, some would consider delaying retirement if the work environment were altered to support older nurses. Others suggest that employer must be able to accommodate aging workers with technology aimed at reducing physical strain. Other strategies suggested retaining aging nurses include flexible scheduling and benefits, continuing education aid and wellness program.

Another short term solution to the current shortage has been the importation of foreign nurses, particularly by developed countries from developing countries. While such importation can result in positive global economic, social, professional development, many of the donor countries, who can least afford it, are experiencing a substantial brain and skills drain.

Long-term solution to a shortage of staff is cross-training. Cross-training involves giving personnel with varying educational backgrounds and expertise the skills necessary to take on tasks normally outside their scope of work and to move between units and function knowledgeable.

However, staffing shortages frequently occur on a day-to-day basis. These occur because of an increase in patient census, an unexpected increase in client needs or an increase in staff absenteeism or illness. Health care organizations have used many methods to deal with an unexpected short supply of staff. Chief among the solutions are closed-unit staffing, drawing from a central pool of nurses for additional staff, requesting volunteers to work extra duty, and mandatory overtime.

Closed-unit staffing occurs when the staff members on a unit make a commitment to cover all absences and needed extra help themselves in return for not being pulled from the unit in times of low census. In mandatory overtime, employees are forced to work additional shifts, often under threat of patient abandonment, should they refuse to do so. Some hospitals routinely use mandatory overtime in an effort to keep fewer people on the payroll.

A health care worker who is in an exhausted state represents a risk to public health and patient safety. Working overtime increases the odds of nurses in making errors. While mandatory overtime is neither efficient nor effective in a long term, it has an even more devastating short-term impact with regard to staff perceptions of a lack of control and its subsequent impact on mood, motivation, and productivity. Nurses who are forced to work overtime do so under the stress of competing duties-to their job, their family, their own health, and their patient’s safety.

However, Manthey suggests that nurses themselves, as well as employing organizations, need to become smarter about workload issues. She maintains that intermittent peak workload issues should not be solved by adding personnel but should be solved by prioritizing what can get done in a shift that will meet patient critical needs and learning what is not critical to be done.

Recruiting and Selecting StaffRecruiting

Recruitment is the process of actively seeking out or attracting applicants for existing positions. It should be an ongoing process in order to meet demand and provide adequate supply of nurses at any given time.

The nurse manager may be greatly or minimally involved in recruiting interviewing and selecting personnel depending on (a) the size of the institution, (b) the existence of a separate personnel department, (c) the presence of a nurse recruiter within the organization, and (d) the use of centralized or decentralized nursing department.

Generally speaking, the more decentralized nursing management and the less complex personnel department, the greater the involvement of lower-level managers in selecting personnel or individual units or departments. When deciding whether to hire a nurse-recruiter or decentralize the responsibility for recruitment, the organization needs to weigh benefits against costs. Costs include more than financial considerations. For example, an additional cost to an organization employing a nurse-recruiter might be the eventual loss of interest by managers in the recruiting process. The organization loses if managers relegate their collective and individual responsibilities to the nurse recruiter.

Recruiting adequate number of nurses is less difficult if the organization is located in a progressive community with several schools of nursing and if the organization has a good reputation for quality patient care and fair employment practices.

Because most recruiting methods are expensive, health care organizations often seek less costly means of recruitment. One of the best ways to maintain an adequate employee pool is by word of mouth; the recommendation of the organization’s own satisfied and happy staff. Recruitment, however, is not the key to adequate staffing in the long term. Retention is and only occurs when the organization is able to create a work environment that makes staff want to stay.

Some turnover, however, is normal and, in fact, desirable. Turnover infuses the organization with fresh ideas. It also reduces the probability of groupthink, in which everyone shares similar thought processes, values, and goals. However, excessive or unnecessary turnover reduces the ability of the organization to produce its end product and is expensive.

Clearly, the manager must recognize the link between retention and recruitment. Atencio and colleagues (2003) suggest that the social climate of the workplace is the primary initiator of a nurse’s intent to stay or leave and that this social climate may reflect either work frustration or work excitement. Similarly, Lynn and Redman (2005) suggest that retention programs must focus on both organizational commitment and work and professional satisfaction. The middle level manager has the greatest impact in addressing these concerns and creating a positive social climate.

In addition, the closer the fit between what the nurse is seeking in employment and what the organization can offer, the greater the chance that the nurse will be retained.

Interviewing An interview may be defined as a verbal interaction between individuals for a particular purpose. Although other

tools such as testing or reference checks may be used, the interview is frequently accepted as the foundation for hiring. The

purpose or goals of te selection interview are threefold: (a) the interviewer seeks to obtain enough information to determine the applicant’s suitability for the available position; (b) the applicant obtains adequate information to make an intelligent decision about accepting the job, should it be offered; and (c) the interviewer seeks to conduct the interview in such a manner that regardless of the interview’s result, the applicant will continue to have respect for and goodwill toward the organization.

Types of Interview:Unstructured interview – requires little planning because the goals for hiring may be unclear, questions are not prepared in advance, and often the interviewer does more talking than the applicant.

Structured interview – requires greater planning time because questions must be developed in advance that address the specific job requirements, information must be offered about the skills and qualities being sought, examples of the applicant’s experience must be achieved, and the willingness or motivation of the applicant to do the job must be determined. The interviewer who uses a structured format would ask the same essential questions of all applicants.Limitations of Interviews

The major defect of interview is subjectivity. Most interviewers feel confident that they can overcome this subjectivity and view the interview as a reliable selection tool, whereas most interviews still have an element of subjectivity. The applicant, trying to create a favorable impression, also may be unduly influenced by the interviewer’s personality.

As a predictor of job performance and overall effectiveness, the structured interview is much more reliable that the unstructured interview.Overcoming Interview Limitations

Prepare for the InterviewAsselin (2006) suggests that managers should “have a complete and clear understanding of the open position” before the interviewing candidate. This includes obtaining a copy of the job description and knowing the educational and experiential requirements for the position. The manager should also create a list of competencies that are essential for success on the job as well as the professional values, characteristics, and behaviors that are most likely to ensure success in the position.

Use Team ApproachHaving more than one person interview the job applicant reduces individual bias. Staff involvement in hiring can be viewed on a continuum from no involvement to a team approach, using unit staff for hiring decisions.

Develop A Structured Interview Format for Each Job ClassificationBecause each job has different position requirements, interviews must be structured to fit the position. The same structured interview should be used for all employees applying for the same job classification. The structured interview is advantageous because it allows the interviewer to be consistent and prevents the interview from becoming side-tracked.

Use Scenarios to Determine Decision-Making AbilityIn 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 Multiple InterviewsCandidates should be interviewed more than once on separate days. This prevents applicants from being accepted or rejected merely because they were having a good or bad day. Regardless of the number of interviews held, the person should be interviewed until all the interviewers’ questions have been answered, and they feel confident that they have enough information to make the right decision.

Provide Training in Effective Interviewing TechniquesTraining should focus on communication skills and advice on planning, conducting, and controlling the interview. It is unfair to expect a manager to make appropriate hiring decisions if he or she has never had adequate training in interview techniques. Unskilled interviewers often allow subjective data rather than objective data affect their hiring evaluation. In addition, unskilled interviewers may ask questions that could be viewed as discriminatory or that are illegal.

Planning, Conducting, and Controlling the InterviewPlanning the interview in advance is vital to its subsequent success as a selection tool. If other interviewers are to be present, they should be available at the appointed time. The plan also should include adequate time for the interview. Before the interview, all interviewers should review application, noting questions concerning information supplied by the applicant. Although it takes considerable practice, consistently using a planned sequence in the interview format will eventually yield a relaxed and spontaneous process. The following is a suggested interview format:1. Introduce yourself, and greet the applicant.2. Make a brief statement about the organization and the available positions.3. Ascertain the position for which the person is applying.4. Discuss the information on the application, and seek clarification or amplification as necessary.5. Discuss employee qualifications and proceed with the structured interview format.6. If the applicant appears qualified, discuss the organization and the position further.7. Explain the subsequent procedures for hiring, such as employment physicals, and hiring date. If the applicant is

not hired at this time, discuss how and when he or she will be notified of the interview results.8. Terminate the interview.

The interviewer should have control of the interview and set the tone. During the meeting, the manager should pause frequently to allow the applicant to ask questions. The format should always encourage ample time for questions from the applicant.

The following are methods that help to reach the goals of the interview: Ask only job-related questions. Use open-ended questions that require more than a “yes” or “no” answer. Pause a few seconds after the applicant has seemingly finished before asking the next question. This gives the

applicant a chance to talk further. Return to topics later in the interview on which the applicant offered little information initially. Ask only one question at a time. Restate part of the applicant’s answer if you need elaboration. Ask questions clearly, but do not verbally or nonverbally indicate the correct answer. Otherwise, by watching the

interviewer’s eyes and observing other body language, the astute applicant may learn which answers are desired. Always appear interested in what the applicant has to say. The applicant should never be interrupted, nor should

the interviewer’s words ever imply criticism of or impatience with he applicant. Language should be used that is appropriate for the applicant. Terminology or language that makes applicants feel

the interviewer is either talking down to them or talking over their heads is inappropriate. A written record of all interviews should be kept. Note taking ensures accuracy and serves as a written record to

recall the applicant. Keep note taking or use of a checklist, however, to a minimum so that you do not create an uncomfortable climate.

Ten Tips to Boost Interview IQ1. Practice Good Nonverbal Communication. 2. Dress for the Job or Company3. Listen 4. Don't Talk Too Much5. Don't Be Too Familiar 6. Use Appropriate Language 7. Don't Be Cocky 8. Take Care to Answer the Questions 9. Ask Questions10. Don't Appear Desperate

Interviewing Tips for the Applicants

1. Prepare in advance for the interview.2. Obtain copies of the philosophy and organization chart of the organization to which you are applying.3. Schedule an appointment for the interview.4. Dress professionally and conservatively.5. Practice responses to potential interview questions in advance.6. Arrive early on the day of the interview.7. Greet the interviewer formally, and do not sit down before he or she does unless given permission to do so.8. Shake the interviewer’s hand upon entering the room and smile.9. During the interview, sit quietly, be attentive, and take notes only if absolutely necessary.10. Do not chew gum, fidget, slouch, or play with your hair, keys, or writing pen.11. Ask appropriate questions about the organization or the specific job for which you are applying.12. Avoid a “what can you do for me?” approach, and focus instead on whether your unique talents and interests are a

fit with the organization.13. Answer interview questions as honestly and confidently as possible.14. Shake the interviewer’s hand at the close of the interview, and thank him or her for his or her time.15. Send a brief, typed thank-you note to the interviewer within 24 hours of the interview.

Interview EvaluationInterviewers should plan post-interview time to evaluate the applicant’s interview performance . Interview note should be reviewed as soon as possible and necessary points clarified or amplified. Using a form to record the interview evaluation is good idea. The final question on the interview report form is a recommendation for or against hiring. In answering this question, two aspects must carry the most weight: The requirements for the job. Regardless of how interesting or friendly people are, unless they have the basic skills

for the job, they will not be successful at meeting the expectations of the position. Likewise, those overqualified for a position will usually be unhappy in the job.

Personal bias. Because completely eliminating the personal biases inherent in the interview is impossible, it is important for the interviewer to examine any negative feelings that occurred during the interview. Often, the interview discovers that the negative feelings have no relation to the criteria necessary for success in the position.

SelectionSelection is the process of choosing from among the applicants the best-qualified individual or individuals for a particular job or position. This process involves verifying the applicant’s qualifications, checking his/her work history, and deciding of a good match exists between the applicant’s qualifications and the organization’s expectations.

Educational and Credential RequirementsConsideration should be given to educational requirements and credentials for each job category as long as a

relationship exists between theses requirements and success on the job. Reference Checks

All applications should be examined to see if they are complete and to ascertain that the applicant is qualified for the position. At this point, references are requested, and employment history is verified. According to Asselin (2006), the manager should always be cognizant of red flags in applications such as “unexplained gaps in employment history or frequent changes of employer without acceptable explanation”. Positions should never be offered until information on the application has been verified and references have been checked.

Pre-employment TestingPre-employment testing is used only when such testing is directly related to the ability to perform a specific job.

Although testing is not a stand-alone selection tool, it can, when coupled with excellent interviewing and reference checking, provide additional information about a candidate to make the best selection. Physical Examination as a Selection Tool

A medical examination is often a requirement for hiring. This examination determines if the applicant can meet the requirements for a specific job and provides a record of the physical condition of the applicant at the time of hiring. The

physical examination also may be used to identify applicants who will potentially have unfavorable attendance records or may file excessive future claims against the organization’s health insurance.

Finalizing the SelectionThe closure of pre-employment process is as follows:1. Follow up with applicants as soon as possible, thanking them for applying and informing them when they will be

notified about a decision.2. Candidates not offered a position should be notified of this as soon as possible. Reasons should be provided when

appropriate, and candidate should be told whether their application will be considered for future employment or if they should reapply.

3. Applicants offered a position should be informed in writing of the benefits, salary, and placement. This avoids misunderstandings later regarding what employees think they were promised by the nurse-recruiter or the interviewer.

4. Applicants who accept the job offers should be informed as to pre-employment procedures such as physical examinations and supplied with the date to report to work.

5. Applicants who are offered positions should be requested to confirm in writing their intention to accept the position.

PlacementThe astute leader is able to assign a new employee to a position within his or her sphere of authority where the

employee will have a reasonable chance for success. Nursing units and departments develop subcultures that have their own norms, values, and methods of accomplishing work. It is possible for one person to fit in well with an established group, whereas another equally qualified person would never become part of this group.

Conversely, proper placement fosters personal growth, provides a motivating climate for the employee, maximizes productivity, and increases the probability that organizational goals will be met. Managers who are able to match employee strengths to job requirements facilitate unit functioning, accomplish organizational goals, and meet employee needs.

IndoctrinationIndoctrination refers to the planned, guided adjustment of an employee to the organization and the work

environment. Although the words “induction” and “orientation” are frequently used to describe this function, the indoctrination process includes three separate phases: induction, orientation, and socialization.

Indoctrination seeks to (a) establish favorable employee attitudes toward the organization, unit, and department; (b) provide the necessary information and education for success in the position; and (c) instill a feeling of belonging and acceptance. The employee indoctrination process begins as soon as person has been selected for a position and continues until the employee has been socialized to the norms and values of the work group. Employee Indoctrination Content:1. Organization history, mission, and philosophy2. Organization service and service area3. Organizational structure, including department heads, with an explanation of the functions of the various

departments4. Employee responsibilities to the organization5. Organizational responsibilities to the employee6. Payroll information, including how increases in pay are earned and when they are given (progressive or unionized

companies publish pay scales for all employees)7. Rules of conduct8. Tour of the facility and of the assigned department9. Work schedules, staffing and scheduling policies10. When applicable, a discussion of the collective bargaining agreement11. Benefit plans, including life insurance, health insurance, pension, and unemployment12. Safety and fire programs13. Staff development programs, including in-service and continuing education for relicensure.14. Promotion and transfer policies15. Employee appraisal system16. Workload assignments17. Introduction to paperwork/forms used in the organization18. Review of selection in policies and procedures19. Specific legal requirements, such as maintaining a current license, reporting of accidents, and so forth20. Introduction to fellow employees

21. Establishment of a feeling of belonging and acceptance, showing genuine interest in the new employee

InductionInduction, the first phase of indoctrination, takes place after the employee has been selected but before performing

the job role. The induction process includes all activities that educate the new employee about the organization and employment and personnel policies and procedures.

Employee handbooks, an important part of induction, are usually developed by the personnel department. Managers, however, should know what information the employee handbooks contain and should have input into their development. Most employee handbooks contain a form that must be signed by the employee, verifying that he or she has received and read it. The signed form is then placed in the 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. However, providing an employee with a personnel handbook is not sufficient for real understanding. The information must be followed with discussion by various people during orientation. The most important link in promoting real understanding of personnel is the first-level manager.

OrientationOrientation provides information about the activities more specific for the position. The purpose of the orientation

process is to make the employee feel like a part of the team. This will reduce burnout and help new employees become independent more quickly in their new roles.Sample of Line-up of Activities Done in Orientation- Welcome by personnel department; employee handbooks distributed and discussed- General Orientation by staff development- Tour of the Organization- Fire and safety films, body mechanics demonstration- Introduction to each unit supervisor- Report to individual units (time with unit supervisor and introduction to assigned preceptor)- General orientation of policies and procedures- CPR recertification- Work with preceptor on shift and unit assigned, gradually assuming greater responsibilities- Carry normal workload aster a week. Have at least a 30-minute meeting with immediate supervisor to

discuss progress.

Socialization and Resocialization“Socializing new nurses into the healthcare culture will help retain them.” - Sandy Keefee, MSN, RN Role Theory- The phenomenon of socialization has generally focused on this theory- Explains that behaviors that accompany each role are learned socially and by instruction, observation and trial and

error

Socialization- First occurs during nursing school and after graduation- Because nurse administrators and nursing faculty have found to hold different values and both this groups assist in

socializing the new nurse, there is potential for the new nurse to develop conflict and frustration.

Resocialization- Occurs when individuals are forced to learn new values, skills, attitudes and social rules as a result of changes in

the type of work they do, the scope of responsibility they hold, or in the work setting itself- Individuals who need resocialization include new graduates leaving school and entering the work world;

experienced nurses who change work settings, either within the same organization or in the new organization; and nurses who undertake new roles.- Some employees adapt easily to resocialization, but most experience stress with the role change.

Overcoming Motivational Deficiencies

- Difficulties in socialization and resocialization occurs because of motivational deficiencies- There are 2 ways to correct motivational deficiencies: positive and negative sanctions

Positive Sanctions- Can be used as an interactional or educational process- The reference group sets of norms of behavior and then applies sanctions to ensure that new members adopt the

group norms before acceptance in the group.- Managers should become aware of what role behavior they reward and what new employee behavior the senior

staff is rewarding.

Negative Sanctions- They are like rewards- Provide cues that enable the people to evaluate their performance consciously and to modify behavior when

needed- They are often applied in very subtle and covert ways- They should be constructive and not destructive

Employees with unique socialization needs- Managers who provide appropriate socialization assistance for these groups increase the chance of positive

employment outcome

The New Nurse- Reality Shock – was coined by Kramer (1974) which described fears and difficulties in adapting to work setting that

are common to new graduate nurses; it occurs as a result of conflict between a new graduate 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:

Nurse Managers should not rely in anticipatory socialization prepared by nursing schools. They should be alert for signs and symptoms of the shock phase of role transition. They should also ensure that some of the new nurse’s values are supported and encouraged so that work and

academic values can blend.

International Nurses- One solution to current nursing shortage (applicable only to U.S.)- Ryan (2003) suggests that socialization to the professional nursing role is one of four basic needs that must be

addresses if foreign nurses are to adapt successfully to American workplaces.- Bola, Driggers, Dunlap, and Ebersole (2003) state that international nurses also frequently experience culture shock

regarding nonverbal communication that may interfere with their assimilation.- Ryan (2003) suggests that using a Cultural Diversity Enhancement Group (CDEG) and a buddy program may assist

in socializing these international nurses; includes staff nurses and management personnel from varied ethnic backgrounds who agreed to buddy with the international nurses to make them feel welcomed in the organizational culture.- Dumpel (2005) says that international nurses need the same socialization as other transition groups such as

mentors and preceptors, support groups and other orientation programs.

New Managers- Sullivan, Bretschneider, and McCausland (2003) found that many new managers perceived themselves as lacking

basic and introductory managerial skills related to communication, conflict resolution, role transitioning, scheduling, budgeting and payroll management, performance evaluation, and staff counseling which result in management errors.- The direction a new manager needs comes from several sources within the organization which includes:

The new manager’s immediate superior A group of the new manger’s peers A mentor

- Role ambiguity- describes the stress that occurs when job expectations are unclear- Role Overload- occurs when the demands of the role are excessive

The Experienced Nurse in the New Position Transition from expert to novice

- a very difficult role transition- Many nurses transfer or change jobs because they can no longer find their present job challenging

Transition from familiar to unfamiliar- In the old surroundings, the employee knew everyone and where everything was located. In the new position, the

employee will not be only learning new job skills but also be in an unfamiliar environment.- Specialized orientation material should be developed and necessary staff development orientation programs should

be provided

Assisting the Experienced Nurse in Role Transition- Managers should not assume that the experienced nurse is aware of the new role’s expected attitudes.- Managers need to support employees during this value resocialization.

Clarifying Role Expectations through Role Models,Preceptors and Mentors“In looking for a role model, I didn’t have to go far.”- William M. Keane Jr. Role Model- Defined as someone worthy of imitation- They are experienced, competent employees- One of the exciting aspects of role models is their cumulative effect. The greater the number of excellent role

models available for new employees to emulate, the greater the possibilities for new employees to perform well. Preceptor- An experienced nurse who provides knowledge and emotional support, as well as a clarification of role

expectations, on a one-on-one basis- An effective preceptor can role model and adjust teaching to each learner as needed.

Mentor- Madison (2006) described mentoring as a distinctive interactive relationship between two individuals, occurring

most commonly in a professional setting.- A mentor is able to instill the values and attitudes that accompany each role; often a role model and visionary for

the mentee.- A preceptor is different from a mentor.

PRECEPTOR MENTOR- Usually assigned- Relatively short relationship with the person to whom they were assigned

- Freely choose who they will mentor- Relationship is longer and more intense

Four phases in mentoring relationships:1. Initiation – occurs when the relationship is established2. Cultivation – characterized by coaching, protection and sponsorship as well as counseling, acceptance and the

creation of a sense of competence. 3. Separation --- 4. Redefinition – Both are difficult, as the mentor and mentee may share different perceptions about whether it is time

to separate and what their new relationship should be.

Validities and Legalities in Hiring“Healthcare facilities are more interested in hiring nursing students who can think critically and organize than those who boast competencies, such as an impressive number of injections given.”Lorraine Steefel, RN, MSN, CTN

Given the importance of a decision to hire, it is understandable that human resources and first- level managers have sought refined methods to evaluate and screen applicants. A wide variety of pre employment tests are used to determine which candidate is best suited for a position. Testing- It has an impact on selection of employees- If the employees to be hired fail the test in significantly greater percentages than the overall failure rate, the

employer using the test must prove that it is a valid indicator of the abilities that are needed to perform the job

3 Forms of Validity in testing: Content Validity – The test recreates or represents significant sample parts of the job, such as typing tests. Construct Validity – The test identifies a psychological or personality trait that is important to successful performance, such as leadership or problem solving abilities. Criterion-related Validity – The test contains elements on which anyone who would do well on the job perform well or anyone who would do poorly on the job will perform poorly.

Legal Aspects of Pre employment Inquiries

Subject of Inquiry

It may not be discriminatory to inquire about:

It may be discriminatory to inquire about:

1. Name Whether applicant has ever worked under a different name

a. Original name of an applicant whose name has been legally changed

b. The ethnic association of applicant’s name

2. Age a. If applicant is over the age 18

b. If applicant is under the age 18 or 21 if job related

a.Date of birth

b.Date of high school graduation

3. Residence a. Applicant’s place of residence where employer is located

a.Previous addresses

b.Birthplace of applicant or applicant’s parents

4. Race or color

a.Applicant’s race or color of applicant’s skin

5. National origin and ancestry

a.Applicant’s lineage, ancestry, national origin, parentage, or nationality

6. Sex and Family composition

a. Sex of applicant

b. Dependents of applicant

c. Marital Status

d. Child- care arrangements

7.Creed or religion

a.Applicant’s religious affiliation

b.Church, parish, or holiday’s observed

8. Citizenship a. Whether the applicant is a citizen of the United States

b. Whether the applicant is in the country on a visa that permits him or her to work or is a citizen

a.Whether applicant is a citizen of the country other than the United States

9. Language a. Language applicant speaks and or writes fluently, if job related

a.Applicant’s native language; language commonly used at home

10. References a. Names of people willing to provide professional and/or character references of the applicant

a. Name of applicant’s pastor or religious leader

11. Relatives a. Names of relatives already employed by the employer

a.Name and/or address of any relative of applicant

b.Whom to contact in case of emergency

12. Organizations

a. Applicant’s membership in any professional, service or trade organization

a. All clubs or social organizations to which applicant belongs

13. Arrest record and convictions

a. Convictions if related to job performance

a. Number and kinds of arrests

b. Convictions unless related to job performance

14. Photographs

a.Photographs with application, with resume, or before hiring

15. Height and Weight

a.Any inquiry into height and weight of applicant except where a bona fide occupational qualification

16. Physical limitations

a. Whether applicant has the ability to perform job- related functions with or without accomodation

a.The nature or severity of an illness or the individual’s physical condition

b.Whether applicant has ever filed a worker’s compensation claim

c.Any recent or past operations or surgery dates

17. Education a. Training applicant has received if related to job under consideration

b. Highest level of education

attained, if validated that having certain educational background is necessary to perform the specific job

18. Military a. What branch of military applicant served in

b. Type of education or training received in the military

c. Rank at discharge

a. Type of military discharge

19. Financial Status

a.Applicant’s debts and assets

Hiring – A Shared ResponsibilityThe question of who makes the final employment hiring from among screened candidates is critical. Hiring remains

an inexact science despite all the techniques that have been developed and used. Ideally, the decision is made by the manager to whom the new employee will report, with the advice and counsel of the human resources department. This approach has the advantages that stipulated and necessary credential requirements are met, organizational policies and employment laws are followed, and individuals selected meet the quality standards and conform to its vales and culture.

Patient Care Classification SystemThe patient care classification system is a method of grouping patients according to the amount and complexity of

their nursing care requirements and the nursing time and skill they require. This assessment can serve in determining the amount of nursing care required, generally within 24 hours, as well as the category of nursing personnel who should provide that care.

As a result, of patient classification systems (PCS), also known as workload management, or patient acuity tools, were developed in the 1960s. Because other variables within the system have an impact on nursing care hours, it is usually not possible to transfer a PCS from one facility to another. Instead, each basic classification system must be modified to specific institution.

Adomat and Hewison (2004) suggest that most PCSs can be classified as robust measures for severity of illness. However, they maintain that although they are helpful, they are not accurate tools for determining nurse-patient ratios, and that all PCS measurement tools need nursing input if they are to measure nurse-patient needs accurately.

There are several types of PCS measurement tools. The critical indicator PCS uses broad indicators such as bathing, diet, intravenous fluids and medications, and positioning to categorize patient care activities. The summative task type requires the nurse to note for frequency of occurrence of specific activities, treatments, and procedures for each patient. For example, a summative task-type PCS might ask the nurse whether a patient required nursing time for teaching, elimination, or hygiene. Both types of PCSs are generally filled out prior to each shift, although the summative task type typically has more items to fill out than the critical incident or criterion type.

Once an appropriate PCS is adopted, hours of nursing care must be assigned for each patient classification. Although an appropriate number of hours of care for each classification is generally suggested by companies marketing PCSs, each institution is unique and must determine to what degree that classification system must be adapted to that institution. White (2003) suggests that average length of stay, and practitioner specialty in defining its patient population. In addition, staff competency, core staff versus visiting staff, and skill mix must be considered (White, 2003).

To develop a workable patient classification system, the nurse manager must determine the following:1. The number of categories into which the patients should be divided;2. The characteristics of patients in each category;3. The type and number of care procedures that will be needed by a typical patient in each category; and4. The time needed to perform these procedures that will be required by a typical patient in each category.

The number of categories in a patient classification may range from three to four, which is the most popular, to five or six. These classes relate to the acuity of illness and care requirements, whether minimal, moderate, or intensive care. Other factors affecting the classification system would relate to the patient’s capability to meet his physical needs to ambulate, bathe, feed himself, and other instructional needs including emotional support.

Patients care classifications have been developed primarily for medical, surgical, pediatrics, and obstetrical patients in acute care facilities.

Classification CategoriesThe various units mat develop their own ways of classifying patient care according to the acuity of their patient’s

illness. Following is an example of a patient care classification in the medical-surgical unit. Level I – Self Care or Minimal Care – Patient can take a bath on his own, feed himself, feed and perform his

activities of daily living. Falling under this category are patients about to be discharged, those in non-emergency, those newly admitted, do not exhibit unusual symptoms, and requires little treatment/observation and/or instruction. Average amount of nursing care hours per patient per day is 1.5. Ratio of professional and non-professional nursing personnel is 55:45.

Level II – Moderate Care or Intermediate Care – Patients under this level need some assistance in bathing, feeding, or ambulating for short periods of time. Extreme symptoms of their illness must have subsided of have not yet appeared. Patients may have slight emotional needs, with vital signs ordered up to three times per shift, intravenous fluids or blood transfusion; are semi-conscious and exhibiting some psychosocial or social problems; periodic and treatments, and/or observations and/or instructions. Average nursing care hours per patient per day is 3 and the ratio of professional to non-professional personnel is 60:40.

Level III – Total, Complete or Intensive Care – Patients under this category are completely dependent upon the nursing personnel. They are provided complete bath, are fed, may or may not be unconscious, with marked emotional needs, with vital signs more than three times per shift, may be on continuous oxygen therapy, and with chest or abdominal tubes. They require close observation at least every 30 minutes for impending hemorrhage, with hypo or hypertension and/or cardiac arrhythmia. The nursing care hours per patient per day is 6 with a professional to non-professional ratio of 65:35.

Level IV – Highly Specialized Critical Care – Patients under this level need maximum nursing care with a ratio of 80 professionals to 20 non-professionals. Patients need continuous treatment and observation; with many medications, IV piggy backs; vital signs every 15-30 minutes; hourly output. There are significant changes in doctor’s orders and care hours per patient per day may range from 6-9 more, and the ratio of professionals to non-professionals also ranges from 70:30 to 80:20.

Patient Care Classification Using Four Levels ofNursing Care Intensity

Area of Care Category 1 Category 2 Category 3 Category 4Eating Feeds self or

needs little foodNeeds some help in preparing food tray; may need encouragement

Cannot feed self but is able to chew and swallow

Cannot feed self and may have difficulty swallowing

Grooming Almost entirely self-sufficient

Needs some help in bathing, oral hygiene, hair combing, and so forth

Unable to do much for self

Completely dependent

Excretion Up and to bathroom alone or almost alone

Needs some help in getting up to bathroom or using urinal

In bed, needs bedpan or urinal placed; may be able to partially turn or lift self

Completely dependent

Area of Care Category 1 Category 2 Category 3 Category 4Comfort Self-sufficient Needs some help

with adjusting position or bed (e.g., tubes, IVs)

Cannot turn without help, get drink, adjust position of extremities, and so forth

Completely dependent

General Health Good – in for diagnostic procedure, simple treatment, or surgical procedure (D & C, biopsy, minor fracture)

Mild symptoms – more than one mild illness, mild debility, mild emotional reaction, mild incontinence (not more than once per shift)

Acute symptoms – severe emotional reaction to illness or surgery, more than one acute illness, medical or surgical problem, severe or frequent incontinence

Critically 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

Any category 1 treatment more than once per shift, Foley catheter care, I & O; bladder irrigations, sitz baths, compresses, test procedures requiring medications or follow-ups, simple enema for evacuation, vital signs every 4 hours

Any treatment more than twice per shift, medicated IVs, complicated dressings, sterile procedures, care of tracheostomy, Harris flush, suctioning, tube feeding, vital signs more than every 4 hours

Any elaborate or delicate procedure requiring two nurses, vital signs more often than every 2 hours

Medications Simple, routine, not needing pre-evaluation or post evaluation; medications no more than once per shift

Diabetic, cardiac, hypotensive, hypertensive, diuretic, anticoagulant medications, prn medications, more than once per shift, medications needing pre-evaluation or post evaluation

High amount of category 2 medications; control of refractory diabetes (need to be monitored more than every 4 hours)

Extensive category 3 medications; IVs with frequent, close observation and regulation

Teaching and emotional support

Routine follow-up teaching; patients with no unusual or adverse emotional reactions

Initial teaching of care of ostomies; new diabetics; tubes that will be in place for periods of time; conditions

More intensive category 2 items; teaching of apprehensive or mildly resistive patients; care of moderately upset

Teaching of resistive patients; care and support of patients with severe emotional reaction

requiring major change in eating, living, or excretory practices; patients with mild adverse reactions to their illness (e.g., depression, overly demanding)

or apprehensive patients; confused or disoriented patients

Table 2. Categories or levels of care of patients, nursing care hours needed per patient per day and ratio of professionals to non-professionalsLevels of Care NCH Needed

Per Pt. Per DayRatio of Prof. to Non-Prof.

Level I 1.50 55:45Self Care or Minimal Care

Level II 3.0 60:40Moderate or Intermediate Care

Level III 4.5 65:35Total or Intensive Care

Level IV 6.0 70:30Highly Specialized or Critical Care

7 or higher 80:20

The Hospital Nursing Service Administration Manual of the Department of Health has recommended the following nursing care hours for patients in the various nursing units of the hospital.

Table 1. Nursing care hours per patient per day according to classification of patients by units.Cases/Patients NCH/Pt/day Prof. to Non Prof. Ratio1. General Medicine 3.5 60:402. Medical 3.4 60:403. Surgical 3.4 60:404. Obstetrics 3.0 60:405. Pediatrics 4.6 70:306. Pathologic Nursery 2.8 55:457. ER/ICU/RR 6.0 70:308. CCU 6.0 80:20

Percentage of Nursing Care HoursThe percentage of nursing care hours at each level of care also depends on the setting in which the care is being

given. For primary hospitals, about 70 percent of their patients need minimal care, 25 percent need moderate care. Patients needing intensive care are given emergency treatment and when their condition becomes stable or when immediate treatment is necessary and the hospital has no facilities for this, the patient is transferred to a secondary of tertiary hospital.

In a secondary hospital, 65 percent of the patients need minimal care, 30 percent need moderate care, and only 5 percent need intensive care. In tertiary hospitals, about 30 percent of patients need minimal care; 45 percent need moderate care, 15 percent need intensive care, while 10 percent will need highly specialized intensive care. In special tertiary hospitals about 10 percent will need minimal care; 25 percent need moderate care; 45 percent need intensive care; while about 20 percent will need highly specialized intensive care.

Table 3. Percentage of patients at various levels of care per type of hospitalPercentage of Patients in Various Levels of CareType of Hospital Minimal Care Moderate Care Intensive Care Highly Spl. Care

Primary Hospital 70 25 5 -Secondary Hospital 65 30 5 -Tertiary Hospital 30 45 15 10Spl. Tertiary Hospital 10 25 45 20

Computing for the Number of Nursing Personnel NeededWhen computing for the number of nursing personnel in the various nursing units of the hospitals, one should

ensure that there is sufficient staff to cover all shifts, off-duties, holidays, leaves, absences, and time for staff development programs.

The Forty-Hour Week Law (Republic Act 5901), provides that employees working in hospitals with 100-bed capacity and up will work only 40 hours a week. This also applies to employees working in agencies with at least one million population. Employees working in agencies with less than one hundred-bed capacity or in agencies located in communities with less than one million population will work forty-eight hours a week and therefore will get only one off-duty a week.

There are also benefits that have to be enjoyed by each personnel regardless of the working hours per week. The latest is the granting of the three-day special privilege to government employees by the Civil Service Commission as per Memorandum Circular No. 6, series of 1996, which may be spent for birthdays, weddings, anniversaries, funerals (mourning), relocation, enrollment or graduation leave, hospitalization, and accident leaves.

Table 4. Total number of working and non-working days and hours of nursing personnel per year.Rights and Privileges Given Each Personnel

Working Hours Per Week

Per Year 40 Hours 48 Hours1. 1. Vacation Leave 15 15

2. Sick Leave 15 153. Legal Holidays 10 104. Special Holidays 2 25. Special Privileges 3 36. Off-Duties as per R.A. 5901 104 527. Continuing Education Program 3 3

______ ______Total Non-Working Days Per Year 152 100Total Working Days Per Year 213 265Total Working Hours Per Year 1,704 2,120

Relievers NeededTo compute for relievers needed, the following should be considered:1. Average number of leaves taken each year - - - - - - 15

a. Vacation Leave - - - - - - - - - - - - - - - - - - - - - - - 10b. Sick Leave - - - - - - - - - - - - - - - - - - - - - - - - - - - 5

2. Holidays - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 123. Special Privileges as per CSC MC#6 s.1996 - - - - - - -34. Continuing Education Program for Professionals - - 3

Total Average Leaves 33

It will be noted that although an employee is entitled to 15 days sick leave and 15 days vacation leave, 12 holidays, 3 days for continuing education, plus 3 days of special privileges or 48 days total, he or she gets only an average of 33 days leave per year.

To determine the relievers needed, divide 33 (the average number of working days an employee is absent per year) by the number of working days per year that each employee serves (whether 213 or 265). This will be 0.15 per person who works 40 hours per week and 0.12 per person for those working 48 hours per week.

Multiply the computed reliever per person by the computed number of nursing personnel. This will give the total number of relievers needed.

Distribution by ShiftsStudies have shown that the morning or day shift needs the most number of nursing personnel at 45 to 51 percent;

for the afternoon shift 34 to 37 percent; and for the night shift 15 to 18 percent. In the Philippines the distribution usually followed is 45 percent for the morning shift, 37 percent for the afternoon shift, and 18 shift for the night shifts.

Staffing FormulaTo compute for the staff needed in the In-Patient units of the hospital the following steps are considered:

1. Categorize the number of patients according to the levels of care needed. Multiply the total number of patients by the percentage of patients at each level of care (whether minimal, intermediate, intensive or highly specialized).

2. Find the total number of nursing care hours needed by the patients at each category level.a. Find the number of patients at each level by the average number of nursing care hours needed per day.b. Get the sum of the nursing care hours needed at the various levels.

3. Find the actual number of nursing care hours needed by the given number of patients. Multiply the total nursing care hours needed per day by the total number of days in a year.

4. Find the actual number of working hours rendered by each nursing personnel per year. Multiply the number of hours on duty per day by the actual working days per year.

5. Find the total number of nursing personnel needed.a. Divide the total number of nursing care needed per year by the actual number of working hours rendered by an

employee per year.b. Find the number of relievers. Multiply the number of nursing personnel needed by 0.15 (for those working 40 hours

per week) or by 0.12 (for those working 48 hours per week).c. Add the number of relievers to the number of nursing personnel needed.

6. Categorize the nursing personnel into professionals and non-professionals. Multiply the number of nursing personnel according to the ratio of professionals to non-professionals.

7. Distribute by shifts.

To illustrate:Find the number of nursing personnel needed for 500 patients in a tertiary hospital.

1.Categorize the patients according to level of care needed. 500 (pts) x .30 = 150 patients needing minimal care 500 (pts) x .45 = 225 patients needing moderate care 500 (pts) x .15 = 75 patients need intensive care 500 (pts) x .10 = 50 patients need highly specialized nursing care 5002.Find the number of nursing care hours (NCH) needed by patients at each level of care per day. 150 pts x 1.5 (NCH needed at Level I) = 225 NCH/day 225.5 pts x 3 (NCH needed at Level II) = 675 NCH/day 75 pts x 4.5 (NCH needed at Level III) = 337.5 NCH/day 50 pts x 6 (NCH needed at Level IV) = 300 NCH/day Total 1537.5 NCH/day3.Find the total NCH needed by 500 patients per year.

1537.5 x 365 (days/year) = 561,187.50 NCH/year4. Find the actual working hours rendered by each nursing personnel per year. 8 (hrs/day) x 213 (working days/year) = 1,704 (working hours/year)5.Find the total number of nursing personnel needed.

a. Total NCH per year = 561,187.50 = 329Working hrs/year 1,704

b. Relief x Total Nursing Personnel = 329 x 0.15 = 49c. Total Nursing Personnel needed 329 + 49 = 378

6. Categorize to professional and non-professional personnel. Ratio of professionals to non-professionals in a tertiary hospital is 65:35.378 x .65 = 246 professional nurses378 x .35 = 132 nursing attendants

7. Distribute by shifts.246 nurses x .45 = 111 nurses on AM shift246 nurses x .37 = 91 nurses on PM shift246 nurses x .18 = _ 44 _nurses on night shift

Total 246 nurses 132 Nursing attendants x .45 = 59 Nursing attendants on AM shift

132 Nursing attendants x .37 = 49 Nursing attendants on PM shift132 Nursing attendants x .18 = _ 24 _Nursing attendants on night shift

Total 132 Nursing AttendantsIt should be noted that the above personnel are only for the in-patients. Therefore, additional personnel should be

hired for those in supervisory and administrative positions and for those in special units such as the Operating Room, the Delivery Room, the Emergency Room, and Out-Patient Department.

A Head Nurse is provided for every nursing unit. Likewise, a Nursing Superior is provided 1) to cover every shift in each clinical department or area specialty unit; 2) for each geographical area in hospitals beyond one hundred (100) beds and; 3) for each functional area such as Training, Research, Infection Control, and Locality Management.Manager’s Responsibilities in Meeting Staffing Needs

The manager must ascertain that adequate numbers and an appropriate mix of personnel are available to meet daily unit needs and organizational goals.

It is important that staffing patterns and scheduling policies must be administered fairly as well as economically because they both directly affect the daily lives of all personnel.

Leadership Roles and Management Functions Associated with Staffing and SchedulingLEADERSHIP ROLES MANAGEMENT FUNCTIONS1. Identifies creative and flexible staffing methods to meet the needs of the patients, staff and the organization.2. Is knowledgeable regarding contemporary methods of scheduling and staffing.3. Assumes a responsibility toward staffing that builds trust and encourages a team approach.4. Periodically examines the unit standard of productivity to determine if changes are needed.5. Is alert to extraneous factors that have an impact on staffing.6. Is ethically accountable to patients and employees for adequate and safe staffing.7. Plans for staffing shortages so patient care goals will be met.8. Assesses if and how workforce intergenerational values impact staffing needs and responds accordingly.

1. Provides adequate staffing to meet patient care needs according to the philosophy of the organization.2. Uses organizational goals and patient classification tools to minimize understaffing and overstaffing as patient census and acuity fluctuate.3. Schedules staff in a fiscally responsible manner.4. Develops fair and uniform scheduling policies and communicates these clearly to all staff.5. Ascertains that scheduling policies are not in violation of local and national labor laws, organizational policies or union contracts.6. Assumes accountability for quality and fiscal control of staffing.7. Evaluates scheduling and staffing procedures and policies on a regular basis.

Inflexible scheduling is a major contributor to job dissatisfaction and turnover on the part of nurses. Managers should do whatever they can to see that employees feel they have some control over scheduling, shift options and staffing policies.

The overall responsibility for scheduling continues to be an important function of first- and middle-level managers, although staffing clerks and computers assist with staffing in some organizations. Each organization has different expectations regarding the unit manager’s responsibility in long-range human resource planning and in short-range planning for daily staffing.

Centralized Staffing is where staffing decisions are made by personnel in a central office or staffing center. Such centers may or may not be staffed by RNs, although someone in authority would be a nurse when a staffing clerk carries out the day-to-day activity.

Advantages:The manager’s role is limited to making minor adjustments and providing input. The manager continues to have ultimate responsibility for seeing that adequate personnel are available to meet the needs of the organization.

It is fairer to all employees because policies tend to be employed more consistently and impartially.

It allows for the most efficient (cost effective) use of resources since the more units that can be considered together, the easier it is to deal with variations in patient census and staffing needs.

Disadvantages:It does not provide as much flexibility for the worker, nor can it account as well for a worker’s desires or special needs. Managers may be less responsive to personnel budget control if they have limited responsibility in scheduling and staffing matters.

Decentralized Staffing is where the unit manager is often responsible for covering all scheduled staff absences, reducing staff during periods of decreased patients or acuity, adding staff during periods of high patient census, preparing monthly unit schedules, and preparing holiday and vacation schedules.

Advantages:The unit manager understands the needs of the unit and staff intimately, which leads to increased likelihood that sound staffing decisions will be made.

The staff feels more in control of their work environment because they are able to take personal scheduling requests directly to their immediate supervisor.

It leads to increased autonomy and flexibility, thus, decreasing nurse attrition.Disadvantages:It carries the risk that employees will be treated unequally or inconsistently.

The manager may be viewed as granting rewards or punishments through the staffing schedule.

It is time consuming for the manager and often promotes more “special pleading” than centralized staffing.

The major difficulty is ensuring high-quality staffing decisions throughout the organization.

Budreau, Balakrishnan, Titler and Hafner (1999) state that nursing management is highly decentralized in most hospitals, with considerable variation found in staffing among patient care units. This means that many nurse-manager have some control over factors that affect cost on their specific units.

Managers must also be cognizant of the need to have an ethnically and culturally diverse staff to meet the needs of an increasingly diverse patient population.

unique cultural and linguistic needs of patient population = appropriately diverse staff

Malloch, Deveonport and Hatler (2003) suggest that the importance of providing culturally competent caregivers cannot be overstated since health care congruent with cultural beliefs and values is essential for optimal outcomes.

Nurse-managers must be cognizant of new recommendations and legislation affecting staffing.For example: minimum staffing ratiosProponents of legislated minimum staffing ratios say that ratios are needed because many hospitals’ current staffing levels are so low that both RNs and patients are negatively affected.Poor staffing = (-) nurses’ health & safety + (-) patient outcomes3 Arguments against Staffing Ratios:

1. The current nursing shortage will make it difficult to fill the slots when the ratios appear. 2. The ratios may merely serve as a Band-aid to the greater problems of quality care.3. Numbers alone do not ensure improved patient care since not all RNs have equivalent clinical experience and skill levels.

Scheduling OptionsSome of the more frequently used creative staffing and scheduling options include: 10- or 12- hour shifts

The resultant nurse satisfaction must be weighed against the increased costs because extending the workday with 10- to 12-hour shifts may require overtime pay.

Extending the length of shifts may result in increased judgment errors as nurses become fatigued.Organizations limit the number of consecutive 10- or 12-hour days a nurse can work or the number of hours that can be worked in a given day. Premium pay for weekend work Part-time staffing pool for weekend shifts and holidays Cyclical staffing, which allows long term knowledge of future work schedule because a set staffing pattern is repeated

every few weeks Job sharing Allowing nurses to exchange hours of work among themselves Flextime

It is a system that allows employees to select the time schedules that best meet their personal needs while still meeting work responsibilities.

Most flextime has been possible only for nurses in roles that did not require continuous coverage. Staff nurses recently have been able to take part in a flextime system through prescheduled start times. Variable start times may be longer or shorter than the normal 8- hour workday.

Units have employees coming and leaving the unit at many different times when a hospital uses flextime. Although flextime staffing creates greater employee choices, it may be difficult for the manager to coordinate and could easily result in overstaffing or understaffing. Use of supplemental staffing from outside registries and float pools

Agency nurses or travel nurses are usually directly employed by an external broker and work for premium pay (2-3 times that of regularly employed staff), without benefits.

While such staff provide scheduling relief, especially in response to unanticipated increases in census or patient acuity, their continuous use is expensive and can result in poor continuity of care.

Some hospitals have created their own internal supplemental staff by hiring per-diem employees and creating float pools.

Per-diem staff generally has flexibility to choose if and when they want to work. In exchange for this flexibility, they receive higher rate of pay, but usually no benefits.

Float pools are generally composed of employees who agree to cross train on multiple units so that they can work additional hours during periods of high census or worker shortages. Wing (2001) argues, however, that float pools are adequate for filling intermittent staffing holes but, like agency or registry staff, are not an answer to the ongoing need to alter staffing according to census. It results in lack of staff continuity. Staff self-scheduling

It was developed in 1960s where it allowed nurses in a unit to work together to construct their own schedules rather than have schedules created by management.

Employees are typically given four to six week schedule worksheets to fill out several weeks in advance of when the schedule is to begin.

These employees typically have one to two weeks to fill in the blanks on the schedule, following whatever guidelines or requirements are set by the management (i.e., number of weekend shifts that must be worked, maximum number of consecutive shifts) (Hung, 2002).

The nurse-manager then reviews the worksheet to make sure all the guidelines or requirements have been met.Points to consider:

Although self-scheduling offers nurses greater control over their work environment, it is not easy to implement. Success depends on the leadership skills of the manager to support the staff and demonstrate patience and perseverance throughout the implementation.

Shullanberger (2000) found that it provides greater worker participation in decision making but requires greater worker involvement and management flexibility to be successful.

It saves management time, improve morale and professionalism and reduces personnel turnover (Hung, 2002). Nurses most satisfied with self-scheduling were those who shared responsibility for adequate staffing and those who

had developed good negotiating skills.Obviously, all scheduling and staffing patterns, from traditional to creative, have shortcomings. Therefore, any changes in current policies should be evaluated carefully as they are implemented. Because all scheduling and staffing patterns have a heavy impact on employees personal lives, productivity and

budgets, it is wise to have a six-month trial of new staffing and scheduling changes, with an evaluation at the end of that time to determine the impact on financial cost, retention, productivity, risk management and employee and patient satisfaction.

Workload Measurement ToolsRequirements for staffing are based on whatever standard unit of measurement for productivity is used in a given unit.NCH/PPD = Nursing Hours Worked in 24 hours

Patient CensusThis is the simplest formula for calculating nursing care hours per patient day in use and continues to be widely used.

In this formula, all nursing and ancillary staff are treated equally for determining hours of nursing care and no differentiation is made for differing acuity levels of patients.These two factors alone may result in an incomplete or even inaccurate picture of nursing care needs. Jennings, Loan, DePaul, Brosch and Hildreth (2001) concur, suggesting that the use of NCH/PPD as a workload measurement tool may be too restrictive, since it may not present the reality of today’s inpatient care settings, where staffing fluctuates not only among shifts, but within shifts.

As a result, Patient Classification Systems (PCS), also known as workload management or patient acuity tools, were developed in the 1960s.

PCSs group patients according to specific characteristics that measure acuity of illness in an effort to determine both the number and mix of staff needed to adequately care for those patients.It is usually not possible to transfer a PCS from one facility to another because other variables within the system have an impact on nursing care hours. Instead, each basic classification system must be modified to fit a specific institution.Seago (2002) suggest that most PCSs can be classified as:

Critical indicator or criterion type uses broad indicator such as bathing, diet, IVF and medications and positioning to categorize patient care activities.

Summative task type requires the nurse to note the frequency of occurrence of specific activities, treatments and procedures for each patient.

Both type of PCSs are generally filled out prior to each shift although the summative task type typically has more items to fill out than the critical incident or criterion type.Once an appropriate PCS is adopted, hours of nursing care must be assigned for each patient classification. Each institution is unique and must determine to what degree that classification system must be adapted for them. White (2003) suggests that each patient population is different and that each unit must examine clinical profiles of patients, average length of stay and practitioner specialty in defining their patient population. In addition, core staff versus visiting staff and skill mix must be considered. Any classification system has many variables and all systems have their faults. It is a mistake for managers to think that the PCS will solve all staffing problems. Although such systems provide a better definition of problems, it is up to the people in the organization to make judgments and use the information obtained by the system appropriately to solve staffing problems.The middle-level manager must be alert to internal or external forces affecting unit need that may not be reflected in the organization’s PCS. Ex. Sudden increase in nursing or medical students using the unit, a lower skill level of new graduates, or cultural and language difficulties of recently hired foreign nurses. The organization’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 cognizant of justifiable reasons for variations.

Some futurists have suggested that eventually workload measurement systems may replace acuity-based staffing systems. Workload measurement is a relatively new technique that evaluates work performance as well as necessary resource levels (Walsh, 2003). Thus, it goes beyond patient diagnosis or acuity level, and examines the specific number of care hours needed to meet a given 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.Regardless of the workload measurement tool used (NCH/PPD, PCS, workload measurement system, etc), the units of workload measurement that are used need to be reviewed periodically and adjusted as necessary. This is both a leadership role and management responsibility.

Nursing Care Hours, Staffing Mix and Quality CareThe relationship between nursing care hours, staffing mix and quality of care has occurred in response to the

“restructuring” and “reengineering” boom that occurred in many acute care hospitals in 1990s.Restructuring and reengineering was done to reduce costs, increase efficiency, decrease waste and duplication and

reshape the way care was delivered. Given that health care is labor intensive, cost cutting under restructuring and reengineering often included staffing models

that reduced RN representation in the staffing mix and increased the use of unlicensed assistive personnel (UAP).

This fairly rapid and dramatic shift in both RN care hours and staffing mix provide fertile ground for comparative studies that examined the relationship between:Nursing Care Hours + Staffing Mix = Patient Outcomes As RN hours decrease in NCH/PPD, adverse patient outcomes increase, including increased medication errors and

patient falls and decreased patient satisfaction with pain management.

Unit managers must understand the effect that major restructuring and redesign have on their staffing and scheduling policies as well. As new practice models are introduced, there must be a simultaneous examination of the existing staff mix and patient care assessments to ensure that appropriate changes are made in staffing and scheduling policies. Decreased licensed staff, increasing numbers of unlicensed staff and developing new practice models have a tremendous

impact on patient care assignment methods. Past practices of relying on part-time staff, responding to staff preferences for work and providing a variety of shift lengths

and shift rotations may no longer be enough. Administrative practices also have saved money in the past by sending people home when there was low census; they

have also floated them to other areas to cover unit needs, not scheduled staff for consecutive shifts because of staff preferences and had scheduling policies that were unreasonably accommodating.

Patient assignments in the past were often made without attention to patient continuity and assigned by numbers rather than workload.

Some of these past practices have benefited the staff, and some have been for the benefit of the organization, but few of them have benefited the patient. Indeed, assigning a different nurse to care for a patient each day of an already reduced length of stay may contribute to

negative patient outcomes.

Therefore, there must be an honest appraisal of current staffing, scheduling and assignment policies simultaneously as organizations are restructured and new practice models are engineered. Having an adequate number of knowledgeable trained nurses is imperative to attaining desired patient outcomes. Ascertaining an appropriate skill mix depends on the patient care setting, acuity of patients and other factors. There is no national standard to determine whether staffing decisions are suitable for a given setting. Manthey (2001) describes several factors that will drive additional new staffing plans in the coming decade, Work Force

2000:o Increased importation of foreign nurses who must be safely incorporated into the care delivery systemoOngoing fiscal restraints that result in the need for lean staffingoAnd plentiful, attractive career options for nurses outside the hospital.

Ethical Accountability for Staffing The manager has ethical accountability both to patients and staff. Their needs should be met. Regardless of the difficulties inherent in PCSs and the assignment of nursing care hours, they remain a method for

controlling the staffing function of management. As long as managers realize that all systems have weaknesses and as long as they periodically evaluate the

system, managers will be able to initiate the needed change.

It is critical, however, for managers to make every effort to base unit staffing on their organization’s patient classification system.

It is important for managers to use staff to provide safe and effective care economically. Managers must increase staffing when patient acuity rises as well as decrease staffing when acuity is low; to do

otherwise is demoralizing to the staff. Shift staffing based on patient acuity system does, however, allow for more consistent staffing and is better able to

identify overstaffing and understaffing on a more timely basis. oThis is a fairer method of allocating staff. oThe disadvantage of shift-based staffing is that it is time-consuming and somewhat subjective, because acuity or

classification systems leave much to be determined by the person assigning the acuity levels.oThe greater the degree of objectivity and accuracy in any system, the longer time required to make staffing

computations. Perhaps the greatest danger in staffing by acuity is that many organizations are unable to supply the extra staff when the system shows unit understaffing. However, the same organization may use the acuity-based staffing system to justify reducing staff on an overstaffed unit. Therefore, a staffing classification system can be demotivating if used inconsistently or incorrectly.

Employees have the right to expect a reasonable workload. Managers must ensure that adequate staffing exists to meet the needs of staff and patients.

Managers who constantly expect employees to work extra shifts, stay overtime and carry unreasonable patient assignments are not being ethically accountable.

Effective managers, however, do not focus totally on numbers of personnel, but look at all components of productivity; they examine nursing duties, job descriptions, patient care organization, staffing mix, and staff competencies.

Management must work just as hard as the staff in meeting patient needs; and that the organization’s overriding philosophy is based on patient interest and not on financial gain.

A leadership challenge for the manager is to develop policies that focus on outcomes rather than constraints or rules that limit responsiveness to individual employee needs.

STAFF DEVELOPMENTThe staff’s knowledge level and capabilities are a major factor in determining the number of staff required to carry out unit goals.

2 components of staff development:- Education- Training

Early staff development emphasized on:- Orientation- In-service training

Training vs EducationTraining- An organized method of ensuring that people have knowledge and skills for a specific purpose and that they have

acquired the necessary knowledge to perform the duties of the job.

Education- More formal and broader in scope than training.- Designed to develop the person in a broader sense

Responsibilities of the Education DepartmentMost education departments on the organization chart are depicted as having staff or advisory authority rather than line authority. Likewise, unit manager has no authority over personnel in the education department.

Because of the ambiguity of overlapping roles and difficulties inherent in line and staff positions, educating and training employees may be neglected.

It is necessary to delineate and communicate the authority and responsibility for all components of education and training.

Other difficulties are frequent lack of cost-effectiveness evaluation and little accountability for the quality and outcomes of the educational activities.

The following suggestions can help overcome the difficulties inherent in a staff development system in which there is shared authority:

The nursing department must ensure that all parties involve should understand and carry out their responsibilities in that process.

If the nursing department is not directly responsible for the staff development department, there must be input from the nursing department in formulating staff development policies and delineating duties.

An advisory committee should be formed with representatives from all departments and all classification of employees receiving training and education.

Accountability for various parts of the staff development program must be clearly communicated. Some method of determining the cost and benefits of various programs should be used.

Theories of LearningUnderstanding teaching-learning theories allows managers to structure training and use teaching techniques to change employee behavior and improve competence-goal for all staff development.

Adult learning theory- Pedagogical-Usually ineffective for mature learners because adults have special needs.- Adult learners are mature, self-directed people who have learned a great deal from life experiences and are

focused toward solving problems that exist in their immediate environment.

PEDAGOGY ANDRAGOGYCharacteristics:- Learner is dependent - learner is self-directed- Learner needs external rewards and punishment - learner is internally motivated- Learner’s experience is unimportant or limited - learner’s experiences are

valued- Self-centered - task- or problem-centered- Teacher-directed - self-directed

Learning Environment:- Climate is authoritative - climate is relaxed and informal- Competition is encouraged - collaboration- Teacher sets goals - teacher & class sets goals- Decisions are made by teacher - decisions are made by teacher & class- Teacher lectures - students process activities and inquire about projects- Teacher evaluates - teacher, self, peers evaluate

Obstacles and assets to adult learningOBSTACLES ASSETS- Institutional barriers - high self-motivation- Time - self-directed- Self-confidence - a proven learner- Situational obstacles - knowledge experience reservoir- Special individual obstacles - special individual assets

Social Learning Theory

- Builds on reinforcement theory as part of the motivation to learn and have many of the same components as the theory of socialization.

- Bandura (1977) suggests that people learn most behavior by direct experience and observation, and behaviors are retained or not retained based on positive Involves four processes: people learn as a result of the direct experience of the effects of their actions knowledge is obtained through various experiences people learn by judgments voiced by others people evaluate the soundness of the new information by reasoning through deductive and inductive

reasoning- Soundness of this theory is determined by the effectiveness of role models, preceptors and mentors.

Social learning theory process

Other learning theories:- readiness to learn- motivation to learn- reinforcement- task learning- transfer of learning- span of memory- chunking- knowledge of results

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 development needs

Staff development activities are carried out to:- establish competence- meet new learning needs- satisfy interests the staff may have in learning specific areas

Competence-having the abilities to meet the requirements for a particular role.-state board licensure, national certification and performance review are some methods used to satisfy competency requirements

The following plan outlines the sequence that should be used in developing an educational program:

1. identify the desired knowledge or skills the staff should have2. identify the present level of knowledge or skill3. determine the deficit of desired knowledge and skills4. identify the resources available to meet the needs5. make maximum use of available resources6. evaluate and test outcomes after use of resources

Evaluation of Staff Development ActivitiesEvaluation of staff development consists of more than merely having class participants fill out an evaluation form at the end of every class session, or assigning a preceptor for each new employee.

Control- the evaluation phase of the management process, becomes extremely difficult when accountability is shared.

Evaluation of the three components of staff development (indoctrination, training and education) should include the following four criteria:

1. learner’s reaction2. behavior change3. organizational impact4. cost-effectiveness

Coaching as a strategyCoaching- as a means to develop and train employees is a teaching strategy rather than a learning theory.- Is one person helping the other to reach an optimum level of performance- The emphasis is always on assisting the employee to recognize greater options, to clarify statements and

to grow.

*short-term coaching- effective as a teaching tool for assisting with socialization and for dealing with short-term problems- frequently involves spontaneous teaching opportunities

*long-term coaching- as a tool for career management and in dealing with disciplinary problems is different.

Meeting the Educational Needs of a Culturally Diverse Staff(Seago,2000)- require well-planned learning activities. There should be sufficient opportunity for small group so that

personnel can begin recognizing their own biases and prejudices.

- This type of learning activity is especially important as more unlicensed assistive personnel(UAP) are added to the staff.- Education to support cultural diversity should be part of staff development of RNs and UAP to facilitate their

learning to work together in teams.

LaDuke(2001)- pairing an older nurse with a much younger one could result in conflict and mutual disrespect and result in

less effective learning during a critical time in the older nurse’s socialization to the facility.

Building Team Unity Through Staff Development-the new momentum in organizations is toward encouraging a team effort through team building and providing a continual supportive learning environment.-Fitzpatrick(2001) thinks that a leader who is a good coach, and who can inspire others to join and remain with the team, ignites the team spirit.

“The Leader is a Role Model of the life-long learner.”

Staffing Patterns and Scheduling OptionsSchedule – it is a timetable showing planned work days and shifts for Nursing personnel. The objective in scheduling is to assign working days and days-off to the nursing personnel so that adequate patient care is assured. A desirable distribution of off-duties can be achieved and the individual members of the nursing team will feel that they are treated fairly. They will also know their schedule ahead of time.

Factors to be considered in Making Schedules different levels of nursing staff adequate coverage for 24 hours seven days of the week staggered vacations and holidays weekends long stretches of consecutive work days evening and afternoon shifts relieving

Scheduling may vary from each agency, but the scheduling system must function smoothly in terms of:

1. ability to cover the needs of the unit – the minimum required number of staff must meet the nursing needs of the clients in all the units and in all the shifts;

2. quality to enhance the nursing personnel’s knowledge, training, and experience – while a permanent assignment to one unit enhances skills in caring for a particular kind of patient, many nurses who have future plans to go to teaching, or specialization or even taking a job abroad, would prefer to experience being assigned to various units before settling down to a particular unit of their choice.

3. fairness to the staff – all nursing personnel should get their fair share of weekends, holiday offs, rotation patterns for the whole year including assignment to “difficult” or “light” or “undesirable” units or shifts;

4. stability – the nursing personnel would like to know in advance their schedule of assignment so that their personal schedules are in harmony with one another;.

5. flexibility – flexibility means the ability to handle changes brought about by emergency leaves, scheduled or unscheduled leaves of absence.

Types of Scheduling (Table on the Last Page): 1. Centralized Schedule – one person, usually the chief nurse or her designate, assigns the nursing personnel to

the various units of the hospital. This includes the on-duty and off-duty shifts. 2. Decentralized Schedule – the shift and off-duties are arranged by the Supervising Nurse or Head or Senior

Nurse of the particular unit

3. Cyclical Schedule – the cyclical schedule covers a designated number of weeks called the cycle length and is repeated thereon. It assigns the required number of nursing personnel to each nursing unit consistent with the 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 2 or 4 weeksb. shift rotationc. week-ends offd. holiday offse. vacation leavesf. special days ( birthdays, weddings etc.)g. scheduled events in the hospital, training programs, or meetingsh. job categoriesi. continuing professional education programs Four Week Cyclical Schedule

In the table above, it shows a typical 4 week cyclical schedule that gives each personnel a fair share of week ends off. Since Mondays are usually busy days, minimal offs on these days are observed.

The table also shows the typical ward staffing where the morning shift has a Head or Senior Nurse and a staff nurse with two nursing attendants. The afternoon and evening shifts are provided with relievers. This ensures coverage when either the nurse or nursing attendants are off duty. Note that the relievers are given off duties after a night shift such that it avoids an afternoon shift the following day. Thus ensures adequate rest and sleep between tours of duty.

For those actually involved in patient care, it is advisable that their work days be not on a 5 consecutive work days or else they will get easily tired. Rotation from night to afternoon shift must be avoided because the staff nurse or nursing attendant may not have sufficient time to rest between shifts. Insufficient rest and sleep greatly affects nursing care performance and its quality so ample rests should be provided.

Advantages of a Cyclical Schedule1. It is fair to all2. it saves time 3. it enables the employees to plan ahead for their personal needs preventing frequent changes in schedule4. scheduled leave coverage such as vacation, holidays and sick leaves are more stable5. productivity is improved

Developing Job DescriptionsJob Description – it is a statement that sets the duties and responsibilities of a specific job. It includes the needed characteristics and qualifications of the individual to perform such duties successfully. It is an important management tool to make certain that responsibilities are wisely delegated, that work is efficiently distributed, that talents are fully used, and morale is maintained.

Contents of a Job Description1. Identifying Data

a. Position Titleb. Departmentc. Supervisor’s Title

2. Job Summary – includes the essential features of the job that distinguishes it from the others3. Qualification Requirements – Educational Preparation, training and experience necessary to fill the position4. Job Relationships5. Specific and Actual Functions and Activities

Uses of a Job Description1. for recruitment and selection of qualified personnel2. to orient new employees to their jobs3. for job placement, transfer or dismissal4. as an aid in evaluating the performance of an employee5. for budgetary purposes

6. for determining departmental functions and relationships to help define the organizational structure7. for classifying levels of nursing functions according to skills level required8. to identify training needs9. as basis for staffing 10. to serve as a channel for communication

Sample Job Description of a Staff Nurse

Position Title: Staff Nurse/Nurse IDefinition:The staff nurse is a professional nurse responsible for rendering holistic nursing care to patients in assigned areas, the specific functions and responsibilities of which depend upon the organizational structure of the Nursing Service/Department/Division.

Qualification Requirements:Education: Bachelor of Science in NursingLicense: Registered Nurse

Job Summary:The Staff Nurse provides nursing care to patients towards the promotion of health, prevention of diseases, restoration of health, alleviation of suffering, and assisting the dying to face death with dignity and in peace.

Employment Variables:Professional affiliation with professional nursing associations

Job Relationships:Source of Workers: RegisteredPromoted to: Senior Nurse/ Nurse IIResponsible to: Senior Nurse/ Nurse II

Functions:A. Patient Care Management

The Staff Nurse shall initiate and perform nursing care services to meet the needs of patients in assigned areas/units utilizing the nursing process1. Assesses the individual’s needs for nursing care based on the patient’s history, results of physical, diagnostic,

and laboratory examinations2. Infers correct nursing diagnosis3. Plans/Prioritizes nursing care activities considering overall health needs of the patient, the extent of his coping

abilities including that of his family and significant others and his readiness, acceptance, and abilities of self-care4. Institutes nursing interventions consistent with the overall plan of care with special considerations for the

patient’s safety and comfort5. Executes written legal prescriptions for treatment, therapies, medication including hypodermic, intramuscular

and intravenous injections; provided that in intravenous injections, special training be required and according to protocol established

6. Provides health teaching to patients, their family and significant others so that they may understand this illness and participate actively in his care

7. Coordinates patient’s care services with members of the health care team 8. Evaluates/modifies nursing care provided in terms of:

a. Effectiveness and efficiency of nursing measures renderedb. Feedback from patient/family/significant others

9. Conducts discharge planning with patient, family and significant others with the health team. Refers to community health agencies as needed

10. Documents accurately the observations and services rendered to the patients

B. Hospital and Nursing Service Policies and Regulations1. Observes hospital and nursing service rules, regulations and policies

2. Interprets to patients, family and visitors the rules, regulations, and policies that affect them

C. Learning Experiences of Nursing and Midwifery Students1. Coordinates with Clinical Instructors the activities of the affiliating students such as helping select patient

assignments to enhance learning experiences particularly on patient care2. Demonstrates good nursing in the way he or she cares for patients. He or she also serves as role-model to the

students

D. Orientation of Non-Professional Workers in the Unit Participates in the orientation of new, non-professional nursing personnel

E. Research and StudiesParticipates in/initiates nursing research and studies. Utilizes results for improvement of Nursing Practice

F. Professional Responsibilities1. Takes initiative and responsibility in membership in professional organizations and participates actively in their

programs and activities2. Keeps self professionally updated through continuous education3. Update professional license

Sample Job Description of the Head Nurse/Senior Nurse/Nurse II

Position Title: Head Nurse/Senior Nurse/Nurse IIDefinition:A Head Nurse/Senior Nurse/Nurse II is a professional nurse who assumes responsibility for managing the human and material resources of a nursing unit to provide quality patient care and an environment conducive to staff growth and satisfaction

Qualification Requirements:Bachelor of Science in Nursing; Registered Nurse; at least one year of clinical nursing experience; with supervisory development training or training in the specialty of the clinical nursing unit to which he/she is prepared for promotion; or 9 units of Nursing Management and Supervision in the Graduate School by RA 9173

Employment Variable:Membership in the agency’s nursing association and other professional associations such as the Integrated Nurses of the Philippines and the Philippine Nurses Association.

Job Relationships:Source of Workers – Nurse I/Staff NursePromotion to: Nurse III/Supervising NurseResponsible to: Nurse III/Supervising NurseResponsible for: Nurse I/Staff Nurse; Nursing Attendant

Functions:A. Patient Care Management – assumes responsibility for the delivery of quality patient care for the

nursing unit1. Participates in the development of nursing standards, policies, procedures, regarding

patient care and updates these as necessary2. Promotes/utilizes quality assurance standards and programs in the unit3. Supervises and evaluates the quality of patient care through frequent rounds4. Acts as liaison with the medical staff to coordinate medical and nursing management of

patient care5. Serves as resource person to nursing personnel under him/her in assessing, planning,

implementing, and evaluating nursing care provided6. assumes the role of patient advocate

7. coordinates patient care with other members of the health team, other hospital units, services, and/or divisions

8. Serves as Committee member within the department, hospital or professional organization9. keeps superiors informed regarding problems/issues in patient care within the nursing unit

B. Management of Nursing Personnel – provides leadership and direction to nursing personnel in accordance with organizational and departmental goals and objectives1. Participates in the selection of nursing staff of the unit2. schedules staff assignments considering experiences, interests and training3. adjusts staffing levels/ratio according to the severity of the patient’s illness, the number of

patients and number of nurses4. advises and/or informs staff about new or revised policies and procedures5. keeps the supervising nurse informed of personnel actrivities and problems6. present changes or innovations to staff in a positive manner7. produce a conducive climate in which the staff will feel free to consult him/her for problems

or assistance

C. Management of Patient Care Units – maintains an environment that encourages quality patient care and staff satisfaction1. provides safe, clean, secure environment for patients, visitors and personnel2. requisitions adequate supplies and equipment needed for patient care 3. monitors utilization of supplies and equipment through monthly audits and inventories4. cooperates/coordinates with other hospital service/ departments for appropriate support

services5. prepares monthly, semi-annual, annual reports of achievements/prblems6. Maintains effectiveness of communication within unit/departments and other services

through conference meetings

D. Educational Responsibilites1. assists in staff development activities in the unit:

a. coordinates with training staff in planning, implementing and evaluating orientation of new personnel

b. Informs Training Staff of the training needs of the nursing personnel under him/her

2. assists clinical instructors of affiliating colleges of nursing or school of midwifery in planning, implementing, and evaluating the learning experience of the students

3. assumes responsibility for won learning and development needse. Acts as supervising nurse in the absence of one and when so delegated.

Dealings with ConflictsConflict – defined as internal or external discord that results from the differences in ideas, values, or feelings between two or more people. Conflict is created when there is a mesh of different values, beliefs, backgrounds and goals in which an individual possesses uniquely and is in not in harmony with another. Conflict is also created when there are differences in economic and professional values and when there is competition among professionals. Scarce resources, restructuring, and poorly defined role expectations also are frequent causes of conflict.

The current sociological view of conflict is that conflict is neither good nor bad, encouraged or avoided, but instead be managed accordingly. The manager’s role is to create a work environment where conflict may be used as a conduit for growth, innovation, and productivity.

Categories of Conflict:

Intergroup Conflict – occurs between two or more groups of people, departments or organizationsIntrapersonal Conflict – occurs within the person. Interpersonal Conflict - also known as “horizontal violence” or “bullying” happens between two or more peopleThe Conflict Process

I. Latent Conflict- implies the existence of antecedent conditions such as short staffing and rapid change. Much unnecessary could be prevented or reduced if managers examined the organization much more closely for antecedent situations

II. Perceived Conflict- or substantive conflict; intellectualized and often involves issues and rolesIII. Felt Conflict – occurs when conflict is emotionalized with such emotions as fear, hostility, mistrust,

anger etc.IV. Manifest conflict – or overt conflict; action like withdrawal, compete, debate or resolution is takenV. Conflict Resolution or Conflict Management – addressing of conflictVI. Conflict Aftermath – positive or negative effects of conflict

Conflict ManagementThe optimal goal for conflict management is to create a win-win solution for all involved.

Strategies for Conflict Management1. Compromising- each party gives up something it wants2. Competing – used when one party pursues what it wants at the expense of the others. Usually results in a win-lose

situation where the loser commits negative emotions. Is used when a quick or unpopular decision needs are to be made. It is also appropriately used when one party has more information or knowledge about the situation than the other

3. Cooperating – the opposite of competing. One party sacrifices his or her beliefs and allows the other party to win4. Accommodating – one party leaves a favor/IOU to be used at another time5. Smoothing – one person smoothes the persons involved in an effort to reduce emotional component of the conflict

such that it may lead to accommodation or cooperation. Appropriate for minor disagreements but rarely resolves conflicts6. Avoiding – the parties involved are aware of a conflict but choose not to acknowledge it or to attempt to resolve it.

May be indicated in trivial disagreements, when the cost of dealing exceeds the benefits of solving it, when the problem should be solved by other people than you, or when the problem will solve itself.

7. Collaborating – all parties set aside their original goals and work together to establish a supraordiante goal or priority common goal. Often leads to a win-win situation.

Ten Rules of Collaborating accdg. To Gardner1. Know thyself2. Learn to value and manage diversity3. Develop constructive conflict resolution skills4. Use your power to create win-win situations5. Master interpersonal and process skills6. Recognize that collaborating is a journey7. Leverage multidisciplinary forums to increase collaboration 8. Appreciate that collaboration can occur spontaneously9. Balance autonomy and unity in collaborative relationships10. Remember that collaboration is not required for all decisions

Manging Unit ConflictCommon Causes of Organizational Conflict

Poor Communication Inadequately defined organizational structure Individual Behavior Unclear Expectations Individual or group conflicts of interest Operational or staffing changes Diversity in Gender, Culture, or Age

Strategies to effectively manage unit conflicts:1. Confrontation 2. Third party Consultation3. Behavior Change4. Responsibility Charting

5. Structure Change6. Soothing one party7. Negotiations8. Consensus