Staffing an in-Patient Unit Essay Paper

Staffing an in-Patient Unit Essay Paper

Staffing an in-Patient Unit Essay Paper

Patients’ needs should be paramount in any hospital, and coverage to maintain continuity of care is the first consideration. Someone must be there to do provide the care. Scheduling quality is the level of affordability the plan has with the nurses. If the schedule doesn’t facilitate the nurses’ needs, then there will be no one to provide coverage. Many staff have family and/or off work activities to schedule, and the dependability of our work routine represents the stability that is required to do so.

Though stability is an important factor, our lives always have vacillation’s and vicissitudes. Today’s work scheduling must be flexible enough to accommodate capricious events. Last but certainly not least is cost. In today’s political/fiscal healthcare environment every institution must adjust effectively and appropriately to changing payer policies to survive. Since Labor costs can easily reach forty percent of a hospitals budget, ensuring fiscal viability of the scheduling model is paramount (Ocean, 2009). Staffing an in-Patient Unit Essay Paper


Current Model This unit’s 8/40 five-hour model has very little room for adjusting to changes in patient acuity based demands, requiring a rigid staffing schedule. This does not accommodate the highly important flexibility factor. This model may have a few advantages for staff that live in relatively close proximity to the institution since it provides them a very short day, leaving time for after hour personal activities that typically are within their neighborhood.

However many nurses today travel significant distances (22 to 55 minutes) (ROWS, 2012) to work in institutions that facilitate their needs. This is approximately 41 miles compared to the general average of 12 miles or minutes (Moses, 2012). This makes it very difficult to recruit nurses to replace the deed staff positions that are being filled by very expensive agency nurses, effecting yet another factor, cost. Though this cyclical model does provide stability, it does not make it easy to accommodate flexibility (Ocean, 2009). Staffing an in-Patient Unit Essay Paper

Recommendations Do to the lack of coverage, a discretionary system would provide the flexibility and cost savings that this unit unstable working conditions require (Ocean, 2009). I would recommend a discretionary system, but avoid a staggered start or staggered week modality due to the increased cost and lack of malleability to accommodate the sired 6-8 hours of uninterrupted training for the pending new charting system.

Flexible scheduling systems make the best use of resources; they increase continuity of care, holiday flexibility and teamwork, which boosts unit morale and unity partly because nurses can choose a pattern that works best for them (Ocean, 2009). Flexible scheduling also decreases workload and the need for floating nurses as long as a sound core level of staffing is established and augmented by daily reallocations. Flex scheduling is best adapted to accommodating training time and vacillations in attain demand, which is needed in this institution.

Conclusion This regional hospital is challenged with rectifying its rigid scheduling system to accommodate its lacking coverage, schedule quality to attract nurses willing to commute, excessive budget, and flexibility to accommodate training. A discretionary flexible scheduling system will facilitate the needed upward managerial mobility and staff satisfaction to meet the units objectives through strategic alignment with the crucial five factors of staff scheduling. References Moses, A. (2012). U. S. News. Health. That Long Commute May Be Harming Your Health. Staffing an in-Patient Unit Essay Paper

NURSE STAFFING Nurse Staffing: Does One Size Fit All? Iva Roach Abstract Two major forms of staffing guidelines will be discussed, nurse-to-patient ratio and staffing by acuity. This paper will discuss the history of each staffing form. It will point out the benefits and negative features of both practices, describe how hospitals deal with staffing and discuss the states that have laws requiring certain guidelines be followed. Nurse Staffing: Does One Size Fit All? What is the one conversation that usually gets heated when talking to nurses? Bring up the subject of staffing levels on their unit.

As a nurse assistant, staff nurse, charge nurse or nursing administrator, inadequate staffing creates tension and stress. When staffing is inadequate patient safety, infection rates, patient satisfaction and staff satisfaction are only a few of the areas affected. Many hospital administrators and lawmakers want to make patient care a numbers game. The Joint Commission on Accreditation of Healthcare Organizations requires hospitals to create a staffing plan that defines staffing effectiveness as the skill mix, competence, and effectiveness related to the services needed. Morgan, 2004) When it comes to staffing, one size does not always fit all. Patients are individuals with individual needs and one patient with a certain diagnosis can take much less attention and time from the nurse than a patient of the same age with the same diagnosis. For good nurses the main goals during their shift is giving exception patient care and providing a safe environment. “The notion of high-quality care in hospitals is essential to public safety isn’t new. In 1751 Benjamin Franklin founded America’s first hospital-Pennsylvania Hospital-and commented that patients ultimately suffer and die without sound nursing care. (Clarke, 2003) Nursing leaders are under tremendous pressure to lower costs while improving quality. (Carter, 2004) It is often found that hospitals during low census times or times of budget cuts will try to let ancillary staff go and assign their duties to the nurse caring for the patient. Nurses can replace several other positions in a healthcare setting but no other position can replace the nurse. Nursing is not only a highly trained individual but someone who is called to be compassionate, caring and dedicated individual. Staffing an in-Patient Unit Essay Paper

There are many reasons why staffing by acuity or nurse-to-patient ratios should not be mandated by lawmakers. Direct care nurses should be involved in staffing decision. Outcomes are better when nurses have control of their workload. (Anonymous, 2005) Adequate staffing must be priority for anyone involved in healthcare and there are pros and cons to both staffing by acuity and nurse-to-patient ratios. With our aging population and the increased age of the baby boomer generation nurses are going to increase in demand. Healthcare is changing so quickly and this also affects the shortage.

The average acuity of patients has increased over the last decade while the nursing shortage continues. Nurse-to-patient ratios are supposed to draw people into the filed but there is a shortage of educators at present time as well. Many colleges have long waiting list for nursing programs, yet many nurses only stay in the field for a short time after graduating. Many universities turn away good candidates to nursing programs due to insufficient number of faculty, clinical sites, classroom space, clinical preceptors, and budget constraints. (Allen, 2008) We as a nation must come to a conclusion to deal with the nursing shortage. Staffing an in-Patient Unit Essay Paper

Too many lawmakers are paying attention to the staffing formats suggested above and not doing anything to fix the nursing shortage. Whether by acuity or ratios, for each nurse to take fewer patients we will definitely need more nurses. Staffing by acuity is a format used to decide how many nursing hours are needed for certain diagnosis or types of patients. Typically areas within a healthcare facility where patients are less ill such as rehabilitation and medical-surgical units, nurses can care for as many as seven patients at a time. Their acuity score is much lower than a patient in the intensive care unit or a step-down unit.

Healthcare systems that utilize staffing by acuity are looking at the safe number of certain levels of patients that one nurse can care for. The down side to staffing by acuity is that many feel administration will influence numbers to maintain a high number of patients per nurse. If all patients on a unit were a level eight then most acuity systems would call for three patients to one nurse but if all patients on a unit were all level ones then a nurse could be caring for as many as eight to ten patients. Acuity does not take every patient encounter into consideration.

For instance a dementia patient may have a low acuity based on the nursing care since they usually do not have indwelling lines or invasive procedures. Although the same patient may require a high amount help with activities of daily living, decision making and education. (Walsh, 2003) Thus staffing by acuity can be a subjective form of nurse staffing. When done accurately, acuity based staffing can be very beneficial for the nursing staff. Illinois is one of many states that have implemented laws requiring hospitals to base staffing on acuity systems and then report compliance on a quarterly basis.

Illinois Hospital Association supports acuity based staffing over nurse-to-patient ratios. (Anonymous. 2008) SB867 is a law in Illinois that requires hospitals to base staffing on a model that has been developed by a nursing care committee made up of at least 50% direct care nurses. (Anonymous. 2008) This assures the bedside nurse a significant voice in the staffing process. It allows nurses to base their staffing on the work they perform. The model should include levels of care and examples that fit you patient population. Staffing an in-Patient Unit Essay Paper

At times, nurses will under staff themselves by simply not giving their patients credit for their true acuity level. This law and practice demonstrates hospital’s commitment to their direct nurse staff. Acuity based staffing is believed to take all facts into the picture. Nurses should be trained to develop and use their acuity tool to best describe the patients they are caring for, thus supporting the need for additional staff. Nurse-to-patient ratios are a concept that mandates a certain number of patients for each nurse to care for. Depending on the types of patients being cared for this number can differ.

California has a law requiring nurse-to-patient ratios be following in hospitals. This law was signed in 1999 but was unable to be implemented for another four years. California state guidelines say that medical-surgical patients are one to five and in the intensive care units ratios are one to one. Illinois also has a law up for approval, HB0485 that would mandate ratios. “Establishing a minimum, specific and numerical ratio implies that there is a scientific basis for determining the number of nurses to patients above which good outcomes patients can be guaranteed. ( Flowers, 2009) This law would put even more stringent regulations on hospitals. California has seen many issues related to the ratios law. Ratios can cause longer transfer times for patients, increased ER bypass and postponed elective surgeries. California has experienced 12 hospital closures and downsizing of services since ratios was implemented. Patients are not all alike, their needs are individually different. Nursing units are different and ratios do not take into account the nurse’s level of experience or the physical layout of the facility. Staffing an in-Patient Unit Essay Paper

Many times hospitals will attempt to meet ratio laws by terminating such positions as nurse assistants and environmental services workers. So in reality nurses may only have four patients to care for but they are responsible for total care of those patients. The other strategy hospitals have used to meet ratio guidelines is to replace registered nurses with licensed practical nurses and have only one register nurse on each shift as a charge nurse. Under California law, nurses are considered registered or licensed practical nurses.

HB0485 prohibits this by stating the nurse ratio can only be made up from registered nurses. Supporters of nurse-to-patient ratios believe that these types of laws will recruit more individuals into the field and retain our current nurses. According to CNA President Deborah Burger, the ratio law is a mafor reason why more nurses are coming into California and why RN’s are staying at the bedside. (Anonymous, 2005) The working conditions are believed to be better when a nurse has fewer patients. The environment is considered safer when more nurses are available to care for the patients.

Nurses feel they will have more time for direct patient care and fully evaluate the patient’s needs. Individuals, who support both staffing by acuity and ratios, believe that research is needed to support both ideas. I feel that acuity is the most accurate way to determine safe ratios. At Union County Hospital, where I work, we use our acuity tool to establish a level for each patient. This is nursing staff’s first indicator of needed staffing levels. We also use ratios to staff. Once the acuity is finished the charge nurses takes the acuity of the patients, level of experience of the oncoming shift and also ur staffing matrix into consideration and staffs the next shift appropriately. I did a simple study recently and based on our staffing matrix that the charge nurse can take up to three patients and each additional staff nurse should not routinely take over six patients, we met the staffing matrix 84% of the time. Of that 84%, only 12% of the time did the acuity call for different staffing levels and most of that was that the acuity actually called for less staff. We are a for-profit hospital and as a manager I have to validate our staffing to the CFO on a weekly basis. Staffing an in-Patient Unit Essay Paper

I asked the nurses to accurately and honestly complete the acuity, keep our matrix in their mind, and make the best decision for the patients. I also ask that if there are any circumstances that influenced their decision they should leave note of this on the daily staffing sheet. I think that acuity and ratios complement each other when used together, but one size does not fit all in nurse staffing models. Lawmakers and hospital administrators should not be making these decisions for nurses, the bedside nurse should be able to make an individualized staffing plan for each shift based on the patients on the unit.


References Allen, L. (2008). The Nursing Shortage Continues As Faculty Shortage Grows. Nursing Economics, 26(1), 35-41. Retrieved March 1, 2009, from ProQuest Education Journals database. Anonymous (2005). Schwarenegger flexes muscles on nurses. Australian Nursing Journal, 12(7), 29. Retrieved March 1, 2009, from ProQuest Education Journals database. Anonymous (2005). Ratios: Savior or villain? Australian Nursing Journal, 13(1), 15. Retrieved March 1, 2009, from ProQuest Education Journals database. Anonymous (2008).

Keep Contacting You State Representative To Oppose Nurse Staffing Ratio. Illinois Hospital Associations Position Paper. Retreived Febuary 24, 2009, from http://www. ihatoday. com/issues/workforce/hb392. html Carter, M. (2004). The ABC’s of staffing decisions. Nursing Management, 35(6), 16. Retrieved March 1, 2009, from ProQuest Education Journals database. Clarke, S. (2003). Patient safety series, part 2 of 2: Balancing staffing and safety. Nursing Management, 34(6), 44-48. Retrieved March 1, 2009, from ProQuest Education Journals database. Staffing an in-Patient Unit Essay Paper

Flowers, M. (2009). Nursing Care and Quality Improvement Act HB0485. 96th Illinois General Assembly. Retreived Febuary 24, 2009, from http://www. ilga. gov/legislation/96/HB/09600HB0485. htm. Morgan, S & Tobin, P. (2004). Managing the Nursing Workforce. Nursing Management. Chicago, 35, 4-6. Retrieved March 1, 2009, from ProQuest Education Journals database. Walsh, E. (2003). Get Real With Workload Measurement. Nursing Management. Chicago, 34(2), 38-42. Retrieved March 1, 2009, from ProQuest Education Journals database.

Patient instruction is best when viewed as a personal manner of carry oning interpersonal communicating between two people: the instructor and the scholar. The learning procedure follows a method that should be disposed per instance and per individual. focus oning more on the side of the scholar and the affiliated fortunes. context. and environment. For clinical instruction that is bound by dynamic interrelatednesss and interactions. successful instruction and acquisition requires understanding three things: the scholar. the scholar. and the scholar.

It is best to come up with a patient instruction program that would accommodate the specific instance for a successful processing of the instruction and larning methods. Main Body The instance In a given instance wherein a Latino household. holding low societal economic and instruction position. and one that speaks merely the Spanish linguistic communication. acquires an epilepsy instance on one of the parents’ male kid ( about 10 old ages old ) . extended instruction is chiefly needed to educate the parents and the patient on how to take attention of an epileptic individual. Staffing an in-Patient Unit Essay Paper

With the obvious deficiency of cognition on the child’s disease. it is really obvious that they need to larn what the unwellness is all approximately. how it affects the kid. how it would impact the household. and what they can make to buoy up the effects of the said unwellness. The scheme should be dependent on the given case… taking note of the basic challenges. such as the family’s deficiency of cognition on the disease. their rigidness in footings of linguistic communication. civilization. and instruction. every bit good as the province of the kid being male of Latino civilization.

The basic end should be for the parents ( and the patient ) to understand basically what the unwellness is all approximately. or what they should make during the onslaughts. The scheme The patient instruction program is composed of five basic stairss that should be processed efficaciously: foremost is the assessment phase ; second is the planning phase ; third is the execution phase ; 4th is the checking phase ; 5th and concluding is the rating phase. For the assessment phase. we calculate the communicating degree of the scholars. Staffing an in-Patient Unit Essay Paper

Significant issues have something to make with the ability to read and compose. to understand and to be aware of the said event. It would besides be good to mensurate the degree of willingness or the preparedness to larn. the overall credence. and the basic attitude that they have. These are damaging in planing the scheme that should fit the specific context and instance. Most likely the instance would uncover a not-very-willing attitude. deficiency of motive and credence. and an attack that centers on privateness and confidentiality.

They would most likely choose to undertake the issue in a more private and personal manner. with a demand to go forth their religion and self-importance integral by uncovering that their instance is non really dangerous or really terrible. For the planning phase. we design the things that they would necessitate to cognize. as based on the appraisal of demands that was conducted on the scholars. It is definite that the general information on epilepsy should be included in patient instruction.

Yet. before concentrating on the basic facts about the unwellness. there foremost has to be some talks centered on the undermentioned issues: foremost. the demand for willingness by explicating how the kid severely needs their support ; 2nd. the preparedness to larn by uncovering the things that they can make in order to assist the kid ; 3rd. the overall credence by explicating the general facts about epilepsy ; eventually. a motivated mentality by uncovering to them that people are willing to assist them and their kid in combating over the disease.

Reflecting over the instance. it would be harder to give talks on Latino people without larning how to pass on with them efficaciously. It would be best to happen a nurse or medical employee. who is Spanish-speaking. who has a bosom to assist people. and who speaks efficaciously so as to actuate the scholars more easy. For the execution phase. the information can be sent by agencies of talk. press releases. treatment. or presentation. Staffing an in-Patient Unit Essay Paper

However. because the issue includes methods of handling the kid during paroxysm onslaughts ( e. g. . seting spoon in the oral cavity. keeping or talking calmly to the kid ) . it would be best to utilize methods that are conducted in face-to-face instruction and preparation. It would be best to incite the usage of talks. treatments. and presentations. It is of import. nevertheless. to take a talker who would be able to convey the basic thoughts efficaciously. It is non of import whether the talk finishes in a twenty-four hours. a hebdomad or a month.

What is more of import is that the scholars are able to hold on their mission refering the kid. and that there is nil new or unusual about their holding a ill kid. It would besides be best to include merely the parents during the talk period because the general biological form of the unwellness might scare the kid. The kid can be included. nevertheless. during the treatment period. when the topic is being tackled more lightly ; and during the presentation period. when the focal point displacements to practical methods used in managing the kid.


The checking phase can be conducted hebdomadal during meetings with the doctor. It is of import that the parents and the kid develop a personal bond with both the doctor and the nurse for best intervention of the instance. As for the rating phase. this is done merely temporarily after the processing of patient instruction. In truth. nevertheless. patient instruction should travel on until the clip that the patient is already cured of his or her unwellness. Decision To cover with patients is to cover in a personal manner. Staffing an in-Patient Unit Essay Paper

Given the specific instance. this would likely intend holding to happen ways that would financially assist the household in covering with the challenges. The deficiency of cognition and instruction mean longer and more punctilious methods in implementing the scheme. Being of Latino civilization. male kids are being regarded as the really hope. hereafter. and foundation of the household. In utilizing targeted individualised patient information. we come up with a scheme that is more effectual. suited. and appropriate.Staffing an in-Patient Unit Essay Paper

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