Nursing Department Staffing Plan

Purpose:

The Staffing Plan for Nursing Services reflects specific service needs to meet patient care and organizational needs. Evaluation of department specific needs and staffing requirements is a component of the annual budget process. Nursing Directors/Managers and the Vice President of Nursing include input from continuous improvement projects, patients, families, employees and the Medical Staff when reviewing and updating department specific service needs to provide patient care and manage resources. In addition, the Nursing Practice Staffing Committee will review staffing plans on an annual basis.

Guidelines:

  • The Nursing Staffing Plan has been developed to identify staffing needs based on the following criteria:
  • Patient population
  • Average daily census
  • Length of stay
  • Specialty needs of patient population served/acuity
  • Physical environment and available technology
  • Type of patient care delivered system utilized
  • Skill mix
  • Competencies required
  • Measurable outcomes of nursing care
  • Nationally recognized evidence based standards of nursing practice.

Cross training of personnel and “floating” augments staffing and optimizes resources. Utilization of outside agencies is limited to episodes when other means of staffing have been exhausted. Evaluation is performed within each unit to ensure the skill mix reflects the patient care needs availability of staff, vacancy and budget standards. 

Staff Qualifications:

A. Nursing Department Staff is composed of both licensed and unlicensed personnel.RNs and LPNs shall maintain a current Ohio License that is verified bi-annually. The qualifications and performance expectations for all skill levels including RN, LPN, Ward Clerks, Certified Surgical Techs, Patient Care Technicians, and Midlevel Providers are outlined in hospital policies and Standards of Performance  and as applicable, state law. (see Employee Standards of Performance policy and Job Descriptions)

B. Personnel assigned to patient care shall have completed competency documents (Competency Assessments policy) for that area or be under the supervision of a preceptor.

Core Coverage:

A. The minimum staffing needed for each skill level (RNs, LPNs, Ward Clerks, Certified Surgical Techs, Patient Care Technicians, and Midlevel Providers) is determined by the nurse-patient ratio guidelines and patient care needs. Core coverage staffing plans should be considered guidelines.

B. The minimum staffing levels may be adjusted up or down based on workload assessment, which may include patient acuity, staff skill level, and patient care activities including patient education, procedures, admissions, discharges, and transfers.

Scheduling Limitations:

A. The goal of staffing each nursing unit is to ensure patient safety in healthcare delivery. Nurses are scheduled to provide quality/safe care. The schedules for nursing staff will strive to maintain the budgeted FTE hours.

B. Nurses may be scheduled with approval from their immediate supervisor to work extended or different hours/shifts to ensure patient care is provided. In the case of an emergency, working hours may be also extended to ensure adequate provision of patient care.

C. The maximum number of consecutive hours worked shall not exceed sixteen (16) hours.

Staffing Assessment:

A. Patient care workload and activities can fluctuate and therefore, requires ongoing assessment and planning to assure that adequate and qualified staff is available to meet patient care needs. Therefore, staffing is planned based on average daily census and usual patient acuity.

B. Staffing levels are assessed continuously and adjustments are made for staff assignments based on the needs of the patient. The Nursing Director/Manager/Unit Coordinator, Supervisor or designee completes the assessment prior to the beginning of each shift and staffing adjustments are made to accommodate patient needs.

Staffing Alternatives:

A. Re-assign excess staff, which may be above the minimum staff needed for a specific patient care unit.

B. Schedule available relief staff (PRN) that are unassigned or that can be reassigned.

C. Contact employees that are interested in working.

D. May be requested to adjust regular work hours and/or be asked to rotate shifts during extended low staffing.

If these alternatives are unable to address the staffing needs, the Vice President of Nursing or designee should be contacted to assist in determining other strategies.

Selected Staffing Performance Indicators:

A. The Unit Director/Manager shall regularly review the nursing sensitive indicators (i.e., patient falls, medication variances and/or patient satisfaction surveys) to evaluate the relationship, if any, to its staffing plan and identify yearly the specific indicators they will be measuring.

B. Selected performance indicators that fall below threshold shall cue department leaders to evaluate the data, reviewing factors that may have contributed to the occurrences, including staffing patterns, FTE allocation, skill mix, etc. If the analysis indicates that a staffing problem exists, the Vice President of Nursing and Nursing Directors/Managers may adjust staffing levels to meet patient care needs and monitor.

Selected Staffing Performance Indicators:

A. The written staffing plan will be developed, monitored, evaluated and modified by the Nursing Practice Staffing Committee in conjunction with the Nursing Administrative Team.

B. The Nursing Practice Staffing Committee, to the extent feasible shall:

1. Consist of the Vice President of Nursing and at least 50% of the committee’s membership must consist of registered nurses who provide direct patient care. The RNs included as committee members must be sufficient to provide adequate representation of all types of nursing care services provided in the hospital.

2. Recommend a staffing plan that is consistent with current standards established by accreditation organizations or government entities.

C. Committee Recommendation Requirements (HB 346):

1. The selection, implementation and evaluation of minimum staffing levels for all inpatient care units that ensure that the hospital has a staff of competent nurses with the specialized skills needed to meet patient needs in accordance with evidence-based safe nurse staffing standards. (Department specific staffing plans are located in the individual Scope of Service for each area.)

2. The complexity of complete care, assessment on patient admission, volume of patient admissions, discharges and transfers, evaluation of the progress of a patient’s problems, the amount of time needed or patient education, ongoing physical assessments, planning for a patient’s discharge, assessment after a change in inpatient condition, and assessment of the need for patient referrals.

3. Patient acuity and the number of patients cared for.

4. The need for ongoing assessments of a unit’s patients and its nursing staff levels. 

5. The hospital’s policy for identifying additional nurses who can provide direct patient care when patients; unexpected needs exceed the planned workload for direct care staff.

6. The Vice President of Nursing of the hospital must establish a mechanism for obtaining input from nurses in all inpatient care units who provide direct patient care regarding what should be included in the staffing plan recommendations.

D. Annually the Staffing Plan Committee will:

1. Review how the most current nursing services staffing plan (a) affects the inpatient care outcomes, (b) affects clinical management, and (c) facilitates a delivery system that provides, on a cost-effective basis, quality nursing care consistent with acceptable and prevailing standards of safe nursing care and evidence-based guidelines established by national nursing organizations.

2. Make recommendations, based on the most recent review, regarding how the most current staffing plans should be revised, if at all.

Nursing Practice Staffing Committee:

The act (R.C. 3427.56) requires a hospital to provide copies of its nursing services staffing plan as follows:

1. Free of charge to each member of the hospital’s nursing staff and;

2. For a fee not exceeding actual copying costs to any person who requests a copy.

In a conspicuous location in the hospital, a notice must be posted informing the public of the availability of the staffing plan. The notice must specify the appropriate person, office, or department to be contacted to review or obtain a copy of the plan.

References:

  • A. AACN (American Association of Critical Care Nurses)
  • B. AMSN (Academy of Medical-Surgical Nurses)
  • C. ENA (Emergency Nurses Association)
  • D. AORN (Association of Perioperative Registered Nurses)

Written By: Lori Koethe (VP of Nursing & CNO)
Approved By: 
Nursing Administration, Nursing Practice Staffing Committee
Location: Nursing Administration
Revised: 
05/11/2017
Reviewed: 
06/12/2017
Approved Date: 06/12/2017