Staffing Decisions
You are the staffing coordinator for a small community hospital. It is now 12:30 PM, and your staffing plan for the 3 PM to 11 PM shift must be completed no later than 1 PM. (The union contract stipulates that any “call offs” that must be done for low census must be done at least 2 hours before the shift begins; otherwise, employees will receive a minimum of 4 hours of pay.) You do, however, have the prerogative to call off staff for only half a shift (4 hours). If they are needed for the last half of the shift (7 PM to 11 PM), you must notify them by 5 PM tonight. A local outside registry is available for supplemental staff; however, their cost is two and a half times that of your regular staff, so you must use this resource sparingly. Mandatory overtime is also used but only as a last resort.
The cu
ent hospital census is 52 patients, although the emergency department (ED) is very busy and has 4 possible patient admissions. There are also two patients with confirmed discharge orders and three additional potential discharges on the 3 PM to 11 PM shift. All units have just submitted their PCS calculations for that shift.
You have five units to staff: the ICU, pediatrics, obstetrics (includes labor, delivery, and postpartum), medical, and surgical departments. The ICU must be staffed with a minimum of a 1:2 nurse–patient ratio. The pediatric unit is generally staffed at a 1:4 nurse–patient ratio and the medical and surgical departments at a 1:6 ratio. In obstetrics, a 1:2 ratio is used for labor and delivery, and a 1:6 ratio is used in postpartum. On reviewing the staffing, you note the following:
ICU
Census = 6. Unit capacity = 8. The PCS shows a cu
ent patient acuity level requiring 3.2 staff. One of the potential admissions in the ED is a patient who will need cardiac monitoring. One patient, however, will likely be transfe
ed to the medical unit on 3 PM to 11 PM shift. Four RNs are assigned for that shift.
Pediatrics
Census = 8. Unit capacity = 10. The PCS shows a cu
ent acuity level requiring 2.4 staff. There are two RNs and one CNA assigned for the 3 PM to 11 PM shift. There are no anticipated discharges or transfers.
Obstetrics
Census = 6. Unit capacity = 8. Three women are in active labor, and three women are in the postpartum unit with their babies. Two RNs are assigned to the obstetrics department for the 3 PM to 11 PM shift. There are no in-house staff on that shift that have been cross-trained for this unit.
Medical Floor
Census = 19. Unit capacity = 24. The PCS shows a cu
ent acuity level requiring 4.4 staff. There are two RNs, one LVN, and two CNA assigned for the 3 PM to 11 PM shift. Three of the potential ED admissions will come to this floor. Two of the potential patient discharges are on this unit.
Surgical Floor
Census = 13. Unit capacity = 18. The PCS shows a cu
ent acuity level requiring 3.6 staff. Because of sick calls, you have only one RN and two CNAs assigned for the 3 PM to 11 PM shift. Both confirmed patient discharges as well as one of the potential discharges are from this unit.
ASSIGNMENT:
Answer the following questions:
Which units are overstaffed, and which are understaffed?
Of those units that are overstaffed, what will you do with the unneeded staff?
How will you staff units that are understaffed?
Will outside registry or mandatory overtime methods be used?
How did staffing mix and PCS acuity levels factor into your decisions, if at all?
What safeguards can you build into the staffing plan for unanticipated admissions or changes in patient acuity during the shift?