UNIVERSITY HOSPITAL AND CLINICAL PROGRAMS

 

PROFESSIONAL NURSING ORGANIZATION

 

POLICY STANDARDS

 

 

ADDENDUM:       H.3

 

EFFECTIVE:         1/86

                     

REVISION:           10/08

 

APPROVAL:       10/08

 

  

SOURCE: Policy Standards, Section H, Utilization of Staff/Staffing

 

SUBJECT:  STAFFING - DAILY ALLOCATION FOR INPATIENT UNITS

  

OBJECTIVES:

  1. To provide appropriate, continuous, safe nursing care for patients

DEFINITIONS:

ADON - Assistant Director of Nursing

CDF - Care Delivery Facilitator

CNO – Chief Nursing Officer

CSM - Clinical Services Manager

Flex Staffing Down - Scheduled regular  staff, due to low census, is flexed down

Flex Staffing Up  - Scheduled regular staff is flexed up due to increase census or acuity

Floating - Temporary reallocation of regular staff, unit assigned PRN staff or prescheduled agency staff from their assigned unit to another unit which is in need of supplemental staff

Low Census Conditions - The unit census is below the projected average daily census. Scheduled regular staff is likely to exceed patient care need.

Regular Staff – Staff permanently assigned to one unit

Sister Units – Units under the management of the same CSM

Staffing Division – Units that are clustered by type of nursing care required:  ICU, Medical/Surgical, Maternal/Infant, BMT

Staffing Matrix - A table based on standard hours of care and census which shows recommended number and type of staff  related to  the census changes.

 

Supplemental Staff - Staff allocated to the units by the Staffing Office to include Float Pool staff, PRN personnel,  agency nursing personnel and personnel floated from another unit

Team Leader – RN assigned to Charge Nurse role on shift to shift basis

POLICY:

  1. The staffing matrix, based on the approved budget, for each unit is developed and managed by the CSM with approval by the CNO.
  2. Shift by shift staffing adjustments based on the staffing matrix, patient acuity and available staff are the responsibility of the CDF/Team Leader in collaboration with the CSM or ADON.
  3. The CDF/Team Leader determines/reviews the unit’s staffing requirements prior to each shift and communicates these to the Staffing Office or ADON.
  4. CDFs/Team Leader within a Staffing Division are to communicate any needs to each other.
  5. Decisions regarding the departmental allocation of all classifications of available staff are the responsibility of the CSM, CDF/Team Leader, and/or ADON who have the authority to reallocate staff when necessary from a unit with lesser to a unit with greater need.
  6. Any change in unit staffing is communicated to the Staffing Office or ADON.
  7. Flex staffing  down
  1. When a low census condition exists on one or more units, decreasing staff normally, when all factors (Examples, but not limited to, skills, experience, orientation, continuity of care, shift length) are equal, is accomplished in the following priority order with consideration for pay issues:
  1. Cancellation of -
  1. Agency overtime
  2. Agency
  3. PRN/hourly overtime
  4. Regular staff overtime
  5. PRN/hourly
  6. Regular staff - volunteers
  1. Offering voluntary options to permanent staff:
  1. Time off with pay (accrued vacation, holiday, compensatory time).
  2. Time off without pay and agrees to work another shift during the same week.
  3. Time off without pay for the shift when the employee has no benefit time or does not desire to utilize benefit time.
  4. ICU RNs placed on-call are expected to come to work should the need arise anytime during their 12-hour shift on which they are on-call.  Call pay will be paid to their individuals.
  5. A roster is maintained on each nursing unit to record floating of regular staff and ensure that it is shared equitably.
  1. Flex staffing  up

1.   When additional staff are needed, increasing staff on a unit normally, when all factors (Examples, but not limited to, skills, experience, orientation, continuity of care, shift length) are equal is accomplished in the following priority order with consideration for pay issues:

a.       Float Pool staff

b.       Non-overtime regular staff

c.       PRN staff non-overtime

d.       Floating- reallocation within Sister Units

e.       Floating – reallocation within Staffing Divisions

f.         Voluntary Regular staff overtime

g.        PRN overtime

h.        Agency

i.          Agency overtime

Floating – Reallocation of Staff

  1. All staff are expected to float as required to provide equitable distribution and appropriate skill mix to meet patient care needs. In some instances a regular staff member may be required to float while there are agency or PRN staff on the unit due to special needs on the receiving unit or agency /PRN staff unfamiliar with the receiving unit.
  2. When low census conditions exist, staff are expected to work where there is need.
  3. Float Pool, PRN and agency normally float first.  PRN pulls are to areas where they are oriented.
  4. A roster is maintained on each nursing unit to record floating of regular staff and ensure that it is shared equitably.
  5. Overtime staff will be considered in the rotation of regular staff to float.
  6. New graduate RNs will not be required to rotate outside of their Sister Units until completion of six months of employment.
  7.  Employees floated to units with which they are unfamiliar are to be given a brief orientation by unit staff to include:
  1. Clock in on assigned unit
  2. Introduction to the CDF, team leader, and unit staff
  3. Review of emergency procedures for that unit
  4. Tour of physical facility and location of supplies and equipment
  5. Assignment to a team “ partner”  for the shift
  1. The assignment is reviewed with the individual by the CDF or team leader. The assignment is determined on the basis of the floated staff’s classification, experience/ skill level and the unit’s needs. Floated staff are to seek supervisory guidance and are not required to independently perform tasks/procedures for which they have not been trained.

I. Staffing Division

  1. Generally staff are to float within their Sister Units, but will be expected to float within their Staffing Division
  1. CUs/Intermediate Care (4E, 6B,4A)
  2. Medical-Surgical (2A, 2B,3A, 3B, 3C,  4B, 4C, 4D, 6C,   6E, 6EP, SSU)
  3. Maternal Infant (5A, 5B, 5C, 5D, 5E)
  4. BMT (7A, 7E)                                                                 
  5. Emergency Department (ED)
  1. Under unusual circumstances, staff may be asked to float to areas outside their Staffing Division. In these instances of critical need, staff will be asked to provide patient care services based on nurse's competencies and skills.

PROCEDURE:

A. Daily Staffing

  1. Actual staff scheduled will be compared to anticipated staff requirements by each CSM or CDF based on the following:
  1. Staffing Matrix
  2. Patient needs/acuity
  3. Skill level of scheduled staff
  4. Other information about the unit
  5. Availability of staff 
  1. CDFs within a Staffing Division are to collaborate regarding staffing needs.
  1. ADONs/Staffing Office are contacted for critical needs that have not been covered.
  2. Prior to flexing staffing down, CDF’s are to contact Staffing Division CDF’s and ADON to discuss available staff. 
  1. The Staffing Office or ADON informs the CDF on the unit that has staff available to float of the following:
  1. Number of staff needed
  2. Classification
  3. Unit(s) needing staff
     
  1. The Charge Nurse of the sending unit:
  1. Determines who is to float according to unit floating records considering:

a.       Whose turn it is in the rotation to float

b.       Skills  and experience required of staff required on the receiving unit

c.        Skills and experience of regular staff available

d.       Skills and experience of staff needed on sending unit

            2.   Informs Staffing Office/ADON who will float for that shift

  1. The Staffing Office/ ADON notifies the Charge Nurse of the receiving unit of the number, classification(s), and sources of staff being sent including pertinent information about skill level/limitations when necessary.
  2. The Charge Nurse of the receiving unit:

1. Determines an appropriate assignment for the floated staff
2. Assigns a team member as a “partner” to serve as a resource and support for that shift
3. Assures that the required orientation to the unit is provided

  1. Floated Staff
  1. Identifies themselves to the Charge Nurse and team leader of the receiving unit
  2. Reviews pertinent skill level/concerns in relation to unit orientation and patient assignment with the CDF or team leader, seeks assistance as needed throughout the shift
  3. Reports any difficulties related to floating to the appropriate Charge Nurse or CSM

 

 

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