Nursing Management – Staffing



– is the third phase of the management process.

– In staffing the leader/manager recruits, selects, orients, and promotes personnel development to accomplish the goals of the organization.

– Staffing is an especially important phase of the management process in healthcare organizations because they are labor intensive (i.e., they require many employees to accomplish their goals).

Staffing includes:

1 . Planning for staffing:

– Adequate planning to determine staffing needs is often a neglected part of the staffing process.

– Managers should know the source of their nursing pool, how many students currently enrolled in local nursing schools , staff resignation periods.

2. Recruiting:

– It is the process of actively seeking out or attracting applicants for existing positions.

Recruiting includes:

1. Advertising: in hospitals or journals for job vacancies.

2- Interviewing

– An interview may be defined as verbal interaction between individuals for a particular purpose

– Before interview , all interviewers should review the applications , noting questions concerning information supplied by the applicants


Interview format:

1. introduce self and great applicant.

2. Make a brief statement about the organization and the available position

3. Assert the position for which the person is applying

4. Discuss the information in the application and seek clarification as necessary

5. Discuss employee qualifications and proceed in questions

6. Explain the subsequent procedures for hiring such as physical exam and hiring date

7. If applicant is not hired at this time , discuss how and when he \ she will be notified of the interview results

8. Terminate the interview

If the manager opened well, and the applicant is at ease , the interview will proceed smoothly.

Method that help reach goals of interview:

– Use open-ended questions that require more than yes or no answers

– Pause a few seconds after the applicant has seemingly finished before asking the next question this gives the applicant chance to talk-further

– Ask one question at a time … questions should be clear .

– Do not verbally or non-verbally indicate the correct answer .

– More personal questions should come latter in the interview


3. Selecting:

– Screening job applicants (qualifications, experience) to ensure that the most appropriate candidates are hired.

– Then selecting applicant should have a medical exam … the medical exam is almost universal requirement for hiring … these tests provide a means of determining if the applicant can meet the requirements for job.

– Applicants who are offered position should be requested to confirm in writing their intention to accept the position (sign a contract)


4. Placement:

– Appropriate placement is vital to organizations function and to the new employees success, effectiveness, satisfaction and stability.

– Faulty placement can result in frustration of personal and professional ambition and can result in sacrifice to organizational efficiency and threats to organization integrity.


5. Socialization and orientation:

– New employees should have an orientation to the organizations departments , rules and regulations ,routines and introduction to other staff.

– Orientation period varies between different organizations and it takes one week usually .


Staffing and Scheduling:

– Some health facilities decentralize staffing by having unit managers make schedules, other facilities use centralized stuffing with those schedules being made by single office or stuffing centers.


Decentralized staffing: the manager is responsible for:

1. Covering all scheduled staff absences .

2. Decrease staff during periods of decreased pt. census or acuity .

3. Adding staff during increase number of pt.

4- Preparing monthly unit report .

5- Preparing holidays and vacations schedules.

6- Order all needed supplies stores drugs and equipment….

7- Team assignment .


Decentralized staffing


1- Nurses are more active in planning their own schedules and are able to make personal scheduling requests directly to their immediate supervisor.

2- Decrease nurse attrition.

3- Increase autonomy and flexibility.

4- Increase retention of nurses.


Disadvantages :

1- Unequal treatment, which result in negative staff reaction.

2- Time consuming for manager.

Centralized Staffing:

Health care facilities with centralized staffing use one individual or computer to prepare the staffing and scheduling duties for all department


1. Fairness to employees.

2. Relive head nurses from time-consuming duties and freeing them from other activities.


1. Does not provide much flexibility for nurses .

2. Increase absenteeism, conflict.


Scheduling Options

– Rotating work shifts are common for staff nurses, the frequency of the alternating between days and evenings and nights varies among different organizations .

– Alternating and work shifts rotation creates stress for staff nurses and affect the health of nurses and the quality of their work.


Type of schedules

1. Permanent shifts:

– Relives nurses from stress and health related problems associated with rotating shifts.

– Provide social, educational and psychological advantages.

2. Block or cyclical scheduling:

– use the same schedule repeatedly , every week or every month.

3. Rotating schedules:

– Moving between mornings , and evenings and nights during the week (common in hospitals).


Variable Staffing:

– A method that use pts. needs to determine the number, mix of staff and timing .

– 8-hours shifts in a five day workweek

5-day, 40-hours workweek

The shift usually 7am to 3:30pm, 3pm to 11:30pm, and 11pm to 7:30 am and a half hour overlap time between shifts to provide fro continuity of care.

– 10-hours shifts in Four day workweek

The main problem was fatigue. The long weekends and off were attractions. There is time to finish work, peak work loads can be covered, and there is decreased overtime and decreased costs.

– 12-hours shifts. in seven day workweek

The better use of personnel lower staffing requirements; this consequently lowers the cost per patient day. Fewer communication gaps and better continuity of care. Improved nurse-patient relations, job satisfaction, and morale. Working relations are improved.

Team development is possible. No blames for problems. Total time off is increased, with an increased usefulness fro other duties. Travel time is reduced. Overtime pay has been of some concern.

– Can use 2 hours between shifts as:

7:30-14 / 12-19:30


Staffing to meet fluctuation needs

adjustment to workload

Transfer staff from a less busy area to the overloaded area.

economical to the agency, but disrupts the unity of work groups, causes transferred nurse to feel insecure, and contributes to job dissatisfaction and turnover. Some units require specialized knowledge and skill that not every nurse has (cross training is helpful).

Companion floor system, two units relieve each others.

Float nurse; full time staff nurses who are oriented to many areas and like the challenge of different types of patients and settings. But all of nurse prefer stability.

fulltime staff work a double shift.

Over time.

– part time staff.

– temporary help for the summer to give relief fro vacations.

– External temporary help agencies are available in some areas.

– Mandatory overtime is requiring staff to stay on duty after their scheduled shift ends. Some managers are believe on that using a tired nurse is better than no nurse at all.


Staffing and Assignment

Staffing refers the number and mix of nursing personnel required for nursing unit to provide safe , quality24-hours client care


Staffing is determined by:

1- Number and mix of nursing personnel available

2- Client census

3- Level of client acuity

4- type of nursing care delivery system used


Criteria for making assignment

A- Task related factors:

– The primary task-related concern is that the person assigned to the job has the ability to carry it out.


1- Ability

– Nurses should not to the assigned task they can’t do regardless of their profession level

– to make appropriate assignment you need to know knowledge, skills and job description for each one

– Careful assessment of those characteristics is needed before making assignment.

2. Priority:

– Certain tasks are given priority over others.

3. Efficiency:

– Making procedures in an efficient way, taking in consideration values (cost effect consideration ).

4. Continuity:

– continuity makes a more holistic approach and gives care-givers an opportunity to see the client’s over time.


B. Relationship factors:

1. Fairness:

– Means distributing the work so that no one gets enjoyable tasks, or all the unpleasant ones.

– Fairness also means an equitable amount of consideration for each member including consideration of requests for special assignment, or vacation time and equal sharing of rewards as well as hard work.


2. Learning Opportunities :

– Although the assignment given must be within the capacity of the nurse, another factor to consider is that assignment stimulate motivation and learning.


3. Health:

– The health and well-being of team members are other factors to be considered … certain jobs are very stressful , so team members may need to be rotated through these assignments to keep stress at a tolerable level.

– Another concern is the effect of rotating shifts which disrupts body rhythms and increase fatigue, or special problems which must be considered in making assignments .


4. Compatibility :

– This does not mean that you try to put people who are alike together

– It mean, mixing on this basis of skills chances for sharing and earning from others and can increase the overall efficiency of the team.


5. Preference :

– When they do not conflict with the other criteria for delegating responsibility, the preference of individual team members should also be considered.


How to divide nursing activities?

1. Get complete picture of the whole work load.

a. Obtain a complete report about the pts..

b. Make rounds to the pts..

2. Divide the work load down into smaller units. Be sure that each unit is clearly defined task.

3. Utilize the cardex , chart and report in assessing pts needs and establish priorities.

4. Classify the pts as the following: a. Critically ill pts..

b. Average and stabilized conditions.

c. Under investigations.

5. Decide who will do each unit of the work.

– Assign work according to the abilities needed for each task.

– Assignment should be based on the following criteria:

a. Level of education and qualification.

b. Job description for each level.

c. To be related to the nurse’s past experience.

d. To provide new learning experience.

e. To be within the worker ( nurse) abilities.

f. Should be interesting and provide a sense of satisfaction.

6. Decide when each unit of work will be done.

a. Start work on time.

b. Give priority.

c. Set approximate time limits for each task.

7. Provide the needed equipment and supplies


Assignment technique:

1. Determine if the number of pts. In your ward and their illness state.

2. Check the number of nursing personnel available and their level of education, experience ,abilities and skills.

3. Decide which pts need the most expert care.

4. Decide which nursing care delivery method you will use ( case method functional-primary-team)

– If you have a large number of pts. And an average number of nurses, select the team method because it provides the various abilities and skills of different levels of nursing personnel.

– If you have few very sick pts. And adequate nurses, select the case method the opportunity for nursing education is better and it increases satisfaction.

– If you are in the unfortunate situation, having many pts. And inadequate number of nurses, use the functional method… this allow for completion of essential tasks.

5. Check to see that the entire work is covered.

6. Put your plan in a written form.

7. Post the written assignment in a definite place.

8. Explain orally to each member what his assignment is.

9. Make yourself available to answer any question.

10. Be ready for emergency.

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