You are a nurse manager on a large unit that has 14 FTE RNs on staff, 25 FTE LPN
ID: 126196 • Letter: Y
Question
You are a nurse manager on a large unit that has 14 FTE RNs on staff, 25 FTE LPNs, and 15 FTE nursing aids, orderlies, and clerks. The scheduled for the next 2 months is due in administration by next week, and you are beginning to work on it. Various requests have been submitted by personnel for vacations, educational conferences, time to attend a wedding, and long weekends, and a request from one nurse asks not to be rotated to weekend evenings or night because her husband bowls on weekends, and has no babysitter for their young children. Then answer the following questions:
a) What types of additional information do you need to complete this schedule?
b) How do you honor requests as submitted? What if two of the request for vacation came from ENd scheduled to work the same weekends and they both asked for exactly the same days off?
c) How do you inform staff wether their request have been honored? Are they informed by seeing the posted schedule?
d) Are requests taken in the order in which they are received? Or do you have another means of honoring requests?
Explanation / Answer
a) What types of additional information do you need to complete this schedule?
The additional information to be required or collected are:
The average number of patients on flow on the unit:
Identify and analyse the cause of the shortage of health workers: Usually, it is the responsibility of the unit heads to inform the non-availability of staffs in their respective departments. For example, if a therapist in ICU resigns from the unit, then the ICU in charge should communicate this information to the administrator so that another staff is hired during the notice period of the resigned. This method or protocol ensures the continuous availability of therapist (even if someone is resigned) and helps a newly-employed staff to be acquainted, adapted to the hospital and unit routines, protocols and policies. Any deviation(s) in the policies result in problems like shortage of health workers, etc. Rarely, there may instances where multiple therapists may be on leave.
Therefore, it is the responsibility of the administrator to identify the exact cause of short supply of staff at work and to analyse the root cause of this problem by conducting group meeting with in-charges of various departments and with the human resource department.
Patient-staff availability: One of the important information needed and to be collected are the number and the type of patients being admitted to various units (ICU, medical and surgical wards, etc.) at present and the number of staff available. This helps to identify the current staff to patient ratio and to ascertain whether it is at the desired level.
The number of staff currently working at present and in the past: The data regarding the total number of various workers that hospital had earlier and at present is also crucial. This information provides the actual gap in the manpower resources between the present and the required and helps the human resource department to recruit the exact number of staff required.
All the health professionals’ qualification and experience: This information helps the administrator to mobilize resources temporarily so that the quality of care being rendered to a patient does not get compromised.
Possibility of extending staff to patient ratio: Staff to patient ratio is an important determinant of quality and safety of care. Therefore, checking the feasibility of extending this ratio (i.e. a staff is required to take care of many patients than the acceptable or required level) is not advisable and is considered as a last resort. However, the manager must gather this information also to analyse its practicality.
The possibility of extending the shifts by staff: While it is not advisable for health workers to do double shifts, there are often many times where a hospital suffers from inadequate staff and asks/request health workers to work for extended periods of time. For example, in ICU, due to non-availability or lack of RNs, many RNs may be made to work double shifts, thereby providing their patients’ required care without any interference. However, it should be noted that there is also a high probability of committing errors due to fatigue, increased workload, etc. and therefore, the administrator should avoid this intervention at any cost. However, having this information is valuable.
By collecting this information and by conducting team meeting with unit in-charges and with the human resource manager, the nurse manager can initiate and implement measure to reduce the burden of this problem and improve the quality and safety of patient care.
b) How do you honour requests as submitted? What if two of the request for a vacation came from End scheduled to work the same weekends and they both asked for exactly the same days off?
Individual requests would be honoured through careful analysis of the requests and the reason for their proposal. Proposals which are important such as health issues, family commitment, etc would be considered first rather than taking a mere holiday by staff. This is for ensuring high quality of patient care.
In case if there are two same proposals from different staffs [say a day off on the same day] then, the manager must consider the most important one by investigating the reason for the request. If there is no alternative, but to consider giving leave or day off for both of them on the same day then
In every case, extending the work hours beyond the shift timings [double shifts] is not permitted and every possible measure should be implemented to eliminate it.
c) How do you inform staff weather their request has been honored? Are they be informed by seeing the posted schedule?
It is the responsibility of the nurse manager to inform about their proposal whether accepted or denied before scheduling a duty roaster. The mode of communication may be through direct verbal or written communication, or by phone or email and the time of communication must be prior to duty roaster preparation. In case of denial, the appropriate reason for such denial should also be mentioned.
d) Are requests taken in the order in which they are received? Or do you have another means of honouring requests?
It is the responsibility of a good nurse manager to manage staffs’ leave requests and other shift-change requests on a ‘first come first serve basis’. However, some proposals are of prime importance and should be honoured immediately such as a request by a nurse not to post her on weekends due to babysitting.
Therefore, there should be a balance between these two components [first come - first serve basis and important proposals]. Here, each and every proposal should be carefully analysed before any proposal is accepted so that all the requests will be appreciated eventually benefitting both the organization as well as the staff.
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