EP - Exemplary Professional Practice

EP9: Staffing and Scheduling Processes-Describe and demonstrate how direct-care nurses participate in staffing and scheduling processes.

Direct-care nurses, throughout the facility, participate in staffing by communicating patient care concerns to their Charge Nurse, Nurse Manager, or the Assistant Director of Nursing (ADN). Direct-care nurses consistently communicate patient status updates to their Charge Nurse. All the patient units such as, Critical Care, Emergency Department, Medical/Surgical, and Telemetry/Pulmonary, have Charge Nurses who are empowered by their Nurse Manager to advocate for staffing changes that will promote appropriate and safe patient care. Although patient updates are communicated throughout the day, as needed, there are specific times when patient updates and safety concerns are discussed. For instance, the Medical/Surgical Departments use nursing staff huddles to communicate pertinent patient and unit information. Prior to the huddles, the incoming Charge Nurse receives the unit handoff from the outgoing Charge Nurse, which includes information on, but is not limited to, patients’ condition, patients’ disposition, and safety concerns. The Medical/Surgical Handoff, as well as the Admission, Discharge, and Transfer tools are valuable instruments, used by the primary and Charge RNs, to gather information for an effective staffing plan. (See Appendix EP9-A for Medical Surgical Handoff and Admission, Discharge, Transfer tools). At the beginning of every shift, the Medical/Surgical nursing staff along with the units’ Charge Nurse shares updated pertinent patient and unit information that can impact nursing assignments. This exchange of updated information, between the Charge Nurse and her nursing staff, is utilized to obtain more nursing staff support when needed.

7 west Medical/Surgical Unit am shift huddle. From left to right: Sonia Villaflor BSN, RN, Parul Christian BSN, RN, Coleen Colero BSN, RN Charge RN, Melissa Rivera, BSN, RN, Marie Jean BSN, RN, and Yvette Bryant MSN, RN

Charge Nurses throughout the facility are empowered to make changes to nursing staff assignments. The Critical Care Charge Nurses conduct patient rounds every shift, with the patient’s primary nurse, in addition to interdisciplinary patient rounds. Patient rounds are conducted with a handoff and staffing assignment tools, which provides the following information:

Patient rounds, with the patients’ primary nurse, provide an opportunity for patient and unit updates that assist in the identification of additional staff support. (See Appendix EP9-B for further information on Critical Care Charge Nurse Handoff and Critical Care Patient Assignment).

Information gathered during rounds is utilized to assist in the management of patient flow and the allocation of nursing staff when needed. Charge Nurses take the initiative to inform the units’ Nurse Manager, Nurse Staffing Office, or the ADN of the units’ staffing need. (See Appendix EP9-C for sample on staffing adjustments made by Nursing Staffing Office). The Nurse Manager, Staffing Office, and the ADN facilitate staffing needs by obtaining the needed nursing staff to provide safe patient care. The Charge Nurses also make patient and unit rounds with their Nurse Managers. These rounds occur daily and are used to update one another on vital information that can impact the delivery of safe patient care and the staffing plan.

Jersey City Medical Center’s nurses fulfill their committed working hours and support the delivery of effective and efficient patient care by self-scheduling their preferred shift work hours to cover the unit. On almost all the patient care units, an empty grid containing the names of staff, their skill level and shift for a four week period is generated from the computer. This grid is utilized as a work sheet which is presented to the staff for them to self-schedule. The master staffing schedule is prepared for a four week period. The finalized schedule must be completed two weeks prior to the start date of the actual schedule. Staff nurses are encouraged to fill in the schedule in accordance with the unit’s needs as well as their own needs. The Nurse Manager also takes into consideration school attendance schedules in order to accommodate nurses who have returned to further their education. The Nurse Manager also accommodates time-off for staff members who are involved in one of the Councils and/or may have projects to complete or requests for an educational conference day. The Nurse Manager reviews the completed work sheet and validates and balances it in order to provide the proper nursing/staff coverage. The completed schedule is entered into the Res-Q staffing application and a finalized schedule is produced and posted in an area where the employees can ascertain their schedule. An example of self-scheduling and Staff Nurse involvement occurs in the Emergency Department (ED). The ED utilizes 12 hour shifts with the exception of the PCTs, who work eight hour shifts. Kim Palestis BSN, RN, Assistant Nurse Manager provides oversight for the scheduling process. A blank grid with the nurses’ names is placed in a centralized area for the nursing staff to access. Ms. Palestis fills in requested vacation time and holidays, which may occur during that four week period. The staff fills in their request directly onto the scheduling grid with the only given that they must fill their obligation to work alternate weekends. They have a two week period to complete their requests. Ms. Palestis, following that two week period, reviews and validates the schedule for appropriate staffing requirements. If requested time off can not be given Ms. Palestis will notify the nurse accordingly. If a particular request is denied the staff has the option to find appropriate coverage for that time period.

6 West is a Medical Surgical Unit that utilizes eight hour shifts for all staff. Clare Cinelli BSN, RN, Nurse Manager places a schedule grid in a centralized place in the staff lounge. Staff is required to work every other weekend, unless they can find appropriate coverage for the requested day. They have a two month time period to determine their days off. They can find appropriate coverage if it is essential that they have that time off. (See Appendix EP9-D for samples of unit schedules).

The Operating Room is a specialized area and staff cannot be floated to work in another area nor can anyone be floated from another area to the Operating Room. It is therefore deemed a “closed unit.” The Operating Room staff has specialized competencies and requires specialized education and training to be deemed competent to work in this area. The Operating Room has additional coverage through a call schedule and requires that two teams take call on evenings, nights, and weekend shifts. One team is considered a trauma team and the second team is an Open Heart call team. We do have in house coverage for all three shifts, as well as weekends. The staff initially volunteers for the call shifts they desire, but they will be assigned if the coverage is not obtained on a rotating basis. (See example of call schedule and regular schedule in Appendix EP9-E).