DDHA 8203 Week 5 Staffing Plan Example

Staffed for the Monday Day Shift, Not the Average One: A Telemetry Unit Staffing Plan With Its Relief Factor Opened Up and One 5:45 a.m. Call-Out Worked Through

Student Name

Walden University

DDHA 8203: Advanced Healthcare Operations Management

Instructor Name

Month Day, Year

Staffed for the Monday Day Shift, Not the Average One: A Telemetry Unit Staffing Plan With Its Relief Factor Opened Up and One 5:45 a.m. Call-Out Worked Through

The Unit and the Problem the Plan Solves

The plan covers 5 West, the 32-bed telemetry unit of a composite community hospital I will call Cedar Mill Medical Center. The unit's current roster was built from its average daily census of 27 and its average workload, and it fails in a predictable way. On Monday and Tuesday day shifts, when weekend admissions meet the week's first discharges and cardiac catheterization returns, the unit routinely runs short, the charge nurse takes a patient assignment, and the incident log shows a cluster of late medication doses and missed telemetry alarm reviews. This plan staffs the unit against its heaviest shift rather than its typical one, specifies skill mix by hour, shows how the relief factor was built and works one realistic failure through to a decision.

The case for building against the heavy shift rests on evidence about what thin shifts do. Needleman et al. (2011) found that inpatients exposed to shifts staffed well below target, and to shifts with unusually high admission, discharge and transfer activity, had a higher risk of death. Griffiths et al. (2019) reported a similar pattern in English hospitals, where patients' risk of death rose with days spent on wards staffed with registered nurses below their usual level. An average-based roster creates exactly those shifts, on a schedule anyone could predict.

The Workload Measure

Coverage is calculated from patients per registered nurse, adjusted for turnover. The unit's baseline ratio is one nurse to four patients, consistent with its acuity scores and with the hospital's staffing committee guidelines. A turnover adjustment then adds one nurse for any day shift with eight or more admissions, discharges and transfers combined, since each movement takes a nurse away from her patients for about 45 minutes. Six months of unit data show that Monday and Tuesday day shifts exceed that threshold on 85% of weeks, while no other shift exceeds it more than a quarter of the time. That is why those two shifts carry an extra nurse in the grid.

Shift-by-Shift Coverage and Skill Mix

Skill mix is stated rather than implied. Between 07:00 and 11:00 on weekdays, the unit receives patients from the catheterization laboratory and manages most of its heparin and antiarrhythmic infusions, so at least four day-shift nurses must have two or more years of telemetry experience and current competency for cardiac infusions. Nights require at least three such nurses, because the unit has no resource nurse after 19:00 and the rapid response team serves the whole hospital. New graduates in their first year are never scheduled as more than two of the day nurses on Monday or Tuesday.

Table 1

Registered Nurse Positions per Shift, Two-Week Cycle (Both Weeks Identical)

Day charge nurses carry no patient assignment; night charge nurses carry up to three patients. Each shift also has a monitor technician and two or three patient care technicians, not counted here.

The Relief Factor, With Its Parts Shown

A position is not a person. Each position that must be filled every shift requires more than one full-time equivalent, because staff take leave, call in sick, orient and attend required education. The relief factor converts positions into people, and it should be visible so that each part can be challenged.

Orientation is the weakest number in the table. It depends on how many nurses leave, which the plan cannot know in advance, and it is labeled as an assumption for that reason. If turnover rises to 18%, orientation time roughly doubles and the relief factor rises to about 1.24.

Table 2

Components of the Relief Factor for 5 West

The relief factor is 1 divided by (1 minus 0.175), or about 1.21.

From Positions to People

The grid requires 126 day-shift nurse positions and 112 night-shift positions over a two-week cycle, counting charge nurses, which comes to 2,856 registered nurse hours. Over a year that is about 74,300 productive hours, or roughly 35.7 full-time equivalents, taking a paid year as 2,080 hours. Applying the relief factor of 1.21 gives a staffing requirement of about 43.2 registered nurse full-time equivalents. The unit currently budgets 41.8, built on the old roster and an older relief factor of 1.19. The plan therefore asks for 1.4 additional full-time equivalents: about 0.7 to fund the extra Monday and Tuesday day nurse with the leave that position generates, and about 0.7 because the old relief factor understated unscheduled absence.

Kane et al. (2007), in a meta-analysis of registered nurse staffing and patient outcomes, found that higher staffing was associated with lower rates of hospital-related mortality and adverse events, with the associations stronger in intensive care and surgical patients. Their analysis supports the direction of the request but not its exact size, which comes from this unit's own data.

Contingency: One Call-Out at 5:45 on a Monday

The plan is tested against its most likely failure. At 5:45 on a Monday, one day nurse calls out sick. The shift is the heaviest of the week, so losing one nurse returns the unit to the staffing level the plan was written to replace. Three responses are available.

The first is to request a nurse from the hospital float pool. The float pool costs nothing extra, but in the past six months it filled only about 60% of Monday requests before 07:30, because every medical unit makes the same request on the same morning. The second is for the charge nurse to take a patient assignment. This costs nothing either, but it removes the one person coordinating catheterization returns, discharges and alarm review on the busiest shift, which is the exact condition the incident log ties to late doses. The third is to call a nurse from the unit's incentive list, which pays time and a half for a short-notice shift.

The plan commits to a sequence: a float pool request at 5:45 and, if no float nurse is confirmed by 6:15, a call to the incentive list. The charge nurse does not take an assignment on Monday or Tuesday day shifts under any circumstances. At the unit's average rate of $62 per hour, an incentive shift costs $1,116 against $744 for a regular one, a premium of $372. Payroll data show about two short-notice gaps a month on those shifts, and the float pool would cover more than half of them, so the expected annual premium is roughly $3,600. That figure is small beside the cost of one serious medication event, and the plan states it so that the finance partner can see what is being bought.

Limits of the Plan

The grid assumes that census and turnover patterns will look like the last six months. The relief factor depends on a turnover assumption. The incentive list works only if enough nurses are willing to take short-notice shifts, which the unit should review every quarter. Finally, the plan sets positions, not names; a schedule that meets the grid with too many first-year nurses on a Monday would still fail the skill-mix rule.

Conclusion

Staffed against the Monday and Tuesday day shifts, with a relief factor of 1.21 built from four visible components, 5 West needs about 43.2 registered nurse full-time equivalents, 1.4 more than it budgets now. When a nurse calls out at the start of the heaviest shift, the plan protects the charge nurse's role and pays an incentive premium of about $372 for the shift. The request is modest because it is aimed at the two shifts that are short every week, not at the average shift that rarely is.

References

Griffiths, P., Maruotti, A., Recio Saucedo, A., Redfern, O. C., Ball, J. E., Briggs, J., Dall'Ora, C., Schmidt, P. E., & Smith, G. B. (2019). Nurse staffing, nursing assistants and hospital mortality: Retrospective longitudinal cohort study. BMJ Quality & Safety, 28(8), 609-617. https://doi.org/10.1136/bmjqs-2018-008043

Kane, R. L., Shamliyan, T. A., Mueller, C., Duval, S., & Wilt, T. J. (2007). The association of registered nurse staffing levels and patient outcomes: Systematic review and meta-analysis. Medical Care, 45(12), 1195-1204. https://doi.org/10.1097/MLR.0b013e3181468ca3

Needleman, J., Buerhaus, P., Pankratz, V. S., Leibson, C. L., Stevens, S. R., & Harris, M. (2011). Nurse staffing and inpatient hospital mortality. New England Journal of Medicine, 364(11), 1037-1045. https://doi.org/10.1056/NEJMsa1001025