MMHA 5500 Week 4 Shift Coverage Model Paper Example

Shift Coverage Model: Licensed Minimums and a Call-Out Ladder for Two Urgent Care Clinics and a Surgery Center

Student Name

Walden University

MMHA 5500: Human Resource Management and Organizational Development and Leadership for Healthcare Administrators

Instructor Name

Month Day, Year

Shift Coverage Model: Licensed Minimums and a Call-Out Ladder for Two Urgent Care Clinics and a Surgery Center

Introduction

The composite Lakeside Outpatient Network runs two extended-hours urgent care clinics, North and South, open from 8 a.m. to 8 p.m. daily, and Lakeside Surgery Center, whose last patient sometimes leaves recovery well after its posted 5 p.m. close. The three sites share one clinical staff pool. This model sets a licensed minimum for every open hour at each site, then lays out a call-out ladder showing who replaces whom when someone calls out, which substitutions a license forbids and what the network's collective agreement lets it require. All schedules and staffing figures are illustrative.

Licensed Minimums

Table 1 sets the minimum staff, by license, that must be present whenever each site is open. Below these numbers, the site does not operate.

Table 1

Minimum Coverage by License, Each Open Hour

Why a Second Nurse in Phase I

The minimum most likely to be questioned is the second licensed nurse at the surgery center whenever a patient remains in phase I recovery after hours. Perianesthesia practice recommendations call for two licensed nurses, one of them a registered nurse competent in phase I care, to be present whenever a patient is in phase I recovery, so that one nurse is never alone with a patient who may need airway support or resuscitation (American Society of PeriAnesthesia Nurses, 2022). During the day, other nurses in the building meet that requirement. After the last case, they may have gone home, which is why the model makes the second nurse explicit and keeps one of the day's nurses until the last phase I patient moves to phase II or is discharged.

The Call-Out Ladder

When a staff member calls out, the site lead works down the ladder in order until the minimum is restored.

Step 1, float pool. The network's float pool includes licensed nurses, medical assistants and one radiology technologist, scheduled to cover gaps across the three sites. The float is sent first.

Step 2, volunteers from the other clinic. If North and South are both open, a volunteer from the less busy clinic may move, provided the sending clinic stays at its minimum.

Step 3, on-call list. Staff on the on-call rotation are called in, under the agreement's call-in terms below.

Step 4, where the ladder stops. Some roles have no licensed substitute. A medical assistant cannot replace a licensed nurse; a licensed practical nurse cannot replace the registered nurse required in phase I recovery; and no one but a radiology technologist can take X-rays. If steps 1 to 3 fail for one of those roles, the site must limit services: an urgent care clinic stops X-ray services and posts that it cannot take injuries needing imaging, and the surgery center does not start a new case that would put a patient in phase I without two licensed nurses available. The model writes these limits down so that no site lead is tempted to substitute an unlicensed person under pressure. National guidance on delegation is clear that licensure, not convenience, determines which tasks a person may perform, and that a registered nurse's assessment and judgment cannot be handed to someone without that license (National Council of State Boards of Nursing, 2016).

Table 2

Substitutions Permitted and Forbidden by License

What the Collective Agreement Allows

The network's collective agreement with its clinical staff sets the terms on which staff can be required to work beyond their schedules. As the scenario supplies them, the relevant clauses state that "employees on the on-call rotation shall report within one hour of being called and shall be paid a minimum of three hours at time and one-half," and that "no employee shall be required to work more than twelve consecutive hours except in an emergency declared by the site administrator." The model uses the on-call rotation as step 3 and assumes the one-hour response time when deciding whether a site can open on time. It does not use mandatory overtime as a routine tool: the twelve-hour limit means a nurse who started at 7 a.m. at the surgery center cannot be kept past 7 p.m. to cover phase I unless the administrator declares an emergency, which the model treats as a rare exception that must be documented.

Using the Model

Each site lead keeps the minimums table and the ladder at the desk, along with the on-call list for the week. Call-outs, the step at which each was covered and any service limits imposed are logged and reviewed monthly by the network's operations director. If the same role repeatedly reaches step 3 or 4 at the same site, the float pool is too small for that role, and the model's next revision should add capacity there rather than rely on on-call staff, whose repeated use carries the agreement's premium pay and risks fatigue. Research on hospital nurses has linked heavier workloads to higher burnout and job dissatisfaction (Aiken et al., 2002), and staff repeatedly called in on their days off are likely to feel the same strain, which makes the on-call rotation itself a retention risk if it is used too often.

References

Aiken, L. H., Clarke, S. P., Sloane, D. M., Sochalski, J., & Silber, J. H. (2002). Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA, 288(16), 1987-1993. https://doi.org/10.1001/jama.288.16.1987

American Society of PeriAnesthesia Nurses. (2022). 2023-2024 perianesthesia nursing standards, practice recommendations and interpretive statements. American Society of PeriAnesthesia Nurses.

National Council of State Boards of Nursing. (2016). National guidelines for nursing delegation. Journal of Nursing Regulation, 7(1), 5-14. https://doi.org/10.1016/S2155-8256(16)31035-3