SARASOTA MEMORIAL HOSPITAL NURSING DEPARTMENT POLICY TITLE: NURSE STAFFING POLICY #: EFFECTIVE DATE: REVISED DATE: POLICY TYPE: PAGE: Job Title of Reviewer: (Administrative) 11/87 3/18 DEPARTMENTAL INTERDEPARTMENTAL DEPARTMENTS PROVIDING NURSING CARE 1 of 6 Executive Director, Organizational Capacity and Patient Throughput PURPOSE: POLICY STATEMENT: To efficiently provide adequate and clinically competent nursing staff in each nursing department, utilizing the concept of decentralized unit staffing, in combination with a centralized Float and Per Diem pool, taking into consideration patient census, patient care needs and nursing personnel abilities and skills Each nursing department will provide adequate and competent nursing staff to deliver patient care. Patient census, patient care needs, the intensity of nursing care required, and nursing personnel abilities and skills will determine patient care assignments. The Staffing Office and/or Nursing Administrative Supervisors will oversee staffing for the hospital and make changes as necessary for optimal staffing coverage. EXCEPTIONS: DEFINITION(S): Surgery Decentralized Staffing: The director and/or clinical manager of each department will be responsible for providing adequate staffing. Intervention Nurses: Are responsible for the performance of diversified nursing functions in emergency or other unpredictable situations. The Intervention Registered Nurse is specially trained to float to any patient care area, for limited periods of time, to meet the varying needs as assessed by the Nursing Administrative Supervisor. Staffing Resources: A core of nursing staff (SMH Float and temporary Per Diem Float) that is assigned daily by the Nursing Administrative Supervisor to nursing departments to assist in care and are competent to perform identified skills. Staffing Office: A centralized area, under the supervision of the manager of Staffing and Scheduling or a Nursing Administrative Supervisor that is responsible for the assessment of staffing needs and assignment of available resources for the inpatient nursing departments.
Page 2 of 6 Staffing Requirements: Staff required to deliver care to a specific patient population on a designated unit. Developed annually by the Department Director and approved by the Chief Nursing Officer. Staffing Plans: Detail of the staffing requirements based upon budgeted nursing hours per patient day, census, patient acuity and care delivery system. Staffing plans are a guideline for utilization of staffing resources and may be adjusted when needed based upon the intensity of nursing care required. API (Centricity): A computerized staffing and scheduling system that is used by inpatient nursing and functions as the database for nursing scheduling information. Specialty Units (ER, OR, LDR, Bayside): A closed unit is a nursing department that will function independently in fulfilling their staffing requirements. Staff in these units will not be required to float out of the department (*except in time of emergency). Staff may be floated in to cover shortages but will only function within their demonstrated level of competency. Requested Absence: Is pre-approved/requested time off PTO, Permission Time. PROCEDURE: 1. SCHEDULES: Pertains to both open and closed units and will be developed in advance and posted on each nursing department. a. The work schedule will be for a minimum of four weeks and posted at least two weeks before the new schedule start date. b. The clinical manager has the authority to adjust schedules to meet anticipated patient care needs. Adjustments will not drop staffing levels below a level that will compromise patient care. c. Schedule changes and requests for time off will be approved by the unit manager or designee and entered into API. d. Individual units will update schedules, as changes to the current schedule occur in order to maintain adequate records of personnel on duty. e. Approval of Paid Time Off (PTO) and holidays is at the discretion of the unit director. (see Vacation Guidelines Policy #126.075) f. Staffing Office will have access to all nursing unit schedules through the computerized personnel scheduling system process.
Page 3 of 6 g. Nursing Councils and interprofessional organizational decisionmaking group members are paid education time. Time off for these meetings will be given priority during the arbitration process. If meetings occur on scheduled work days, notify clinical manager or coordinator in advance to coordinate coverage. 2. DAILY STAFFING PROCEDURES a. The clinical manager or designee will evaluate staffing requirements on a shift by shift and daily basis. 1) Staffing requirements are detailed in each unit s specific plan, posted on the units or available via the computerized staffing system. 2) Staffing requirements are adjusted as needed for the oncoming shift. Units provide schedule notes to Staffing Office at 2:00AM and 2:00PM. Adjustments are made based upon: Unit census; projected admissions and discharges; special patient care needs (i.e. sitters); the intensity of nursing care required; the available resources; and the experience level of the same. b. On a shift-by-shift basis, the Staffing Office and/or the Nursing Administrative Supervisors oversee hospital staffing, assigning float staff as necessary. c. Adjustments due to shortages or overages will involve collaboration between the clinical manager or designee and the Staffing Office/Nursing Administrative Supervisor. d. The clinical manager/designee must always notify the administrative supervisor prior to calling off or sending home staff, to verify that there are no unfilled staffing needs elsewhere*. Noncompliance of the above will result in the Nursing Administrative Supervisor contacting the unit director for resolution. *Exception: Closed units OHR, LDR. e. A Nursing Administrative Supervisor on second and third shifts will assess staffing needs, and adjust when necessary to prioritize optimal staffing for the shift. f. Cross-staffing to a like unit may sometimes be necessary to better ensure coverage of patient care needs. g. For inpatient nursing, sick calls or other unexpected absences are communicated directly to the Staffing Office/Nursing Administrative Supervisor.
Page 4 of 6 h. For covering unexpected absences, the following will be used as a guide: Assign available float pool staff. Cross-staff from another like unit Access core staff who are willing to work an additional shift. Use overtime as a last resort. i. Acute staffing needs experienced during the shift will be communicated to the Nursing Administrative Supervisors for assistance in determining alternate available resources. When communicating these needs, the communicator must outline the specific need. If the situation cannot be resolved by the Nursing Administrative Supervisor, the unit director will be called for final resolution. j. When nursing staff are reassigned to another department, every effort will be made to honor the commitment. In the event of a short notice or acute situation in the sending department, it is ultimately the decision of the Staffing Office/Nursing Administrative Supervisor to facilitate the resolution of the need. k. If the department to which an employee is floated has an unexpected decrease in census or patient care needs, the clinical manager/designee communicator must contact the administrative supervisor for directions as to further placement or option to go home (only if not needed elsewhere). Any time will be costaccounted to the receiving department. 3. STAFFING CAPACITY MANAGEMENT: a. When house-wide patient care requirements are decreased, staffing resources will be decreased as follows: 1) Cancel overtime hours. 2) Cancel Per Diem staff. 3) Cancel seasonal contract. 4) Cancel traveler staff (within contract requirements-maximum of 2 shifts per contract). 5) Offer PTO for authorized time off. b. If projected 24-hour staffing requirements far exceed available resources, the Director of Patient Flow, Clinical Logistics, Observation Services and Departure Lounge or designee may convene a staffing meeting for all patient care directors to review available resources and determine a plan of action to meet anticipated requirements or call a lavender alert (see Patient Flow and Over Capacity Alert Plan Policy #01.PAT.53).
Page 5 of 6 4. INTERDEPARTMENTAL CROSS STAFFING (FLOATING): a. Every effort will be made to cross staff within like units. b. It is expected that all nursing staff will cross staff to any department to assist in the basic care of patients. c. During times of critical staffing needs when it becomes necessary to cross staff outside of a like unit, the assignment will be adjusted to meet validated clinical competencies and experience. d. When inter-departmental floating occurs, the nurse floated will function under the supervision of the clinical manager or a competent registered nurse. 5. FLOAT TEAM AND INTERVENTION NURSES: a. Orientation and cross training will be provided to members of the float staff prior to those staff being expected to competently perform in specialty areas. b. Intervention Nurses will receive orientation and cross training to all areas where advanced skills may be required. c. Orientation and cross training will be provided by a competent registered nurse, educator or advanced practice nurse. d. All checklists pertaining to orientation and cross-training will be kept in the employee file. e. Float team staff and intervention nurses will only perform those skills where competency is validated. RESPONSIBILITY: REFERENCE(S): It will be the responsibility of the Department Director to ensure that staff is aware of, and adhere to this department policy. Code of Federal Regulations. Code 42. 42CFR 48223 (b). FAIR LABOR STANDARDS ACT, Federal Wage and Hour Law. SMH Nursing Department Policy #126.075 Vacation Guidelines for Patient Care Services. SMH: Author. The Joint Commission (current edition). The Joint Commission Comprehensive Accreditation Manual for Hospitals. Retrieved from: https://e-edition.jcinc/frame.aspx REVIEWING AUTHOR(S): Janet Steves, MBA, BSN, RN, Executive Director, Organizational Capacity and Patient Throughput Susan Grimwood, MSN, ARNP-C, Director, Patient Flow, Clinical
Page 6 of 6 Logistics, Observation Services and Departure Lounge Lissett Masucci, MSN, RN, Clinical Manager, Capacity and Flow Resources ATTACHMENT(S): None. APPROVALS: Signatures indicate approval of the new or reviewed/revised policy Date 3/5/18 Janet Steves, Executive Director, Organizational Capacity and Patient Throughput Committee/Sections (if applicable): Vice President/Administrative Director (if applicable): 3/6/18 Connie Andersen, Vice President, Chief Nursing Officer