Staffing Decision 

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Staffing Decision

Staffing Decision
Staffing Decision

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Read the following case-study scenarios and answer the questions that follow in numerical order. APA formatting is not required, except for the reference page. You must use a minimum of 2 references, and you will need to include a reference list in APA format.

Scenario 1: Making Sound Staffing Decisions

You are the staffing coordinator for a small community hospital. It is now 12:30 p.m. and your staffing plan for the 3 p.m. to 11 p.m. shift must be completed no later than 1 p.m. (The union contract stipulates that any “call offs” that must be done for low census must be done at least two hours before the shift begins; otherwise, employees will receive a minimum of four hours of pay.) You do, however, have the prerogative to call off staff for only half a shift (4 hours). If they are needed for the last half of the shift (7 p.m. to 11 p.m.), you must notify them by 5 p.m. tonight. A local outside registry is available for supplemental staff; however, their cost is two and a half times that of your regular staff, so you must use this resource sparingly. Mandatory overtime is also used but only as a last resort.

The current hospital census is 52 patients, although the emergency department (ED) is very busy and has 4 possible patient admissions. There are also 2 patients with confirmed discharge orders and 3 additional potential discharges on the 3 p.m. to 11 p.m. shift. All units have just submitted their PCS calculations for that shift.

You have five units to staff: ICU, pediatrics, obstetrics (includes labor, delivery, and postpartum), medical, and surgical departments. The ICU must be staffed with a minimum of a 1:2 nurse-patient ratio. The pediatric unit is generally staffed at a 1:4 nurse-patient ratio, and the medical and surgical departments at a 1:6 ratio is used in postpartum. On reviewing the staffing, you note the following:


Census = 6. Unit capacity = 8. The PCS shows a current patient acuity level requiring 3.2 staff. One of the potential admissions in the ED is a patient who will need cardiac monitoring. One patient, however, will likely be transferred to the medical unit on the 3 p.m. to 11p.m. shift. Four RNs are assigned for that shift.


Census = 8. Unit capacity = 10. The PCS shows a current acuity level requiring 2.4 staff. There are two RNs and one CNA assigned for the 3 p.m. to 11 p.m. shift. There are no anticipated discharges or transfers.


Census = 6. Unit capacity = 8. Three women are in active labor, and three women are in the postpartum unit with their babies. Two RNs are assigned to the obstetrics department for the

3 p.m. to 11 p.m. shift. There are no in-house staff on that shift that have been cross-trained for this unit.

Medical Floor

Census = 19. Unit capacity = 24. The PCS shows a current acuity level requiring 4.4 staff. There are two RNs, one LPN, and two CNAs assigned for the 3 p.m. to 11 p.m. shift. Three of the potential ED admissions will come to this floor. Two of the potential patient discharges are on this unit.

Surgical Floor

Census = 13. Unit capacity = 18. The PCS shows a current acuity level requiring 3.6 staff. Because of sick calls, you have only one RN and two CNAs assigned for the 3 p.m. to 11p.m. shift. Both confirmed patient discharges as well as one of the potential discharges are from this unit.

Answer the following questions:

  • Which units are overstaffed, and which are understaffed?
  • Of those units that are overstaffed, what will you do with the unneeded staff?
  • How will you staff units that are understaffed? Will outside registry or mandatory overtime methods be used?
  • How did staffing mix and PCS acuity levels factor into your decisions, if at all?
  • What safeguards can you build into the staffing plan for unanticipated admissions or changes in patient acuity during the shift?

Scenario 2: Choosing a Delivery Care Model and Staffing Pattern


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You have been hired as the unit supervisor of the new rehabilitation unit at Memorial Hospital. The hospital decentralizes the responsibility for staffing, but you must adhere to the following constraints:

  1. All staff must be licensed.
  2. The ratio of LPNs/LVNs to RNs is 1:1.
  3. An RN must always be on duty.
  4. You are not counted into the NCH/PPD, but ward clerks are counted.
  5. Your unit capacity is seven patients, and you anticipate a daily average census of six patients.
  6. You may use any mode of patient care organization.

Your patients will be chronic, not acute, but will be admitted for an active 2- to 12-week rehabilitation program. The emphasis will be in returning the patient home with adequate ability to perform activities of daily living. Many other disciplines, including occupational and physical therapy, will be part of the rehabilitation team. A waiting list for the beds is anticipated because this service is needed in your community. You anticipate that most of your patients will have had cerebrovascular accidents, spinal cord injuries, other problems with neurologic deficits, and amputations.

You have hired four full-time RNs and two part-time RNs. The part-time RNs would like to have at least 2 days of work in a 2-week pay period; in return for this work guarantee, they have agreed to cover for most sick days, vacations, and holidays for your regular full-time RN staff.

You also have hired three full-time LPNs/LVNs and two part-time LPNs/LVNs. However, the part-time LPNs/LVNs would like to work at least 3 days per week. You have decided not to hire a ward clerk but to use the pediatric ward clerk for 4 hours each day to assist with various duties. Therefore, you need to calculate the ward clerk’s 4 hours into the total hours worked.

You have researched various types of patient care delivery models (Chapter 14 in textbook) and staffing patterns. Your newly hired staff is willing to experiment with any type of patient care delivery model and staffing pattern that you select.

Answer the following questions:


  • Determine which patient care delivery model and staffing pattern you will use. Explain why and how you made these choices.
  • Next, show a 24-hour and 7-day staffing pattern.
  • Were you able to create a schedule that adhered to the given constraints?
  • Was this a time-consuming process, and if so, why?