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Staffing Ch.15 & Ch. 17

By Dr. Ali Saleh

School of Nursing The University of Jordan

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Introduction

• In staffing, the leader manager recruits, selects, places, and indoctrinates personnel to accomplish the goals of the organization

• Staffing is an especially important phase of the management process because such organizations are usually labor intensive

• This large workforce must reflect an appropriate balance of highly skilled, competent professionals to ensure the accomplishment of the organizational goals.

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Sequential Steps in Staffing

1. Determine the number and types of personnel needed to fulfill the philosophy, meet fiscal planning responsibilities, and carry out the chosen patient care delivery system selected by the organization.

2. Recruit, interview, select, and assign personnel based on established job description performance standards.

3. Use organizational resources for induction and orientation.

4. Ascertain that each employee is adequately socialized to organization values and unit norms.

5. Use creative and flexible scheduling based on patient care needs to increase productivity and retention.

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Predicting Staffing Needs

Manager should know: • Sources of nursing pool • No. of nurses in local schools • Length of employment of newly hired nurses • Peak staff resignation periods and times • When the patient census is highest. Must consider: • Patient care delivery system. • Education and knowledge level of needed staff. • Budget constraints • Historical staffing needs and availability • Diversity of the patient population

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Recruitment

• Recruitment is the process of actively seeking out or attracting applicants for existing positions and should be an ongoing process.

• In complex organizations, work must be accomplished by groups of people; therefore, the organization’s ability to meet its goals and objectives relates directly to the quality of its employees.

• Wise leader-managers surround themselves with people of ability, motivation, and promise.

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The Nurse Recruiter

• The manager may be greatly or minimally involved with recruiting, interviewing, and selecting personnel depending on: – The size of the institution. – The existence of a separate personnel department. – The presence of a nurse recruiter within the organization. – The use of centralized or decentralized nursing

management.

• ↑ decentralized Nsg and ↓ complex the personnel department → ↑ involvement of the lower-level manager in selecting personnel

• A collaborative relationship must exist between managers and recruiters.

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The Relationship Between Recruitment and Retention

• Because most recruitment is expensive, health-care organizations often seek less costly means to achieve this goal such as promoting nurses retention – Create healthy work environment

– Promote nurse satisfaction • Some turnover is normal

– It infuses the organization with fresh ideas and reduces the probability of groupthink.

• Excessive turnover → – ↓ organization productivity – ↑ cost: advertising, interviewing, recruitment fees, ↑

use of overtime, part time nurses, training nurses.

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The Initial Contact

• Many prospective employees will make their first contact with an organization through the Human Resources Department or the recruiter.

• Generally, these employees are directed to complete an application and set up an appointment for an interview.

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Interviewing as a Selection Tool

• An interview may be defined as a verbal interaction between individuals for a particular purpose.

• Although other tools such as testing and reference checks may be used, the interview is frequently accepted as the foundation for hiring, despite its well-known limitations in terms of reliability and validity.

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Interviewing

Purposes of the Selection Interview The interviewer seeks to obtain enough information

to determine the applicant’s suitability for the available position.

The applicant seeks to obtain adequate information to make an intelligent decision about accepting the job, should it be offered.

The interviewer seeks to conduct the interview in such a manner that, regardless of the interview’s result, the applicant will continue to have respect for and goodwill toward the organization.

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Types of the Interviews

• The unstructured interview requires little planning because the goals for hiring may be unclear, questions are not prepared in advance, and often, the interviewer does more talking than the applicant.

• Semistructured interviews require some planning because the flow is focused and directed at major topic areas.

• The structured interview requires greater planning time, yet because questions must be developed in advance that address the specific job requirements, information must be offered about the skills and qualities being sought.

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Limitations of Interviews

• The major defect of the hiring interview is subjectivity • The validity and reliability of interviews vary:

– The intrarater reliability is said to be high (The same interviewer will consistently rate the interviewee the same)

– Interrater reliability is extremely low in unstructured interviews (If two different interviewers conduct unstructured interviews of the same applicant, their ratings will not be consistent)

– Interrater reliability is better if the interview is structured and the same format is used by both interviewers.

– The experience of the interviewer has little relationship to reliability and validity

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Limitations of Interviews

• Even if the interview has reliability (i.e., it measures the same thing consistently), it still may not be valid.

• Validity occurs when the interview measures what it is supposed to measure, which in this case, is the potential for productivity as an employee.

• Structured interviews have greater validity than unstructured interviews and thus should be better predictor of job performance and overall effectiveness than unstructured interviews.

• High interview assessments are not related to subsequent high-level job performance.

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Limitations of Interviews

• Validity increases when there is a team approach to the interview.

• Although steps can be taken to reduce subjectivity, it cannot be eliminated entirely.

• Negative information is weighed more heavily than positive information about the applicant.

• Decisions about hiring applicants are often formed in the first few minutes of the interview.

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Limitations of Interviews

• In unstructured interviews, the interviewer tends to do most of the talking, whereas in structured interviews, the interviewer talks less.

• The environment is artificial and it is difficult for many interviewees to relax and be natural.

• The interviewer may have poor communication skills and be unable to generate a discussion.

• Physical appearance often contributes substantially to an interviewer’s opinion about an applicant.

• Interviewers frequently ask questions that demonstrate a self-fulfilling prophecy regarding their first impression of the applicant.

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Overcoming Interview Limitations

• Use a Team Approach

• Develop a Structured Interview Format for Each Job Classification.

• Use Scenarios to Determine Decision-making Ability.

• Conduct Multiple Interviews

• Provide Training in Effective Interviewing Techniques

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Planning, Conducting, and Controlling the Interview

1. Introduce yourself and greet the applicant.

2. Make a brief statement about the organization and the available positions.

3. Clarify the position for which the person is applying.

4. Discuss the information on the application and seek clarification or amplification as necessary.

5. Discuss employee qualifications and proceed with the structured interview format.

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Planning, Conducting, and Controlling the Interview

6. If the applicant appears qualified, discuss the organization and the position further.

7. Explain the subsequent procedures for hiring, such as employment physicals, and hiring date. If the applicant is not hired at this time, discuss how and when he or she will be notified of the interview results.

8. Terminate the interview.

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Evaluation of the Interview

• Interviewers should plan post-interview time to evaluate the applicant’s interview performance.

• Interview notes should be reviewed as soon as possible and necessary points clarified or amplified.

• The final question on the interview evaluation report form is a recommendation for or against hiring. In answering this question, two aspects must carry the most weight: – The requirements for the job – Personal bias.

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Tips for the Interviewee

• Prepare in advance for the interview • Review the philosophy and organization chart of the

organization • Schedule an appointment for the interview • Dress professionally and conservatively • Practice responses to potential interview questions in

advance • Arrive early on the day of the interview. • Greet the interviewer formally and do not sit down before

the interviewer does unless given permission to do so • Shake the interviewer’s hand upon entering the room and

smile (smile reduce anxiety) • Maintain eye contact throughout the interview

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Tips for the Interviewee

• During the interview, sit quietly, be attentive, and take notes only if absolutely necessary

• Do not chew gum; fidget; slouch; or play with your hair, keys, or writing pen

• Ask appropriate questions about the organization or the specific job for which you are applying

• Avoid a “what can you do for me?’’ approach and focus instead on whether your unique talents and interests are a fit with the organization

• Answer interview questions as honestly and confidently as possible

• Shake the interviewer’s hand at the close of the interview and thank him or her for his or her time

• Send a brief, typed thank-you note to the interviewer within 24 hours of the interview

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Sample Structured Interview

Specific Questions for RNs

• What do you like most about nursing?

• What do you like least about nursing?

• What is your philosophy of nursing?

Personal Characteristics

• Which personal characteristics are your greatest assets?

• Which personal characteristics cause you the most difficulty?

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Sample Structured Interview

Professional Goals

• What are your career goals? • Where do you see yourself 10 years from now?

Contributions to Organization

• What can you offer this company?

Questions from Interviewee

• What questions do you have about the organization? • What questions do you have about the position? • What other questions do you have?

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Selection

• Selection is the process of choosing from among applicants the best qualified individual or individuals for a particular job or position. – Interview Evaluation

– Educational and Credential Requirements

– Reference Checks and Background Screening

– Preemployment Testing

– Physical Examination

– Making the Selection

– Finalizing the Selection

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Placement

• The smart leader is able to assign a new employee to a position within his or her sphere of authority, where the employee will have a reasonable chance for success

Faulty placement: – ↓ organizational efficiency

– ↑ attrition (erosion)

– Threats to organizational integrity

– Frustration of personal and professional ambitions

Proper placement: – Fosters personal growth

– Motivating climate for the employee

– Maximizes productivity

– ↑ probability of achieving organizational goals

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Indoctrination

• Indoctrination refers to the planned, guided adjustment of an employee to the organization and the work environment.

• Includes three separate phases – Induction – Orientation – Socialization

• It seeks to: – Establish favorable employee attitudes toward the

organization, unit, and department – Provide the necessary information and education for

success in the position – Instill a feeling of belonging and acceptance.

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Induction

• Induction: the first phase of indoctrination, takes place after the employee has been selected but before performing the job role.

• The induction process includes all activities that educate the new employee about: – The organization and employment

– Personnel policies and procedures.

• Employee handbooks, an important part of induction, are usually developed by the personnel department

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Orientation

• Induction provides the employee with general information about the organization, whereas orientation activities are more specific for the position. For example: • The first phase: could be conducted by the

hospital’s personnel department.

• The second phase: could take place in the staff development department.

• The third phase: would be the individual orientation for each department

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Socialization

• Socialization refers to a learning of the behaviors that accompany each role by instruction, observation, and trial and error

• Responsibility for socializing employees:

– The leader-manager

– the education department

– other employees in the organization

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Staffing Needs and Scheduling Policies (Ch. 17)

By Dr. Ali Saleh

School of Nursing The University of Jordan

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Introduction

• Managers must be certain that adequate numbers and an appropriate mix of personnel are available to meet unit needs and organizational goals

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Decentralized Staffing

• Unit managers make scheduling decisions

• Covering staff absences

• Reducing or adding staff according to patient census or acuity

• Preparing monthly unit schedules

• Preparing holiday and vacation schedules

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Decentralized Staffing

Advantages • Manager understands the needs of the unit and staff

intimately • Nurses take personal scheduling requests • Increased autonomy and flexibility → ↓nurse attrition.

Disadvantages • Risk that employees will be treated unequally or

inconsistently • Manager may be granting rewards or punishments

through the staffing schedule. • Time consuming for the manager

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Centralized Staffing

• Staffing decisions are made by personnel in a central office or staffing center.

• Manager’s role is limited to making minor adjustments and providing input.

Advantages

– Fairer to all employees – Frees the middle-level manager to complete other functions – Most efficient (cost effective) use of resources

Disadvantages

– Does not provide as much flexibility for the worker – Managers may be less responsive to personnel budget

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Complying with Staffing Mandates

• Imposing mandatory licensed staffing requirements by government.

• To comply with the minimum staffing ratios such as critical care unit nurse to patient ratio 1:2.

• Was established to: – Improve patient safety

– To ensure that care provided is at least safe and hopefully more

– Improve quality of care – Improve nurse work environment

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Staffing and Scheduling Options

1. Twelve-hour shifts • Extending the length of shifts may result in:

– Increased judgment errors as nurses become fatigued – Lower quality of care – Worse patient safety reports – More care left undone. – Nurse burnout

• Also may results in: – A higher level of satisfaction – An improved work/life balance – less overtime and use of agency nurses – A solution for difficulties with child care – Reduced stress and increased both work continuity and

accountability

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Staffing and Scheduling Options

2. Using of agency nurses or travel nurses (external supplemental nurses) or float pools (internal supplemental nurses) – Expensive

– Poor continuity of care

– Insufficient work setting familiarity and inadequate orientation of these nurses, which in turn affects job performance

3. Flextime is a system that allows employees to select the time schedules that best meet their personal needs while still meeting work responsibilities – Difficult for the manager to coordinate

– Overstaffing

– Understaffing

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Staffing and Scheduling Options

4. Self-scheduling allows nurses in a unit to work together to construct their own schedules – Manager make sure all guidelines have been met – Not easy to implement – Depends on the leadership skills of the manager – Requires greater worker involvement and

management flexibility – ↑worker participation in decision making – Saves management time – Improves morale and professionalism – Reduces personnel turnover

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Workload Measurement Tools

• NCH/PPD = Nursing Hours Worked in 24 Hours/ Patient Census

• Patient classification systems (PCS), (workload management, patient acuity tools): group patients according to specific characteristics that measure acuity of illness (unique for institution). – Critical indicator PCS: broad indicators such as

bathing, diet, intravenous fluids… – The summative task: requires the nurse to note the

frequency of occurrence of specific activities, treatments, and procedures for each patient

• Hours of nursing care must be assigned for each patient classification 40

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Workload Measurement Tools

Workload measurement systems:

• Evaluates work performance as well as necessary resource levels.

• Capture census data, care hours, patient acuity, and patient activities.

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Nursing Care Hours, Staffing Mix, and Quality Of Care

• ↓RN hours in NCH/PPD →

– ↑adverse pt outcomes including; ↑ drug errors and pt falls

– ↓ pt satisfaction with pain.

• Decrease staffing level may lead to negative effect on quality

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The Impact of a Shortage of Nursing Staff Upon Staffing

Long term solutions: • Advanced planning and recruitment • Cross-training: giving personnel with varying

educational backgrounds and expertise the skills necessary to take on tasks normally outside their scope of work.

Short term solutions: • Closed-unit staffing occurs when the staff members on

a unit make a commitment to cover all absences and needed extra help.

• Mandatory overtime: employees are forced to work additional shifts.

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