By Peter Weverka

The nursing shortage has placed an extra burden on every clinic, ward, and hospital unit. Practically speaking, a nurse is too difficult to replace, so clinics and hospitals are going out of their way to retain nurses and see to it that nurses are satisfied with their jobs. Nurses are being given signing bonuses, salary incentives, and tuition reimbursements. Managers are soliciting nurses' opinions and giving them more decision-making power in the workplace.

More than these benefits, however, many nurses want flexible working hours. They want a say in deciding how long they work, what days they work, and which shift they work. Flexible scheduling has added another layer of complexity to the already complex task of scheduling a nursing staff.

How well you schedule your staff affects staff morale and staff retention. It also determines whether you stay within your budget, it figures in your unit's Joint Commission on Accreditation of Healthcare Organizations (JCAHO) evaluation, and most important, it affects the quality of the healthcare you bring to your patients.

For these reasons, nurse managers are giving more consideration than ever before to scheduling shifts and making sure that each shift is properly staffed. Here are a few tips to keep in mind when you schedule your nursing staff.

Identifying your staffing needs

Before you consider how to formulate a schedule, identify your staffing needs. What's the adequate staffing level for the unit or clinic you administer? What's the ideal staffing level? Your goal is to schedule the right combination of nurses for each shift and to deploy your nursing staff in such a way that you don't waste or overextend staff resources.

Here are a few factors to consider as you project and quantify staffing requirements:

• Census estimates   This refers to the number of patients in the unit and how much care each patient requires. You can estimate how many hours of care are needed by multiplying the number of patients by the amount of time each requires on average. The results give you an estimate of how many work hours are needed to fill a shift.
• Acuity   This refers to the level of care that patients need. In an intensive care unit, for example, patients' acuity levels are very high. Some nurse managers assign acuity ratings to patients and use the ratings to help determine staffing requirements.
• Mix of skills   To be properly staffed, each shift requires nurses with the right mix of qualifications. The nurse manager must assemble a team capable of meeting all the patient-care needs of the unit.

Scheduling staff assignments

In the ideal world, all nurses set their own schedules and all shifts are sufficiently staffed with an able array of nurses. As nurse managers know too well, however, some shifts are favored over others, some nurses prefer to work fewer or more than the standard eight hours, and scheduling is always a matter of compromise and accommodation. By keeping in mind these principles, you can make scheduling more employee-centric in your place of work and still fill all your nursing assignments:

• Devise a standard scheduling process.
• Schedule in advance.
• Match staffing resources to staffing needs.
• Keep the budget in mind.

Devise a standard scheduling process

Devise a standard process for staff members to submit their scheduling preferences, and educate staff about how the scheduling process works. With a standardized process, the staff understands that the same scheduling policies apply to all, and there's less haggling about the schedule. You need policies for selecting shifts, choosing vacation times, and swapping shifts, if your clinic or unit permits swapping.

In many clinics and units, managers post a tentative schedule — a schedule subject to final review by management and staff. The tentative schedule can serve as a roundtable for deciding the final schedule.

Schedule in advance

Establishing schedules well in advance gives you plenty of time to negotiate assignments with your staff and come to an equitable agreement about when staff members work. Nurses who want to sign up for extra shifts can look ahead and choose shifts that are unassigned. Scheduling well in advance also cuts down on the number of phone calls that managers have to make to nurses to ask them to fill in at the last minute.

Also, consider converting schedules into HTML documents that can be posted on the Internet. Posting schedules in this way allows employees to view schedules when they're not at work.

Match staffing resources to staffing needs

Each shift requires the right number and mix of properly credentialed staff. To make sure that you bring the right mix of skills to each shift, maintain a profile of each staff member. Include information about the staff member's qualifications and medical certifications, as well as general notes about his or her skills and background. For example, if a nurse speaks a foreign language, make a note of it.

Keep the budget in mind

Calculating the cost of running a shift during the scheduling process is a challenge, especially when employees work overtime. As you formulate the schedule, keep an eye on employees' accumulated hours to make sure that overtime costs don't exceed the limitations of your budget.

On the subject of budgets, instead of using temporary nursing agencies to fill absences, some nurse managers cultivate and recruit a set of temporary and part-time nurses on their own. Paying for agency nurses and per-diem staff is costly and strains the budget.

Getting a fix on the scheduling process

Scheduling a nursing staff means weighing a host of factors. You must take into account patients' needs, nurses' shift preferences and areas of expertise, vacations, overtime, the budget, and other considerations. By establishing scheduling procedures and tracking assignments, you can balance the competing claims that patients and staff make on the scheduling process.

About the author   Peter Weverka is a freelance writer based in San Francisco, California. He has written many computer books as well as articles for various publications, including Harper's Magazine and SPY Magazine.