Alternative staffing patterns.

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As a long-term care administrator, this writer wonders why one day follows another with problems, problems, problems. As I solve an acute problem regarding an admission, the chronic problem of staffing again is brought to my desk, demanding a solution immediately. My nursing and dietary staffing patterns are in place. I know how many nursing and dietary staff hours per resident that I plan to provide. Then, why does this "headache" require so much of my time? Is it because the proposed written staffing patterns do not reflect daily reality?

Staffing patterns in LTC facilities are a top priority in assuring a successful operation. The quality care of the residents depends on balanced staffing. Employee retention and satisfaction are realized when staff ing is stabilized. The profit and loss balance sheet reflects the status of the staffing pattern and the degree of ongoing adjustment based on census and residents' needs.

If there were no variables in providing the service of long-term care, a master staffing pattern would suffice. The number of times that illnesses, vacations, and terminations affect the prescheduled staffing pattern is chronically frequent. Admissions and discharges of residents are a constant variable in staffing schedules. The merit of prescheduling on a four- to six-week basis is acknowledged, but prescheduling is just the fundamental baseline in staffing and planning. Prescheduling addresses anticipated needs, but lacks the actual shift-to-shift, day-to-day pattern of needs. With the four- to six-week schedule, you are estimating each day's census, the mental/physical acuity level of the residents, and the staff's total compliance with the schedule. That data provides the hoped-for results of quality care, but does not address the track record for each day of providing service.

To ensure that you are providing the actual required staff hours per resident per 24 hours, computing the hours daily is necessity. There are days when a study of the staffing is necessary to conduct during each shift - because of unexpected admissions, discharges, and absenteeism of staff personnel. The time and effort re ired to measure the staff hours is paid back tenfold by the increased efficiency of the overall operation. You are on top of what actually is occurring in your facility and know the level of quality care that you are providing.

A possible scenario is shown in Table 1. The resident census in an intermediate facility is 95 out of a possible 100 census. The nursing hours provided on the day, evening, and night shifts for the specific 24 hours are totaled. The total number of nursing hours is divided by the number of residents (95). The sum equals the number of nursing hours provided for each resident. If the total nursing hours are recorded on the nursing staff assignment form, a daily data can be compared. A study of the daily data will reveal ...