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Introduction
I have always been passionate about staffing and scheduling. Passionate that we as nurses and nurse managers do something different. I often think of Albert Einsteins quote: No problem can be solved from the same level of consciousness that created it. How many years and decades have we thought about nurse staffing in the same way? Our profession has evolved greatly over even the last 20 years, so is that reflected in how we staff to care for patients today? There is no magic bullet for solving staffing issues. It will not be found in any one method, including fixed staffing ratios or acuity-based methods; it can be found only in a combination of methods that take into consideration multiple elements. The American Nurses Association (ANA) suggests the following elements should be considered in staffing and scheduling decisions (ANA, 2012a, p. 78): Governance within the setting (shared governance/ leadership) Involvement in quality-measurement activities Quality of work environment Development of comprehensive plans of care Practice environment Architectural geography of unit and organization Evaluation of practice outcomes Available technology Evolving evidence Although many nurses, managers, administrators, unions, and legislators may argue for or against any one element or method, many are not taken into true consideration. Additionally, such components as the role of the advancepractice RN and support services should be considered. If you do not have sufficient staff in those categories on

xv your unit, it can hamper innovation and excellent patient outcomes just as much as inappropriate RN staffing can. As a nurse manager, you staff your unit to take care of the patient and provide the patient with the best outcomes. With staffing, if you want the best patient outcomes, you will need to bring all the pieces together, including the RN, with all the team members and care delivery model. What I want you to learn in this book is how to take into consideration all aspects of the health care team, the meaning and profession of nursing, and the many components of your unit and care delivery model, including how you organize your unit and how technology can lead to satisfied, happy nurses and excellent patient outcomes. There are so many moving parts. Your job, as a manager, is to figure out which parts work, which ones do not, and which ones you need. One size does not fit all in staffing. As you tie this all together, you will need to use your resource-management and workforce-planning skills and knowledge. These are critical components as you manage and plan for your staffing and schedules. To start you thinking, the components of resource management include budgeting, scheduling, daily staffing, and management information (Fralic, 2000). I do not touch much on budgeting with this book, and I instead refer you to the second book in this series, The Nurse Managers Guide to Budgeting & Finance, by Al Rundio, for a great source on budgeting. As the book progresses, I talk about scheduling, daily staffing, and management of information. I also hope you have had the ability to read the first book in this series, The Nurse Managers Guide to Hiring, Firing, & Inspiring, by Vicki Hess. Consider that you may have all the staff you need to have a perfect schedule, but if they are not quality staff, really good nurses and employees, then you will not have committed, great staff ready to work, ready to own the patient-care experience.

xvi As you read this book, in addition to the components already listed, think about the following principles of resource management for your unit (Fralic, 2000): Place the patient first. Limit staff floating. Use data to learn and change. Manage natural variability. Eliminate artificial variability. Control costs. Eliminate wastes. Retain quality staff. Improve quality. Improve safety.

People, or your human resources, are your greatest resource and should be planned for like all other resources. In partnership with resource management, workforce planning may seem overwhelming to think about. Many times people relate workforce planning to the high-level, larger organizations or countrys RN needs for the next 510 years, but it can be as focused as just your units needs for the next year (Bournes, Plummer, Miller, & Ferguson-Pare, 2010). As a matter of fact, you should have an updated plan quarterly. Resource management and workforce planning are important management principles in addition to the other elements that greatly impact your staffing and scheduling.

How This Book Is Organized

Heres the breakdown of the important insights youll gain from the chapters in this book: In Chapter 1, Staffing SMARTT, you will learn what staffing is and why it is important.

xvii Chapter 2, The Current State of Staffing, as its name implies, goes over the current state of staffing, including federal legislation; acuity-, ratio-, and budget-based methods to determining staffing; and the professional organizations role in staffing standards. In Chapter 3, Start With Understanding Your Units Care Delivery Model, I review multiple types of care delivery models and why your care delivery model sets the stage for staffing. In Chapter 4, Maximize the Capacity and Capabilities of Your Nursing Workforce, I discuss the role and potential innovative practice of the RN, LPN/LVN, and unlicensed assistive personnel as well as the legal scope of practice. In Chapter 5, Analyze and Allow Everyone to Fully Practice, I talk about the role and potential of other team members to practice and contribute to staffing and patient outcomes. In Chapter 6, Recognize, Manage, and Maximize Your Variability, I review artificial and natural variability and how you can manage and eliminate issues that create havoc on your staffing and scheduling. In Chapter 7, Target Technology That Improves Staffing and Outcomes, I review and discuss various types of technology and the impacts to budget, staffing, and outcomes. In Chapter 8, Tying All Your Pieces Together, I show how you get your staffing and scheduling numbers as well as methods for dealing with various scheduling issues, such as holidays, vacation, and leave.

xviii Chapter 9, Examples of Staffing Documents and Unique Care Delivery Models, is just that. This chapter is where I give great examples of documents and processes used by others in the real world. The Epilogue highlights some of the most important takeaways from this book. Each chapter in this book offers practical advice, personal experiences, tips, things to consider, and examples. Many of the examples come from RNs who have experience managing a unit or department. Some of these examples are about innovative programs, and others are about things that may not have worked as well as had been hoped. In addition to great shared experiences, you get examples, forms, samples, calculations, and sample processes that can inform your staffing and scheduling processes. You also get a glimpse of my sense of humor, confined by a little professionalism, of course.

A Shift in Thinking
As my graduate students could attest to, I would always tell them that regardless of how many years they have been nurses, they need to put aside what they know unless it was evidence based. Their experiences alone are not sufficient for them to advance their knowledge. Their experiences can bias how they think about something new. Now, was it possible not to be biased, or not to have their experiences still play a part in informing their current ideas and thoughts? No. But what I was able to do most of the time was to get them to incorporate evidence and to think very differently about things. I was looking for a paradigm shift in their thinking. That is what I am looking for from you. I want you to think drastically differently about staffing. Do

xix not just think about how staffing worked or did not when you were a staff nurse. I need you not to think like everyone else about staffing. Remember, no problem can be solved from the same level of consciousness that created it. In the end, my hope is that you learn something useful; that you are able to take what you learn and make a difference in your unit, your staffs work environment; and of course, most importantly, that you are able to positively impact your patients. We owe appropriate staffing to our patients most of all. They have entrusted us with their lives and loved ones. We have been the most trusted profession for more than a decade. Lets not betray that trust; lets not lose that trust.