Sufficient Staffing Policy

Sufficient Staffing Policy

Effective Date: [Original NPP Date]
Revised Date: [Current Date]

Policy:

Staffing, both in numbers and competency, will be sufficient at all times to ensure the following:

I. An R.N. defines, directs, supervises, and evaluates the care of all residents.
II. Assessment and meeting of resident care needs occur on admission, during the stay, and at discharge.
III. Staff capability is matched to resident needs.
IV. Infection control measures are strictly adhered to in staff assignments.
V. Emergency and safety resident care requirements are met.

Additionally, staffing will be adequate to ensure that nursing staff members can participate in committees, staff meetings, quality improvement, and educational activities as assigned. Adequate resources in the form of support services will be available to allow nursing staff to meet the nursing care needs of residents and their significant others.

Staffing Patterns:

Staffing patterns will be developed at the facility level by the Administrator and DNS based on hours of nursing care to be delivered, average daily census, and acuity level. These staffing patterns are to be approved by Athena senior management, including the Director of Operations, Director of Clinical Services, and Director of Finance.

Effectiveness of Staffing Patterns:

Staffing patterns are evaluated to determine the success of the plan in providing sufficient qualified personnel and effective and efficient delivery of nursing care to residents. This evaluation includes a review of staff-to-resident ratios, direct observation of care, review of quality indicators, review of accident/incidents, review of falls, review of grievance logs, results of quality improvement activities, resident satisfaction surveys, employee satisfaction surveys, and employee turnover rates.

Daily:

The DNS and/or designee is responsible for evaluating staffing on a shift-to-shift basis to ensure adequate staffing to meet the residents’ care needs.

Weekly:

Facility staffing is reviewed weekly by the Administrator and the Athena Director of Finance and the Athena Director of Clinical Services to ensure adequate staffing to meet residents’ needs and budgetary compliance.

Quarterly:

Facility staffing patterns are reviewed quarterly by the CEO, CFO, Director of Operations, Director of Finance, Director of Clinical Services, facility Administrator, and facility DNS to ensure adequate staffing to meet residents’ needs and budgetary compliance. This evaluation of staffing adequacy may result in adjustments being made to the facility’s staffing pattern.

Annually:

Facility staffing patterns are reviewed annually by the CEO, CFO, Director of Operations, Director of Finance, Director of Clinical Services, facility Administrator, and facility DNS to ensure adequate staffing to meet residents’ needs and budgetary compliance. This retrospective evaluation of staffing adequacy allows prospective budgetary planning and possible overall staffing adjustments for the new fiscal period.

Staffing Adjustments:

When the above daily/shift-to-shift evaluation of adequate staffing occurs, staffing may be adjusted to ensure that sufficient numbers/skill mix of qualified staff are available to meet defined resident care needs and/or unusual occurrences.

Situations Requiring Adjustments:

Staffing adjustments may need to be made in the following situations:

I. Actual staffing may be inadequate to meet required resident needs in cases where census is above the budgeted number, acuity is excessive beyond the unit’s hours per resident day, or usual staffing has been reduced due to sick calls, vacations, or other absences. II. Actual staffing may be in excess of required resident needs in cases where census is below the budgeted number or acuity is below the facility’s budgeted hours per resident day.

In all cases of inappropriate staffing, the number of persons on duty as well as the skill mix and competency of each staff member must be taken into account. Changes may involve not only the addition or deletion of personnel but also the changing of the skill mix.

Alternative Staffing Mechanisms:

I. Actual Staffing is Inadequate to Meet Required Resident Needs

1. Internal Staffing Resources:

   • Per Diem Personnel
   • Part-time Employees
   • Use of Overtime
   • Bonus shifts

2. External Staffing Resources:

   • Staff from other Athena facilities
   • Nurse staffing agencies

II. Actual Staffing Is In Excess of Required to Meet Resident’s Needs

1. Staff are requested to take vacation and/or holidays.
2. Staff are offered time off without pay.
3. Staff are assigned to facility projects.

References:

• Centers for Medicare & Medicaid Services. State Operations Manual, Appendix PP - Guidance to Surveyors for Long-Term Care Facilities. [Link to current CMS SOM]
• CMS Requirements of Participation for Long-Term Care Facilities. [Link to current guidelines]