Safe and effective nursing care is dependent upon the knowledge and expertise of staff, patient status, amount of nursing time, delivery model, and organizational support. This chapter explores how staffing plans are developed and evaluated. Additionally, different models of delivery are reviewed that apply to a variety of environments and patient populations.

There are key definitions that are used when staffing plans are developed. These definitions include:
? full-time equivalent (FTE) – measure of work commitment of a fulltime employee
? productive and nonproductive hours – staff time available to work and benefit time, such as, sick, vacation, and so forth.
? direct and indirect care – time spent on activities directly related and indirectly related to patient care
? nursing hours per patient day (NHPPD) – standard measure that quantities nursing time available for each patient by staff

Patient classification systems (PCS) are measurement tools used to define the nursing workload for specific patient populations. Patient acuity systems have been further developed to determine workload per individual patient. These systems help predict the amount of nursing time required for planning staffing patterns, budgeting, and benchmarking. Staffing plans include calculations of how many individuals are needed and which types of staff are needed per shift and/or day to staff a nursing unit or department. Considerations in developing these plans include: exploring benchmarking data or best practices, meeting regulatory requirements such as the State Nurse Practice Act and JCAHO standards, balancing the skill mix or percentage of RNs, LPNs, and unlicensed available staff, noting support departments such as, transportation, tube delivery systems, and so forth, and including historical data and the department layout.

In depth calculations along with multiple scheduling tools are depicted to demonstrate how staffing is determined in a variety of settings. Although ultimately the manager is responsible for developing the schedule, staff feedback and continual evaluation is essential to assess the effect on patient care and finances. Simple scheduling guidelines and evaluation processes are included.

There are many different models of care delivery that nurses may use. The models described include: case method, total patient care, functional, team, primary nursing, patient centered, and differentiated practice. Two care delivery management tools are discussed that were developed with the intent to decrease cost and length of stay and improve care. Clinical pathways are one tool that outlines the expected clinical course and outcome for certain patient types and disease patterns. Case management is a second concept whereby a case manager is assigned to a population, and coordinates care across the continuum from preadmission to discharge.