There are no in-house staff on that shift who have been cross-trained for this unit. Two RNs are assigned to the obstetrics department for the 3 to 11 PM shift. Three women are in active labor, and three women are in the postpartum unit with their babies. There are no anticipated discharges or transfers. There are two RNs and one CNA assigned for the 3 to 11 PM shift. The PCS shows a current acuity level requiring 2.4 staff. One patient, however, will likely be transferred to the medical unit on 3 to 11 PM shift. One of the potential admissions in the ED is a patient who will need cardiac monitoring. The PCS shows a current patient acuity level requiring 3.2 staff. On reviewing the staffing, you note the following: ICU Census = 6. In obstetrics, a 1:2 ratio is used for labor and delivery, and a 1:6 ratio is used in postpartum. The pediatric unit is generally staffed at a 1:4 nurse–patient ratio and the medical and surgical departments at a 1:6 ratio. The ICU must be staffed with a minimum of a 1:2 nurse– patient ratio. You have five units to staff: the ICU, pediatrics, obstetrics (includes labor, delivery, and postpartum), medical, and surgical departments. All units have just submitted their PCS calculations for that shift. There are also two patients with confirmed discharge orders and three additional potential discharges on the 3 to 11 PM shift. The current hospital census is 52 patients, although the ED is very busy and has four possible patient admissions. Mandatory overtime is also used but only as a last resort. A local outside registry is available for supplemental staff however, their cost is two and a half times that of your regular staff, so you must use this resource sparingly. If they are needed for the last half of the shift (7–11 PM), you must notify them by 5 PM tonight. (The union contract stipulates that any “call offs” that must be done for low census must be done at least 2 hours before the shift begins otherwise, employees will receive a minimum of 4 hours of pay.) You do, however, have the prerogative to call off staff for only half a shift (4 hours). It is now 12:30 PM, and your staffi ng plan for the 3 to 11 PM shift must be completed no later than 1 PM. Making Sound Staffi ng Decisions You are the staffi ng coordinator for a small community hospital.
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