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Top 10ish reasons why Wards over staff

In a recent survey of (ah-hem, not quite) 100 Ward Managers, we compiled the reasons behind variable/over staffing in roster plans. We're considering locations where patient acuity and counts are as yet unknown - here we're looking for a smooth plan conforming to Trust KPIs and policy.

What we learned was hardly shocking, but nevertheless presents some nice opportunities to disrupt existing behaviour, via "policy compliance monitoring", (which is the bit we can help with!) education, e-rostering reconfiguration and support.

  1. Local, verbal agreements between Ward Managers and staff dictate and limit working availability.

  2. Ward Manager concerns in tracking staff hours mean roster planners add staff to the roster, even if service need is already met.

  3. Ward Managers assume that any overstaffing will be detected at Matron level, with staff moved to understaffed areas.

  4. Bank/Agency cover is booked way in advance. Meanwhile the driving event (holidays etc.) is cancelled, but the cover is not.

  5. Matron’s judgement that the ward needs more resource in order to catch up with appraisals etc. – with this in addition to planned management time.

  6. Long Days are used too frequently, and not mixed up with sufficient Earlies and Lates - so Late shifts that require less staff show more than needed.

  7. Uneven staffing levels. Ward Managers may instinctively fill their staffing requirements “left to right” or find it hard to create the desired smooth, balanced fill due to vacancies.

  8. Counts appear over (especially with Long Days), but these don’t factor in the effect of shorter bank or LD (Late portion) shifts if measured in hours.

  9. The roster planner is undertrained with regards to the significance of roster cost/safety, and how to measure compliance to staffing levels.

  10. Matron’s oversight on planning quality is insufficiently detailed and/or timely.

  11. Leave/Non-Clinical allocations are under target, so contract hours are added to roster to balance time (even where required headcounts are already met).

A Trust should decide which of these types of over staffing is permissible and to what degree. Then, the true (and perhaps scary) cost of over staffing can be pinned down.

Looking forward, the policing (sounds a bit draconian, but we don't mean it that way) of workforce KPIs at an executive level is helpful, if we want to address these issues.

As usual chums, I'd welcome your thoughts - especially if you've had similar experiences you'd like to share.

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