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Chapter 3: The HUC’s Role in Staffing and Scheduling

Staffing Guidelines for the Master Schedule

It is impossible to know how many staff will be required for every shift several months in advance as there is no way to know the number and acuity of patients that far ahead. Instead, master schedules are created based on projected staffing needs, with the understanding that adjustments may need to be made each day based on actual needs.

Master schedules must accommodate the full-time hours required for full-time staff, and then any additional shifts are divided amongst part-time and casual staff (if the contract allows for casual employees).

Staff are scheduled based on the following:

  • projected patient census, or the number of patients expected to be admitted to that unit, and
  • established patient care ratios for that unit, which are the number of patients the nursing staff is expected to provide care to.

British Columbia is the only province in Canada with mandated staffing ratios (Gamage, 2024). All other provinces and territories are free to set their own ratios based on a number of factors.

Practice Activity: Staffing

Perform an internet search for “safe patient staffing levels images” for a variety of informative infographics outlining suggested ratios for nurse-to-patient staffing based on department.

Factors Influencing Patent Care Ratios

Patient care ratios will be influenced by the type of patient care unit, the shift/time of day, and the model of care. See the examples outlined below.

Type of Patient Care Unit

An ICU may have a ratio of 1 nurse: 1 patient; whereas a rehab unit may have a ratio of 1 nurse: 6 patients.

Shift/Time of Day

Ratios may change between days, evenings, and night shifts, with day shifts typically having the highest number of staff scheduled to accommodate the greater workload associated with meals, bathing, scheduled tests, operations, and treatments, and increased interactions with allied health care workers, physicians, and family members. Night shift typically has less staff scheduled, due to lower workloads associated with these hours.

Models of Care

Whether a nurse looks after all the patient’s needs by themselves (i.e., primary nursing) or whether a group of health care workers such as RNs, RPNS, and PSWs work together to deliver patient care (i.e., team nursing).

Example: Staffing Ratios

Primary Nursing

  • Days — 1 RN: 5 Patients
  • Evenings — 1 RN: 7 Patients
  • Nights — 1 RN: 10 Patients

Team Nursing

  • Days — 1 RN, 2 PSW: 10 Patients
  • Evenings — 1 RN, 2 PSW: 14 Patients
  • Nights — 1 RN, 2 PSW: 18 Patients

References

Gamage, M. (2024, March 6). BC introduces Canada’s first mandatory nurse-to-patient ratios. The Tyee.

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