HA255 Unit 6 Behavioral Health Staffing Plan Example

Two Call-Outs Before Dawn and a Patient on One-to-One: A Staffing Plan for a Composite 18-Bed Adult Inpatient Behavioral Health Unit, Converting Census and Care Hours Into Positions, a Grid and a Call Order

[Student Name]

Purdue University Global

HA255: Human Resources for Health Care Organizations

Unit 6 Staffing Plan

[Instructor Name]

[Date]

The unit, its census history, the care-hour target and every calculated figure are composite and bracketed for the writer's own data.

Setting

The unit admits adults in acute psychiatric crisis, many on involuntary holds. Staff work twelve-hour shifts, 0700 to 1930 and 1900 to 0730. Over the past [12] months the average daily census was [16], ranging from [12] to [18]. Registered nurses give medications, assess and lead the shift; mental health technicians run observation rounds, groups and safety checks.

From Census to Hours

Average daily census: [16] Target care hours per patient day, nursing and technicians combined: [7.0] Direct care hours a day: [16] × [7.0] = [112] Direct care hours a year: [112] × 365 = [40,880] Worked positions needed, at 2,080 hours each: [40,880] ÷ 2,080 = [19.7] Each line of the calculation sits on its own row so that anyone can check the arithmetic and change one assumption without redoing the plan.

From Productive to Budgeted Positions

Paid time off, sick days and education hours are paid but not worked on the unit. Using a nonproductive allowance of [12] percent, budgeted positions are [19.7] ÷ 0.88 = about [22.3] full-time equivalents.

Skill Mix

Registered nurses: [55] percent, about [12.3] FTE. Mental health technicians: [45] percent, about [10.0] FTE. The mix keeps at least two nurses on every shift, because medication administration, admissions and restraint orders require a nurse, while technicians carry observation and milieu work. Research on acute psychiatric wards suggests that staffing levels and staff characteristics are linked to how often conflict and containment occur, though the relationship is not simple (Ross et al., 2012).

Staffing Grid

Census [12] to [13]: days 2 RN and 2 technicians; nights 2 RN and 1 technician. Census [14] to [15]: days 3 RN and 2 technicians; nights 2 RN and 2 technicians. Census [16] to [17]: days 3 RN and 3 technicians; nights 2 RN and 2 technicians. Census [18]: days 3 RN and 3 technicians; nights 3 RN and 2 technicians. The charge nurse takes a reduced assignment on every shift.

One-to-One Observation

A patient ordered for continuous one-to-one observation needs a staff member within arm's reach at all times. The grid does not include this. Each one-to-one order adds one technician for the shift, requested through the house supervisor, and is recorded as additional hours outside the target.

Who Gets Called First

When a call-out leaves the unit below its grid level:

1. Staff already scheduled who have offered extra hours, at straight time if under 40 hours for the week.

2. The float pool, if a behavioral health trained float is available.

3. Part-time unit staff, by rotation of a call list kept by the charge nurse.

4. Full-time staff offered overtime, by rotation.

5. Agency staff with behavioral health experience, approved by the house supervisor.

6. If none of these work, the charge nurse takes a full assignment and the unit may hold admissions after discussion with the house supervisor and the attending psychiatrist.

The Five in the Morning Test

At 0500, a nurse and a technician call out for the day shift with a census of [16] and one patient on one-to-one. The grid calls for 3 nurses and 3 technicians plus one technician for the observation. The night charge nurse works the list: one technician from the overtime offer list, one float nurse from the pool. By 0630 the shift is covered, and the overtime is recorded against the pay period's report.

Why Hours Matter

Studies of general hospitals found that shifts with staffing below target were linked to higher patient mortality, which is why the plan treats grid levels as a floor rather than an aspiration (Needleman et al., 2011). Behavioral health units differ from medical floors, and costs on psychiatric wards depend heavily on nurse staffing and bed numbers, which the budget must reflect (Bowers & Flood, 2008).

Watching It Each Pay Period

Measures reported every two weeks: actual care hours per patient day against [7.0]; overtime as a share of all hours worked; agency hours; one-to-one hours; shifts below grid. If overtime stays above [8] percent for three pay periods, the manager will request a position review.

How the Plan Was Built

The census figures came from the midnight census report for the past [12] months. The care hour target came from the unit's budget and was checked against the hours actually worked in the three months with the fewest incidents. Staff on both shifts reviewed the grid in a meeting, and their main change was to add the second night technician at a census of [14], because nights with one technician left nobody free to answer a call light while rounds were underway.

Assumptions to Revisit

The [12] percent nonproductive allowance, the [7.0] care hour target and the census average are each reviewed yearly or after a change in the unit's patient population.

References

Bowers, L., & Flood, C. (2008). Nurse staffing, bed numbers and the cost of acute psychiatric inpatient care in England. Journal of Psychiatric and Mental Health Nursing, 15(8), 630-637. https://doi.org/10.1111/j.1365-2850.2008.01280.x

Needleman, J., Buerhaus, P., Pankratz, V. S., Leibson, C. L., Stevens, S. R., & Harris, M. (2011). Nurse staffing and inpatient hospital mortality. New England Journal of Medicine, 364(11), 1037-1045. https://doi.org/10.1056/NEJMsa1001025

Ross, J., Bowers, L., & Stewart, D. (2012). Conflict and containment events in inpatient psychiatric units. Journal of Clinical Nursing, 21(15-16), 2306-2315. https://doi.org/10.1111/j.1365-2702.2012.04073.x