For nurses who are taking on management responsibilities, one of the most daunting tasks can be tackling the dreaded 'off duty'. Here are some tips for success
It is perhaps the biggest challenge of management. For although working out the 'off duty? offers a keen sense of power, the responsibility that comes with it can be more trouble than it is worth. How you discharge that responsibility will not only determine how popular you are with members of the team, but more importantly, how effectively your work area is resourced and therefore the level of patient care that can be given.
The main aim in working out staffing levels is to provide consistent and effective nursing care to those patients for whom you are responsible. In essence, staff rosters should ensure that:
The service is delivered by competent staff in the right numbers at the right times;
Team members have a reasonable workload and acceptable periods of rest betweenshifts, as outlined by the European Union Working Time Directive.
Shift-based nursing, found in both acute and community settings, poses a major challenge to a manager who has not only to take into consideration the human resources in numbers, often expressed as whole time equivalents (WTE), but also the staff mix, competencies and the needs of the patient/client group, as well as other activities to be performed during the shift.
Even if you do not work in a 24/7 service, you will need to take into consideration annual leave and requests for days off, as well as other absences.
What often increases the challenge is the use of many part-time staff. For example, five WTE staff nurses may comprise at least seven people.
Influenced by the government's Improving Working Lives initiative, nurses are gradually being offered more flexibility to help with other commitments and promote a healthy work-life balance.
We are now seeing fewer standard patterns of work, for example 10 or 12-hour shifts, and instead find nursing staff working anything from five to 37.5 hours a week, often with 'half shifts' that relate to the length of a school day.
In addition, different staff do not have the same skills and competencies. Patient needs also change, not only from day to day, but from shift to shift. There are, in addition, considerable resource issues, both in terms of available supply and budgets.
Budget management is complex and varies between organisations, but it is common for staff to be funded at the mid-point of their grade. If you have many senior personnel then the actual budget needs adjusting. It is expected that, with vacancies and staff members below mid-point, these will balance out your more expensive staff. The aim of Agenda for Change is to even out over the whole year extra payments for unsocial hours such as bank holidays, but this system is still under review. Contact your area's AfC representative if you have queries relating to the new system.
When sitting down to draw up your roster, first consider:
How many weekends do staff work per month and what are the night duty expectations?
Are routine shifts agreed for certain staff?
Next look at absences, for example annual leave, sickness and study leave, and mark them in. Then make a list of their grades, or AfC bands, and how many shifts each staff member usually covers. If it is your first time doing the roster, it can be very useful to refer to previous ones to identify any pattern - as long as these worked well.
After that, identify the grade/skill mix of the shifts required. Certain shifts may require different grades or competencies of nurses, for example assessment days, theatre days or consultant/specialist visits.
Only then are you in a position to be able to consider requests for certain shifts or days off.
Rest assured that it will often be impossible to authorise all requests without further negotiation. As much as you would like to please everyone, the priorities of the service must be met within the budget.
A further challenge is covering sickness absence. Most settings will build in a percentage in anticipating annual leave, study leave and short absences. However, for longer periods it is the remaining team members who must be flexible in their working practices. Financial considerations must be made before employing bank or agency staff, so you should familiarise yourself with your organisation?s policy with regard to their usage.
Once you have finished filling in the roster, you will need to display it where all staff will see it. Amendments may be needed due to changing circumstances relating to the clinical setting or staff. Because you have taken time and energy to write it, you are the one who is best placed to answer any questions.
The time and effort involved in completing the off duty will vary from person to person - but as a novice you should expect it to take many hours. Be sure to have all the information you require, such as requests, patterns and financial information, before you start and, where possible, arrange in advance some undisturbed time - preferably using some of your allotted 'admin time'.
Taking time and consideration to complete the process, maintaining good communication with team members, will ensure you provide an effective roster that all staff can work with, and that allows patient care to be safely delivered.
Learning the secrets of 'doing the off duty':
Work with another person who is practised at writing rosters;
Discuss the financial implications with the accountant/finance officer for your area;
Attend in-house training for budget management (this may be arranged with human resources and finance departments);
Allot specific administration time to the task and do not leave it until the last minute;
If you believe that there are fundamental shortfalls or problems with staffing levels or other human resources issues, arrange to discuss this with your line manager, director of nursing, human resources department or, failing that, union representative.
Adams, A., Bond S. (2003) Staffing in acute hospital wards: part 1. The relationship between number of nurses and ward organisational environment. Journal of Nursing Management; 11: 5, 287?292.
Department of Trade and Industry (2001) Implementation of the Working Time Regulations. London: HMSO.
DoH (2000) Working Lives: Programmes for Change: Team based Self-rostering. London: HMSO.
DoH (2000) Improving Working Lives Standard. London: HMSO.
Marquis, B., Huston, C. (2003) (4th Ed) Leadership Roles and Management Functions in Nursing: Theory and Application. Philadelphia, PA: Lippincott.