Experience with staffing alternatives in a pediatric teaching institution.

Staffing alternatives and recruitment and retention strategies used by the pharmacy department of a pediatric teaching hospital are described. In addition to overtime compensation, the following alternative strategies have been implemented: (1) use of contingent or "on-call" personnel, (2) coverage by management staff, (3) use of temporary agencies, (4) review of ongoing activities, and (5) use of supportive personnel. All these strategies have been effective in compensating for shortages by supplying qualified individuals on an as-needed basis, eliminating nonessential departmental activities, or delegating nonprofessional duties to technicians and other supportive personnel. Effective recruitment and retention strategies include scholarship and training programs, communication with pharmacy staff about management efforts to improve salary and practice opportunities, and insight into the nature of the local competition from chain and mail-order pharmacies. Use of alternate approaches to staffing has helped the pharmacy department at this institution maintain adequate staffing during periods of pharmacist shortages.

Crosstraining.

The small, rural hospitals have effectively crosstrained employees in multiple job skills for years. The large institutions can learn this useful and successful methodology from the small hospitals. A well-established crosstraining program can effectively build a versatile, multi-skilled staff, which can be utilized to meet the unpredictable demands on materiel management and other support services. It is an effective tool to reducing training costs and salary expenses and to improving performance, self-esteem and job security. It could very well be one of the keys to surviving in the 1990s.

Management strategies to minimize nursing turnover.

The nursing shortage continues nationwide. Many factors contribute to the recurring crisis. Some realistic recommendations for short- and long-term solutions are presented here.

Employee leasing ... then and now.

This paper examines the case history of an employee leasing plan for the Green Clinic, beginning in 1980 and terminating in 1987. The advantages, disadvantages and effects on the Clinic's operation are noted within.

Evaluating productivity and budgeting staff.

A principal objective of productivity measurement is the manager's desire to match available labor hours (capacity) with available workload (demand) while concurrently minimizing the cost of carrying that capacity. In this article, Mr. Schwartz presents technical labor capacity concepts from a management engineering perspective. Included is assistance in ascertaining the true number of labor hours in a radiology department, and in understanding workload measurement standards.

Impact of critical care physician staffing on patients with septic shock in a university hospital medical intensive care unit.

To evaluate the effects of reorganizing physician resources in a medical intensive care unit (MICU), we studied the impact of these changes in patients with septic shock. Patients were compared during two consecutive 12-month periods: (1) an interval in which faculty without critical care medicine (CCM) training supervised the MICU (before CCM, n = 100) and (2) following staffing with physicians formally trained in CCM (after CCM, n = 112). Acute Physiology and Chronic Health Evaluation scores were utilized to compare severity of illness and were similar for each group (29 +/- 11 before CCM vs 28 +/- 10 after CCM). However, mortality was significantly lower during the post-CCM interval (74% vs 57%, respectively). There was no significant difference in the frequency of use of mechanical ventilation (83% vs 87%), although pulmonary artery catheters (48% vs 64%) and arterial catheters (24% vs 73%) were employed more frequently after CCM. The number of subspecialty consultations and MICU and hospital length of stay were similar for both intervals. We conclude that the implementation of dedicated staffing by CCM physicians in a university hospital MICU was associated with a favorable impact on patients with septic shock.

Developing a successful recruitment/retention plan for hospital pharmacy personnel.

Due to various external factors, recruitment through traditional methods, such as newspaper ads, failed to produce the pool of applicants for hospital pharmacy staff positions it had in the past. As a result of this and other factors specific to University Hospital, the number of staff pharmacists decreased from 11 to four full-time equivalents (FTEs). The number of technicians dropped to the point where per diem nurses had to be hired to help make IV admixtures. Through some short-term measures (salary increases, intensive recruitment efforts, etc), the number of pharmacist and technician vacancies was reduced by 60%. However, a long-range recruitment/retention plan was needed to achieve full staffing and to prevent such drastic staffing shortages in the future. The four components of the plan that was developed included: commitment to provide for full-time human resources management, improved forecasting of personnel turnover, supply, and demand, design and implementation of retention strategies, and design and implementation of innovative recruitment programs. Seven months after initiation of much of the plan, there was no pharmacist turnover and minimal technician turnover. In fact, one pharmacist stays on staff despite relocation 90 miles away. Almost all positions are filled, despite a large number of openings at other institutions in the area.

Policies and procedures for scheduling student nurses.

A smoothly operating system for student clinical affiliations can save staff time and positively influence recruitment and retention. To ensure a systematic approach to scheduling students, the author shares her approach, policies, and procedures.