Staff scheduling strategies for better care and better business

Staffing comprises 50 to 70 percent of a skilled nursing facility’s (SNF) operating budget. Underestimating the importance of healthy staff management strategies and nimble nurse scheduling processes can lead to unnecessary overtime, unbalanced caseloads and even staff burnout. And as all organizations know, an unhappy staff is a very unhappy business.

Optimal staff scheduling involves the complex balance between resident acuities and nurse skill levels, while keeping the schedule tightly connected to the “heads in the beds” of the current census, experts explain in this week’s Long-Term Living webinar, “The key to quality in 2013: Staffing.”

Not everyone can have the weekends off, and someone has to work the holidays. And no one wants to be that one nurse who always seems to get the highest-acuity cases. Staying consistent and fair in how schedules are created—and adjusting them as the high-acuity cases shift—can keep employees from grumbling and can even reduce turnover by 29 percent, says Shelly Szarek-Skodny, president/CEO of Legacy Business Partners, a Cleveland-based healthcare consulting firm. “Employees are your greatest asset,” she says. “A happy staff means better resident care, and a higher census.”


Long gone are the days when nurse schedules could be created en mass and left pinned to the wall, untouched, says Mark Woodka, CEO of OnShift, a provider of scheduling systems and staff management software. The influx of higher-acuity residents requires the need for staffing the right skill-mix, but without the wasteful overtime. “Pinpoint your staffing needs—every day, every shift,” he suggests. “Compare them against your budget, your census and your acuity.”

Even diligent administrators have trouble doing the math on why tiny reductions in an overstaffed schedule can save big dollars. A reduction of overscheduling by just 0.1 PPD (per day patient) can save as much as $75,000 a year. “Set a policy of no overtime built into the schedule without administrative approval,” Woodka says. “If you’re properly staffed, you shouldn’t have overtime.”

Another challenge is to keep an eye on those part-timers—and waiting for next week’s staff utilization review will be too late. Organizations that exceed the hour limits for part-time labor will have hefty fines to pay. Regardless of the hourly workers’ pay scales, Woodka says, “You have to manage the 30-hour rule just like the overtime rule,” because of the penalties associated with exceeding it.


Staff stability is becoming a recognized component of better care, and one way to do this is to build staff/resident relationships through consistent scheduling, while ensuring that the high-acuity residents aren’t loaded onto a few nurses. Involve nurses in team meetings and give them the ability to submit suggestions or criticisms about the schedules. And, if you’ve asked for their feedback, make sure you’re listening, Szarek-Skodny says.“Nurses and aides that work too many hours make mistakes,” Szarek-Skodny says.“Every time someone works overtime, they’re tired, and that’s a risk management concern every day.”

Diligent attention to how schedules are being prepared and how the staffing decisions are made can improve not only staff happiness but also business reputation, Woodka adds. “If you’re properly staffed, then you’ll be the one that the acute-care providers and the ACOs want to partner with.”

Topics: Articles , Executive Leadership , Finance , Leadership , Risk Management , Staffing